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Cited by 87Nursing care and researchCancer survivorship and careFamily Caregiving in Mental Illness

Systematic review of caregiver burden, unmet needs and quality-of-life among informal caregivers of patients with pancreatic cancer

Open access
Chong, Eric, Crowe, Lisa, Mentor, Keno, Pandanaboyana, Sanjay, Sharp, Linda·2023·Supportive Care in Cancer
DOI 10.1007/s00520-022-07468-7PMC PMC9771849
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Abstract

Purpose: Informal caregivers play an important supportive care role for patients with cancer. This may be especially true for pancreatic cancer which is often diagnosed late, has a poor prognosis and is associated with a significant symptom burden. We systematically reviewed the evidence on caregiver burden, unmet needs and quality-of-life of informal caregivers to patients with pancreatic cancer. Method: PubMed, Medline, CINAHL and Embase databases were systematically searched on 31 August 2021. Qualitative and quantitative data on informal caregivers’ experiences were extracted and coded into themes of burden, unmet needs or quality-of-life with narrative synthesis of the data undertaken. Results: Nine studies (five qualitative, four quantitative), including 6023 informal caregivers, were included in the review. We categorised data into three key themes: caregiver burden, unmet needs and quality-of-life. Data on caregiver burden was organised into a single subtheme relating to symptom management as a source of burden. Data on unmet needs was organised into three subthemes need for: better clinical communication; support and briefings for caregivers; and help with navigating the health care system. Data on quality-of-life indicate large proportions of informal caregivers experience clinical levels of anxiety (33%) or depression (12%-32%). All five qualitative studies were graded as good quality; three quantitative studies were poor quality, and one was fair quality. Conclusion: High-quality pancreatic cancer care should consider the impacts of informal caregiving. Prospective longitudinal studies examining multiple dimensions of caregiver burden, needs, and quality-of-life would be valuable at informing supportive care cancer delivery to pancreatic cancer informal caregivers.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review found that informal caregivers of pancreatic cancer patients experience burden related to managing patients’ symptoms, unmet needs around communication/support/navigation, and high levels of anxiety and depression. Evidence is limited to nine studies, with quantitative data only on psychological quality-of-life and no quantitative data on caregiver burden or unmet needs.

Key findings

  • Nine studies (five qualitative, four quantitative) including 6023 informal caregivers were included; caregivers were predominantly spouses (98.6%, 6058/6142) and female (60.6%, 3748/6178), and most patients cared for had advanced or metastatic pancreatic cancer (74.7%, 4314/5772).
  • Caregiver burden was organised into one subtheme: managing patients’ symptoms as a source of burden; no quantitative data on caregiver burden were reported.
  • Unmet needs were organised into three subthemes: better clinical communication; support and briefings for caregivers; and help navigating the health care system; no quantitative data on unmet needs were reported.
  • Quality-of-life data showed clinical levels of anxiety in 33% and depression in 12%–32% of informal caregivers; one study reported a threefold higher adjusted hazard ratio for first depression in partners of pancreatic cancer patients in the first year after diagnosis (HR 3.2, 95% CI 2.9–3.7).

Methods

  • Systematic search of PubMed, Medline, CINAHL and Embase from inception to 31 August 2021, with no study design filters; reference lists of included studies were also screened.
  • Eligible studies reported qualitative or quantitative data collected from informal caregivers of patients with pancreatic cancer on caregiver burden, unmet needs, and/or quality-of-life; intervention studies, non-English articles, case reports, editorials, opinion pieces, reviews, and conference abstracts were excluded.
  • Data were extracted and coded into themes of burden, unmet needs, or quality-of-life using deductive thematic analysis and narrative synthesis; quality appraisal used CASP for qualitative studies and MINORS for quantitative studies.

Limitations

  • Stated: the review protocol was not registered a priori with PROSPERO or another external database; initial title/abstract screening was done by a single author; inclusion was restricted to English-language studies.
  • Stated: quantitative data on caregiver burden and unmet needs are lacking, quality-of-life data cover only psychological wellbeing, longitudinal studies are lacking, most data pertain to caregivers supporting patients with advanced or metastatic disease, and predictors/interrelationships among burden, needs, and quality-of-life have largely not been examined.
  • Evident from the text: only nine studies were eligible, and three of four quantitative studies were graded poor quality, with all four scoring 0 for prospective calculation of study size, limiting the strength and generalisability of the quantitative findings.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s00520-022-07468-7

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

56 of 163 cited sources checked · 34 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    These effects can impact caregiver quality-of-life.

    “These effects can impact caregiver quality-of-life [15].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [15] Hanly P, Maguire R, Hyland P, Sharp L (2015) Examining the role of subjective and objective burden in carer health-related quality of life: the case of colorectal cancer. Support Care Cancer 23(7):1941–1949 source
  • Findingcitation

    Informal caregivers were predominantly spouses to patients with pancreatic cancer (98.6%, 6058/6142).

    “Informal caregivers were predominantly spouses to patients with pancreatic cancer (98.6%, 6058/6142) [5, 6, 28, 33, 34].”
    Quote in the paperNot a substantial claim2 of 5 sources checked
    • cites [5] Engebretson A, Matrisian L, Thompson C (2015) Pancreatic cancer: patient and caregiver perceptions on diagnosis, psychological impact, and importance of support. Pancreatology 15(6):701–707 source
    • cites [6] Dengso KE, Thomsen T, Andersen EW, Hansen CP, Christensen BM, Hillingso J et al (2021) The psychological symptom burden in partners of pancreatic cancer patients: a population-based cohort study. Supp Care Canc 29(11):6689–6699 source
    • cites [28] Wong SS, George TJ Jr, Godfrey M, Le J, Pereira DB (2019) Using photography to explore psychological distress in patients with pancreatic cancer and their caregivers: a qualitative study. Support Care Cancer 27(1):321–328 source

      The Results section reports that patient-identified caregivers were primarily spouses or partners (85.7%), supporting the predominance of spousal caregivers in this study. It does not support the cited sentence’s 98.6% figure or its count of 6,058 out of 6,142; this study had seven caregivers who completed it. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [33] Witt Sherman D, McMillan SC (2015) The physical health of patients with advanced pancreatic cancer and the psychological health of their family caregivers when newly enrolled in hospice. J Hosp Palliat Nurs 17(3):235–241 source

      The Results (Sample) report that a majority of caregivers were spouses or significant others of patients with advanced pancreatic cancer. The reported proportion was 70.3% of a sample of 64 patient–caregiver pairs, not 98.6% (6058/6142); the source also does not separate spouses from significant others in that figure. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites [34] Janda M, Neale RE, Klein K, O’Connell DL, Gooden H, Goldstein D et al (2017) Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology 17(2):321–327 source
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.
  • Interpretationreasoning

    It is plausible that the impact of pancreatic cancer on informal caregivers is potentially distinct.

    “It is therefore plausible that the impact of pancreatic cancer on informal caregivers is potentially distinct [18].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [18] Harding R, Gao W, Jackson D, Pearson C, Murray J, Higginson IJ (2015) Comparative analysis of informal caregiver burden in advanced cancer, dementia, and acquired brain injury. J Pain Symptom Manage 50(4):445–452 source

      The Introduction says caregiver support should be tailored to diagnostic groups, and the Discussion reports differences in burden between caregivers of people with advanced cancer, dementia, and acquired brain injury. This supports the general possibility of distinct caregiver impacts, but the paper does not assess pancreatic cancer specifically or compare cancer types. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Findingcitation

    Informal caregivers described clinical communication at the time of diagnosis as insensitive.

    “Informal caregivers described clinical communication at the time of diagnosis as insensitive [27].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [27] Saunders C, Gooden H, Robotin M, Mumford J (2009) As the bell tolls: a foundation study on pancreatic cancer consumer’s research priorities. BMC Res Notes 2:179 source
  • Findingreasoning

    The cross-sectional design of the three poor-quality quantitative studies meant they scored 0 points on items assessing duration of follow-up and loss of participants.

    “The cross-sectional design of the three studies meant they scored 0 points on items assessing duration of follow-up and loss of participants [5, 32, 33].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [5] Engebretson A, Matrisian L, Thompson C (2015) Pancreatic cancer: patient and caregiver perceptions on diagnosis, psychological impact, and importance of support. Pancreatology 15(6):701–707 source
    • cites [32] Janda M, Neale RE, Klein K, Beesley VL, O’Connell DL, Gooden H et al (2017) Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology 17(2):321–327 source
    • cites [33] Witt Sherman D, McMillan SC (2015) The physical health of patients with advanced pancreatic cancer and the psychological health of their family caregivers when newly enrolled in hospice. J Hosp Palliat Nurs 17(3):235–241 source
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.
  • Classified as probably not a substantial claim. 44
  • May combine two claims. 39
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Eight included studies were cross-sectional studies and one study was a prospective cohort design.

    “Eight studies were cross-sectional studies [5, 27–33]. One study was a prospective cohort design [6].”
    Quote in the paperNot a substantial claim3 of 9 sources checked
    • cites [5] Engebretson A, Matrisian L, Thompson C (2015) Pancreatic cancer: patient and caregiver perceptions on diagnosis, psychological impact, and importance of support. Pancreatology 15(6):701–707 source
    • cites [27] Saunders C, Gooden H, Robotin M, Mumford J (2009) As the bell tolls: a foundation study on pancreatic cancer consumer’s research priorities. BMC Res Notes 2:179 source
    • cites [28] Wong SS, George TJ Jr, Godfrey M, Le J, Pereira DB (2019) Using photography to explore psychological distress in patients with pancreatic cancer and their caregivers: a qualitative study. Support Care Cancer 27(1):321–328 source

      The citation to this paper is attached to the claim that one study used a prospective cohort design, not to the count of eight cross-sectional studies. The Introduction describes this as a Photovoice study of lived experiences, and Methods > Data analysis describes thematic analysis of group discussions rather than a prospective cohort design (page unavailable). (LLM, conf=0.87)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [29] Sherman DW, McGuire DB, Cheon JY, Free D (2014) A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach. J Pain Symptom Manage 48(3):385 source
    • cites [30] Gooden HM, White KJ (2013) Pancreatic cancer and supportive care - pancreatic exocrine insufficiency negatively impacts on quality of life. Support Care Cancer 21(7):1835–1841 source
    • cites [31] Petrin K, Bowen DJ, Alfano CM, Bennett R (2009) Adjusting to pancreatic cancer: perspectives from first-degree relatives. Palliat Support Care 7(3):281–288 source
    • cites [32] Janda M, Neale RE, Klein K, Beesley VL, O’Connell DL, Gooden H et al (2017) Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology 17(2):321–327 source
    • cites [33] Witt Sherman D, McMillan SC (2015) The physical health of patients with advanced pancreatic cancer and the psychological health of their family caregivers when newly enrolled in hospice. J Hosp Palliat Nurs 17(3):235–241 source
    • cites [6] Dengso KE, Thomsen T, Andersen EW, Hansen CP, Christensen BM, Hillingso J et al (2021) The psychological symptom burden in partners of pancreatic cancer patients: a population-based cohort study. Supp Care Canc 29(11):6689–6699 source
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    At diagnosis, only 10-15% of pancreatic cancer patients have localised disease and are potential candidates for curative resection.

    “At diagnosis, only 10–15% of patients have localised disease and are potential candidates for curative resection [2, 3].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [2] Mizrahi JD, Surana R, Valle JW, Shroff RT (2020) Pancreatic cancer. Lancet 395(10242):2008–2020 source
    • cites [3] Khalaf N, El-Serag HB, Abrams HR, Thrift AP (2021) Burden of pancreatic cancer: from epidemiology to practice. Clin Gastroenterol Hepatol 19(5):876–884 source

      The “Prognosis for patients with pancreatic cancer” section (page not available in our copy) says that around 10% of U.S. patients are diagnosed with localized, resectable disease. This supports the central point, but the cited passage gives a U.S.-specific estimate rather than the unqualified 10–15% range in the claim. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The focus of treatment in the majority of pancreatic cancer patients has been about achieving a balance between palliative chemotherapy and maintaining quality-of-life.

    “Hence, the focus of treatment in the majority of the patients has been about achieving a balance between palliative chemotherapy and maintaining quality-of-life [4].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [4] Kleeff J, Korc M, Apte M, La Vecchia C, Johnson CD, Biankin AV et al (2016) Pancreatic cancer. Nat Rev Dis Primers 2(1):1–22 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Data was collected through questionnaires alone in four studies, semi-structured interviews with individual participants in three studies, focus groups in two studies, and questionnaire and semi-structured interview together in one study.

    “Data was collected through questionnaires alone in four studies [5, 32, 33], semi-structured interviews with individual participants in three studies [29–31], focus groups in two studies [27, 28] and questionnaire and semi-structured interview together in one study [29].”
    Quote in the paperNot a substantial claim3 of 8 sources checked
    • cites [5] Engebretson A, Matrisian L, Thompson C (2015) Pancreatic cancer: patient and caregiver perceptions on diagnosis, psychological impact, and importance of support. Pancreatology 15(6):701–707 source
    • cites [32] Janda M, Neale RE, Klein K, Beesley VL, O’Connell DL, Gooden H et al (2017) Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology 17(2):321–327 source
    • cites [33] Witt Sherman D, McMillan SC (2015) The physical health of patients with advanced pancreatic cancer and the psychological health of their family caregivers when newly enrolled in hospice. J Hosp Palliat Nurs 17(3):235–241 source
    • cites [29] Sherman DW, McGuire DB, Cheon JY, Free D (2014) A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach. J Pain Symptom Manage 48(3):385 source
    • cites [30] Gooden HM, White KJ (2013) Pancreatic cancer and supportive care - pancreatic exocrine insufficiency negatively impacts on quality of life. Support Care Cancer 21(7):1835–1841 source
    • cites [31] Petrin K, Bowen DJ, Alfano CM, Bennett R (2009) Adjusting to pancreatic cancer: perspectives from first-degree relatives. Palliat Support Care 7(3):281–288 source
    • cites [27] Saunders C, Gooden H, Robotin M, Mumford J (2009) As the bell tolls: a foundation study on pancreatic cancer consumer’s research priorities. BMC Res Notes 2:179 source
    • cites [28] Wong SS, George TJ Jr, Godfrey M, Le J, Pereira DB (2019) Using photography to explore psychological distress in patients with pancreatic cancer and their caregivers: a qualitative study. Support Care Cancer 27(1):321–328 source
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • May combine two claims.

    Findingown data

    From a maximum of 22 points, three qualitative studies scored 17 points and two scored 18 points.

    “From a maximum of 22 points, three studies scored 17 points [27–30] and two studies scored 18 points [31].”
    Quote in the paperNot a substantial claim2 of 5 sources checked
    • cites [27] Saunders C, Gooden H, Robotin M, Mumford J (2009) As the bell tolls: a foundation study on pancreatic cancer consumer’s research priorities. BMC Res Notes 2:179 source

      The Abstract > Methods identifies this as a qualitative study, supporting its inclusion among the studies being assessed. The paper’s Study Strengths and Limitations discusses its methodology but reports no score of 17 out of 22; that appraisal cannot be verified from this source. No page numbers are available in our copy. (LLM, conf=0.80)

      Experimental — accuracy not yet measured
    • cites [28] Wong SS, George TJ Jr, Godfrey M, Le J, Pereira DB (2019) Using photography to explore psychological distress in patients with pancreatic cancer and their caregivers: a qualitative study. Support Care Cancer 27(1):321–328 source

      The Methods (Data analysis; page unavailable) and Results (page unavailable) establish that Wong et al. conducted a qualitative study. Our copy does not report a 22-point appraisal or a score of 17 or 18; searches for those scores and quality assessment found no matching passage. The citation can identify a study being assessed, but the score cannot be verified from this source. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [29] Sherman DW, McGuire DB, Cheon JY, Free D (2014) A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach. J Pain Symptom Manage 48(3):385 source
    • cites [30] Gooden HM, White KJ (2013) Pancreatic cancer and supportive care - pancreatic exocrine insufficiency negatively impacts on quality of life. Support Care Cancer 21(7):1835–1841 source
    • cites [31] Petrin K, Bowen DJ, Alfano CM, Bennett R (2009) Adjusting to pancreatic cancer: perspectives from first-degree relatives. Palliat Support Care 7(3):281–288 source
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There has been little improvement in pancreatic cancer survival over the past 30 years.

    “there has been little improvement over the past 30 years [18]”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [18] Harding R, Gao W, Jackson D, Pearson C, Murray J, Higginson IJ (2015) Comparative analysis of informal caregiver burden in advanced cancer, dementia, and acquired brain injury. J Pain Symptom Manage 50(4):445–452 source

      The Discussion compares caregiver burden across advanced cancer, dementia, and acquired brain injury; it does not discuss pancreatic cancer survival. Searches for “pancreatic cancer survival” and “30 years” found no passage in our copy addressing the claimed survival trend. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Disruptions to caregivers' lives can be significant, and many suffer from a wide range of problems.

    “Disruptions to caregivers’ lives can be significant, and many suffer from a wide range of problems [12–14].”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [12] Girgis A, Lambert S, Johnson C, Waller A, Currow D (2013) Physical, psychosocial, relationship, and economic burden of caring for people with cancer: a review. J Oncol Pract 9(4):197–202 source
    • cites [13] Balfe M, Maguire R, Hanly P, Butow P, O’Sullivan E, Timmons A et al (2016) Distress in long-term head and neck cancer carers: a qualitative study of carers’ perspectives. J Clin Nurs 25(15–16):2317–2327 source
    • cites [14] Wang T, Molassiotis A, Chung BPM, Tan J-Y (2018) Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care 17(1):1–29 source

  • May combine two claims.

    Premisecitation

    In cancer, family members and friends are seldom prepared to be caregivers and are thrust into the role at the time when they are coming to terms with the diagnosis.

    “In cancer, family members and friends are seldom prepared to be caregivers [11] and are thrust into the role at the time when they are coming to terms with the diagnosis.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [11] Applebaum AJ, Breitbart W (2013) Care for the cancer caregiver: a systematic review. Palliat Support Care 11(3):231–252 source

  • May combine two claims.

    Findingown data

    The lack of consideration for the relationship between researcher and participants and unsatisfactory data analysis were the two most frequent reasons points were deducted during quality assessments.

    “The lack of consideration for the relationship between researcher and participants [30, 31] and unsatisfactory data analysis [27–30] were the two most frequent reasons points were deducted during quality assessments.”
    Quote in the paperNot a substantial claim2 of 5 sources checked
    • cites [30] Gooden HM, White KJ (2013) Pancreatic cancer and supportive care - pancreatic exocrine insufficiency negatively impacts on quality of life. Support Care Cancer 21(7):1835–1841 source
    • cites [31] Petrin K, Bowen DJ, Alfano CM, Bennett R (2009) Adjusting to pancreatic cancer: perspectives from first-degree relatives. Palliat Support Care 7(3):281–288 source
    • cites [27] Saunders C, Gooden H, Robotin M, Mumford J (2009) As the bell tolls: a foundation study on pancreatic cancer consumer’s research priorities. BMC Res Notes 2:179 source

      The Methods > Data analysis section describes how this study analysed its focus-group transcripts, while Study Strengths and Limitations discusses its own sampling limitations. Neither section reports quality-assessment point deductions or identifies the most frequent reasons for them; searches for researcher–participant relationships and quality assessment found no such passage in our copy. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [28] Wong SS, George TJ Jr, Godfrey M, Le J, Pereira DB (2019) Using photography to explore psychological distress in patients with pancreatic cancer and their caregivers: a qualitative study. Support Care Cancer 27(1):321–328 source

      The Methods > Data analysis section describes transcription, thematic coding, participant review, and theme refinement, but does not assess whether that analysis was satisfactory. The passages from our copy also do not report quality-assessment deductions, their frequency, or an assessment of the researcher–participant relationship. Those judgments appear to belong to the citing authors’ quality assessment and cannot be verified from this source alone. (LLM, conf=0.75)

      Experimental — accuracy not yet measured
    • cites [29] Sherman DW, McGuire DB, Cheon JY, Free D (2014) A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach. J Pain Symptom Manage 48(3):385 source
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Five included studies were conducted in the USA, three in Australia, and one in Denmark.

    “Five studies (three qualitative, two quantitative) were conducted in the USA [5, 28, 29, 31, 33], three (two qualitative, one quantitative) in Australia [27, 30, 32] and one quantitative study in Denmark [6].”
    Quote in the paperNot a substantial claim3 of 9 sources checked
    • cites [5] Engebretson A, Matrisian L, Thompson C (2015) Pancreatic cancer: patient and caregiver perceptions on diagnosis, psychological impact, and importance of support. Pancreatology 15(6):701–707 source
    • cites [28] Wong SS, George TJ Jr, Godfrey M, Le J, Pereira DB (2019) Using photography to explore psychological distress in patients with pancreatic cancer and their caregivers: a qualitative study. Support Care Cancer 27(1):321–328 source

      The Methods (Study procedures and Data analysis) describe this paper as a qualitative study conducted at an academic teaching hospital. Our copy does not identify the hospital’s country or enumerate the other studies, so it cannot verify the USA designation or the five–three–one country totals. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [29] Sherman DW, McGuire DB, Cheon JY, Free D (2014) A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach. J Pain Symptom Manage 48(3):385 source
    • cites [31] Petrin K, Bowen DJ, Alfano CM, Bennett R (2009) Adjusting to pancreatic cancer: perspectives from first-degree relatives. Palliat Support Care 7(3):281–288 source
    • cites [33] Witt Sherman D, McMillan SC (2015) The physical health of patients with advanced pancreatic cancer and the psychological health of their family caregivers when newly enrolled in hospice. J Hosp Palliat Nurs 17(3):235–241 source

      The Methods (Sample; Procedures and Data Analysis, pages unavailable) identify this as a quantitative study of 64 patient–caregiver pairs, using descriptive statistics on NIH-funded trial data. Our copy does not state where the study was conducted, so it does not establish the USA classification attributed to this source. The counts for Australia and Denmark are attached to other citations, not this paper. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [27] Saunders C, Gooden H, Robotin M, Mumford J (2009) As the bell tolls: a foundation study on pancreatic cancer consumer’s research priorities. BMC Res Notes 2:179 source
    • cites [30] Gooden HM, White KJ (2013) Pancreatic cancer and supportive care - pancreatic exocrine insufficiency negatively impacts on quality of life. Support Care Cancer 21(7):1835–1841 source
    • cites [32] Janda M, Neale RE, Klein K, Beesley VL, O’Connell DL, Gooden H et al (2017) Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology 17(2):321–327 source
    • cites [6] Dengso KE, Thomsen T, Andersen EW, Hansen CP, Christensen BM, Hillingso J et al (2021) The psychological symptom burden in partners of pancreatic cancer patients: a population-based cohort study. Supp Care Canc 29(11):6689–6699 source
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    All four quantitative studies scored 0 points for the item assessing prospective calculation of study size.

    “All four studies scored 0 points for the item assessing prospective calculation of study size [5, 6, 32, 33].”
    Quote in the paperNot a substantial claim1 of 4 sources checked
    • cites [5] Engebretson A, Matrisian L, Thompson C (2015) Pancreatic cancer: patient and caregiver perceptions on diagnosis, psychological impact, and importance of support. Pancreatology 15(6):701–707 source
    • cites [6] Dengso KE, Thomsen T, Andersen EW, Hansen CP, Christensen BM, Hillingso J et al (2021) The psychological symptom burden in partners of pancreatic cancer patients: a population-based cohort study. Supp Care Canc 29(11):6689–6699 source
    • cites [32] Janda M, Neale RE, Klein K, Beesley VL, O’Connell DL, Gooden H et al (2017) Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology 17(2):321–327 source
    • cites [33] Witt Sherman D, McMillan SC (2015) The physical health of patients with advanced pancreatic cancer and the psychological health of their family caregivers when newly enrolled in hospice. J Hosp Palliat Nurs 17(3):235–241 source

      The Methods—Sample section reports 64 patient–caregiver pairs, and Methods—Procedures and Data Analysis describes the use of baseline trial data. Neither section states whether study size was calculated prospectively or assigns a score for that item; a search for sample-size and power calculations found no such passage. The score appears to be the citing authors’ assessment, which cannot be verified from this source alone. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • May combine two claims.

    Findingown data

    Four studies reported qualitative data on unmet needs of informal caregivers of pancreatic cancer patients, and no quantitative data on unmet needs was available.

    “Four studies reported qualitative data on unmet needs of informal caregivers [27–29, 31]. No quantitative data was available on unmet needs.”
    Quote in the paperNot a substantial claim2 of 4 sources checked
    • cites [27] Saunders C, Gooden H, Robotin M, Mumford J (2009) As the bell tolls: a foundation study on pancreatic cancer consumer’s research priorities. BMC Res Notes 2:179 source
    • cites [28] Wong SS, George TJ Jr, Godfrey M, Le J, Pereira DB (2019) Using photography to explore psychological distress in patients with pancreatic cancer and their caregivers: a qualitative study. Support Care Cancer 27(1):321–328 source
    • cites [29] Sherman DW, McGuire DB, Cheon JY, Free D (2014) A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach. J Pain Symptom Manage 48(3):385 source
    • cites [31] Petrin K, Bowen DJ, Alfano CM, Bennett R (2009) Adjusting to pancreatic cancer: perspectives from first-degree relatives. Palliat Support Care 7(3):281–288 source

  • May combine two claims.

    Findingcitation

    Informal caregivers described the delivery of diagnosis as lacking empathy and failing to treat the patient as a whole person.

    “They described the delivery of diagnosis as lacking empathy, as exemplified by phrases such as ‘brutal’ or ‘not warm’, and failing to treat the patient as a whole person [27].”
    • Also stated in: § Discussion · plain
      “Informal caregivers’ discontentment with clinical communication was largely directed at the delivery of diagnosis which they felt lacked empathy.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [27] Saunders C, Gooden H, Robotin M, Mumford J (2009) As the bell tolls: a foundation study on pancreatic cancer consumer’s research priorities. BMC Res Notes 2:179 source

  • May combine two claims.

    Findingcitation

    Digestive symptoms (loss of appetite, weight loss, nausea, and constipation) and side effects of treatment were sources of informal caregivers' distress.

    “Digestive symptoms (for example, loss of appetite [28, 30], weight loss [30], nausea [28], and constipation [28]) and side effects of treatment [28] were the sources of informal caregivers’ distress.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [28] Wong SS, George TJ Jr, Godfrey M, Le J, Pereira DB (2019) Using photography to explore psychological distress in patients with pancreatic cancer and their caregivers: a qualitative study. Support Care Cancer 27(1):321–328 source

      In Results, under “Management of weight loss and GI symptoms” (page unavailable), a caregiver describes frustration about the patient’s nausea, difficulty using the bathroom and inability to eat normally, alongside helplessness about treatment or disease side effects. The Discussion also identifies weight loss as a source of distress, but says patients in this study reported a strong appetite. The source therefore supports the overall point about caregiver distress, but not the specific example of loss of appetite. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [30] Gooden HM, White KJ (2013) Pancreatic cancer and supportive care - pancreatic exocrine insufficiency negatively impacts on quality of life. Support Care Cancer 21(7):1835–1841 source
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • May combine two claims.

    Premisecitation

    In the context of pancreatic cancer, the transition into the caregiver role occurs very suddenly, and informal caregivers find themselves required to learn new medical information, coordinate appointments, manage medications, diet and nutrition, search for clinical trials and alternative treatments, and prepare for medical emergencies within a short time span.

    “In the context of pancreatic cancer, the transition into caregiver role occurs very suddenly, and informal caregivers find themselves required to learn new medical information, coordinate appointment, manage medications, diet and nutrition, search for clinical trials and alternative treatments and prepare for medical emergencies within a short time span [28].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [28] Wong SS, George TJ Jr, Godfrey M, Le J, Pereira DB (2019) Using photography to explore psychological distress in patients with pancreatic cancer and their caregivers: a qualitative study. Support Care Cancer 27(1):321–328 source

  • May combine two claims.

    Findingown data

    Four studies provided quantitative data on quality-of-life of informal caregivers of pancreatic cancer patients, and no studies provided qualitative data on quality-of-life.

    “Four studies provided quantitative data on quality-of-life of informal caregivers [5, 6, 32, 33]. No studies provided qualitative data on quality-of-life of informal caregivers.”
    Quote in the paperNot a substantial claim1 of 4 sources checked
    • cites [5] Engebretson A, Matrisian L, Thompson C (2015) Pancreatic cancer: patient and caregiver perceptions on diagnosis, psychological impact, and importance of support. Pancreatology 15(6):701–707 source
    • cites [6] Dengso KE, Thomsen T, Andersen EW, Hansen CP, Christensen BM, Hillingso J et al (2021) The psychological symptom burden in partners of pancreatic cancer patients: a population-based cohort study. Supp Care Canc 29(11):6689–6699 source
    • cites [32] Janda M, Neale RE, Klein K, Beesley VL, O’Connell DL, Gooden H et al (2017) Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology 17(2):321–327 source
    • cites [33] Witt Sherman D, McMillan SC (2015) The physical health of patients with advanced pancreatic cancer and the psychological health of their family caregivers when newly enrolled in hospice. J Hosp Palliat Nurs 17(3):235–241 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Informal caregivers of cancer patients spend an estimated 32.9 hours a week on caregiving tasks, of which 72% involves performing complex medical or nursing tasks.

    “It has been estimated that informal caregivers of cancer patients spend an estimated of 32.9 h a week on caregiving tasks, of which 72% involves performing complex medical or nursing tasks [35].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [35] Trevino KM, Prigerson HG, Maciejewski PK (2018) Advanced cancer caregiving as a risk for major depressive episodes and generalized anxiety disorder. Psychooncology 27(1):243–249 source

      The Background reports that cancer caregivers spend an average of 32.9 hours per week on caregiving tasks. It also says 72% of caregivers perform complex medical or nursing tasks—not that those tasks account for 72% of their caregiving time. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Tools such as guidelines and protocols have limitations but can be useful adjuncts in supporting clinicians in navigating complexities of patient-clinical interactions when discussing cancer-related issues.

    “Though tools such as guidelines and protocols have limitations, they can be useful adjuncts in supporting clinicians in navigating complexities of patient-clinical interactions when discussing cancer-related issues [41].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [41] Eggly S, Penner L, Albrecht TL, Cline RJW, Foster T, Naughton M et al (2006) Discussing bad news in the outpatient oncology clinic: rethinking current communication guidelines. J Clin Oncol 24(4):716–719 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Informal caregivers suggested the development of guidelines or protocols to improve clinical communication.

    “Informal caregivers suggested the development of ‘guidelines’ or ‘protocols’ to improve clinical communication in one study [27].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [27] Saunders C, Gooden H, Robotin M, Mumford J (2009) As the bell tolls: a foundation study on pancreatic cancer consumer’s research priorities. BMC Res Notes 2:179 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the review of Wang et al., on unmet needs in advanced cancer, several studies reported that caregivers had unmet needs in relation to illness and treatment information, which has some parallels with the present findings, although the present findings are more specific.

    “In the review of Wang et al., on unmet needs in advanced cancer, the authors noted that several studies reported that caregivers had unmet needs in relation to illness and treatment information, which has some parallels with our findings, although ours are more specific [14].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] Wang T, Molassiotis A, Chung BPM, Tan J-Y (2018) Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care 17(1):1–29 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A 'single screening' approach is cost-effective and reduces workload but risks missing studies which can impact the findings of the review.

    “A ‘single screening’ approach is cost-effective and reduces workload [48], but risks missing studies which can impact the findings of the review [49].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [48] Doust JA, Pietrzak E, Sanders S, Glasziou PP (2005) Identifying studies for systematic reviews of diagnostic tests was difficult due to the poor sensitivity and precision of methodologic filters and the lack of information in the abstract. J Clin Epidemiol 58(5):444–9 source
    • cites [49] Waffenschmidt S, Knelangen M, Sieben W, Bühn S, Pieper D (2019) Single screening versus conventional double screening for study selection in systematic reviews: a methodological systematic review. BMC Med Res Methodol 19(1):1–9 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a systematic review focused on caregiving in solid tumour patients, management of symptoms also emerged as the foremost reported factor affecting burden.

    “For example, in a systematic review focused on caregiving in solid tumour patients, the management of symptoms also emerged as the foremost reported factor affecting burden [47].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [47] Thana K, Lehto R, Sikorskii A, Wyatt G (2021) Informal caregiver burden for solid tumour cancer patients: a review and future directions. Psychol Health 36(12):1514–1535 source

      The Results section, under “Frequently reported burden factors” (page unavailable), links symptom-management difficulties to greater caregiver burden. But it identifies caregiver physical and psychological health, financial status, social isolation, and family or social support as the five standout factors; it does not identify symptom management as the foremost reported factor. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Findingown data

    Data on unmet needs was organised into a subtheme of need for support and briefings for caregivers.

    “Data on unmet needs was organised into three subthemes need for: better clinical communication; support and briefings for caregivers; and help with navigating the health care system.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • Classified as probably not a substantial claim.

    Findingown data

    The review categorised data into three key themes: caregiver burden, unmet needs and quality-of-life.

    “We categorised data into three key themes: caregiver burden, unmet needs and quality-of-life.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • May combine two claims.

    Findingown data

    Nine studies (five qualitative, four quantitative), including 6023 informal caregivers, were included in the review.

    “Nine studies (five qualitative, four quantitative), including 6023 informal caregivers, were included in the review.”
    • Also stated in: § Search results · plain
      “Thus, nine studies were included in this review of which five were qualitative studies [27–31], and four were quantitative studies [5, 6, 32, 33].”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The systematic search identified all relevant studies on informal caregivers of pancreatic cancer patients.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Data on caregiver burden was organised into a single subtheme relating to symptom management as a source of burden.

    “Data on caregiver burden was organised into a single subtheme relating to symptom management as a source of burden.”
    • Also stated in: § Caregiver Burden · plain
      “Qualitative data were organised into a single subtheme: managing patients’ symptoms as a source of burden.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Data on unmet needs was organised into a subtheme of need for better clinical communication.

    “Data on unmet needs was organised into three subthemes need for: better clinical communication; support and briefings for caregivers; and help with navigating the health care system.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Data on unmet needs was organised into a subtheme of need for help with navigating the health care system.

    “Data on unmet needs was organised into three subthemes need for: better clinical communication; support and briefings for caregivers; and help with navigating the health care system.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One quantitative study was fair quality.

    “All five qualitative studies were graded as good quality; three quantitative studies were poor quality, and one was fair quality.”
    • Also stated in: § Quality appraisal · plain
      “The one prospective study scored 14 points and was graded as fair quality [6].”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The majority of caregivers were female (60.6%, 3748/6178).

    “The majority of caregivers were female (60.6%, 3748/6178).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Quantitative data was restricted to quality-of-life only.

    “Quantitative data was restricted to quality-of-life only.”
    • Also stated in: § Impact of informal caregiving in pancreatic cancer · plain
      “Quantitative data on caregiver experience was limited to quality-of-life and is presented in Table 4.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Excluding a large study which included 5574 informal caregivers, a total of 77 and 363 informal caregivers were included in the qualitative and quantitative studies respectively.

    “Excluding a large study which included 5574 informal caregivers [6], a total of 77 and 363 informal caregivers were included in the qualitative and quantitative studies respectively.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Dengso KE, Thomsen T, Andersen EW, Hansen CP, Christensen BM, Hillingso J et al (2021) The psychological symptom burden in partners of pancreatic cancer patients: a population-based cohort study. Supp Care Canc 29(11):6689–6699 source
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The nine included studies were published between 2008 and 2021.

    “The nine studies were published between 2008 and 2021 (Table 1).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • May combine two claims.

    Findingcitation

    Some informal caregivers reacted with anger and frustration towards the situation, which later led to guilt.

    “Some informal caregivers reacted with anger and frustration towards the situation which later led to guilt [30].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Gooden HM, White KJ (2013) Pancreatic cancer and supportive care - pancreatic exocrine insufficiency negatively impacts on quality of life. Support Care Cancer 21(7):1835–1841 source
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Qualitative data of caregiver experiences were limited to describing caregiver burden and unmet needs.

    “Qualitative data of caregiver experiences were limited to describing caregiver burden and unmet needs.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • May combine two claims.

    Findingcitation

    Informal caregivers' mean score on depressive symptoms, as measured by the CES-D, was low (2.8) but 32% of informal caregivers scored 4 or higher.

    “Informal caregivers’ mean score on depressive symptoms, as measured by the CES-D, was low (2.8) but 32% of informal caregivers scored 4 or higher [31]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Petrin K, Bowen DJ, Alfano CM, Bennett R (2009) Adjusting to pancreatic cancer: perspectives from first-degree relatives. Palliat Support Care 7(3):281–288 source
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • May combine two claims.

    Findingcitation

    Among patients and carers, accessing professional psychological help was significantly associated with subclinical or clinical HADS anxiety, and it was additionally associated with poorer QoL among patients.

    “Among patients and carers, accessing professional psychological help was significantly associated with subclinical or clinical HADS anxiety, and it was additionally associated with poorer QoL among patients [30]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Gooden HM, White KJ (2013) Pancreatic cancer and supportive care - pancreatic exocrine insufficiency negatively impacts on quality of life. Support Care Cancer 21(7):1835–1841 source
    • Rests on an assumption: The included studies are representative of informal caregivers of pancreatic cancer patients generally.

  • May combine two claims.

    Findingcitation

    Timing of delivery of diagnosis was problematic, with the possibility of cancer not mentioned until after surgery.

    “Timing of delivery of diagnosis was also problematic with the possibility of cancer not mentioned ‘until after the surgery’ [29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Sherman DW, McGuire DB, Cheon JY, Free D (2014) A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach. J Pain Symptom Manage 48(3):385 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Informal caregivers suggested a need for 'a point person to serve as coordinator'.

    “They suggested there was a need for ‘a point person to serve as coordinator’ [29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Sherman DW, McGuire DB, Cheon JY, Free D (2014) A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach. J Pain Symptom Manage 48(3):385 source

  • May combine two claims.

    Findingcitation

    In a survey of 213 informal caregivers, upon diagnosis of pancreatic cancer, 12.2% reported feeling scared/anxious and 17.4% reported feeling sad/depressed.

    “A study which surveyed 213 informal caregivers found that upon diagnosis of pancreatic cancer, 12.2% and 17.4% of informal caregivers reported feeling scared/anxious and sad/depressed [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Engebretson A, Matrisian L, Thompson C (2015) Pancreatic cancer: patient and caregiver perceptions on diagnosis, psychological impact, and importance of support. Pancreatology 15(6):701–707 source

  • May combine two claims.

    Findingown data

    The present systematic review, the first on caregivers of pancreatic cancer, identified only nine studies reporting qualitative or quantitative data on burden, unmet needs or quality-of-life among informal caregivers to patients with pancreatic cancer.

    “The present systematic review, the first on caregivers of pancreatic cancer, has identified only nine studies, which reported qualitative or quantitative data on burden, unmet needs or quality-of-life, among informal caregivers to patients with pancreatic cancer.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The review showed a large proportion of informal caregivers with clinical levels of anxiety (33%) and depression (12-32%).

    “The review showed large proportion of informal caregivers with clinical levels of anxiety (33%) and depression (12–32%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In a separate study of 84 informal caregivers recruited soon after diagnosis, 14% had subclinical anxiety and 17% had subclinical depression, while 33% had clinical anxiety and 12% had clinical depression based on HADS.

    “A separate study including 84 informal caregivers who were recruited soon after the diagnosis of pancreatic cancer found that 14% and 17% of the informal caregivers had subclinical levels of anxiety and depression respectively, while 33% and 12% had clinical levels of anxiety and depression, based on the Hospital Anxiety and Depression Scale (HADS) [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Janda M, Neale RE, Klein K, Beesley VL, O’Connell DL, Gooden H et al (2017) Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology 17(2):321–327 source

  • May combine two claims.

    Findingcitation

    Predictors of increased risk of first depression among pancreatic cancer caregivers were low education level, chronic morbidity, and bereavement.

    “Predictors of increased risk of first depression among pancreatic cancer caregivers were low education level, chronic morbidity, and bereavement [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Dengso KE, Thomsen T, Andersen EW, Hansen CP, Christensen BM, Hillingso J et al (2021) The psychological symptom burden in partners of pancreatic cancer patients: a population-based cohort study. Supp Care Canc 29(11):6689–6699 source

  • May combine two claims.

    Findingnone given

    Patient or caregiver characteristics, or other factors, that might be associated with greater burden, more needs and worse quality-of-life, and the interrelationships between different aspects of caregivers' experience, have largely not been examined.

    “Lastly, patient or caregiver characteristics, or other factors, that might be associated with greater burden, more needs and worse quality-of-life, and the interrelationships between different aspects of caregivers’ experience (burden, needs and quality-of-life) have largely not been examined.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Even for pancreatic cancer patients who received resection, the overall 5-year survival rate is less than 25% because of early recurrence.

    “Even for patients who received resection, the overall 5-year survival rate is less than 25% because of early recurrence [1, 2].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Kamisawa T, Wood LD, Itoi T, Takaori K (2016) Pancreatic cancer. The Lancet 388(10039):73–85 source
    • cites [2] Mizrahi JD, Surana R, Valle JW, Shroff RT (2020) Pancreatic cancer. Lancet 395(10242):2008–2020 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Cancer caregivers are estimated to spend an average of 32.9 h a week providing care, with 72% of that duration spent on performing complex medical or nursing tasks.

    “Cancer caregivers are estimated to spend an average of 32.9 h a week providing care and with 72% of that duration spent on performing complex medical or nursing tasks [8].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] Kent EE, Mollica MA, Buckenmaier S, Smith AW (eds) (2019) The characteristics of informal cancer caregivers in the United States. Elsevier source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the context of cancer, informal caregivers may provide support during treatment, manage the patient's medications, coordinate healthcare visits, and update friends and family, in addition to supporting patients with activities of daily living and instrumental activities of daily living.

    “In the context of cancer, informal caregivers may provide support during treatment, manage the patient’s medications, coordinate healthcare visits, and update friends and family, in addition to supporting patients with activities of daily living (e.g. feeding, bathing, and dressing patients) and instrumental activities of daily living (e.g. managing finance, cooking, and cleaning) [5, 6].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] Engebretson A, Matrisian L, Thompson C (2015) Pancreatic cancer: patient and caregiver perceptions on diagnosis, psychological impact, and importance of support. Pancreatology 15(6):701–707 source
    • cites [6] Dengso KE, Thomsen T, Andersen EW, Hansen CP, Christensen BM, Hillingso J et al (2021) The psychological symptom burden in partners of pancreatic cancer patients: a population-based cohort study. Supp Care Canc 29(11):6689–6699 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The overall survival at 5-years for pancreatic cancer is 6-10%, due in large part to late diagnosis which precludes curative resections.

    “The overall survival at 5-years is 6–10%, due in large part to late diagnosis which precludes curative resections [1, 2].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Kamisawa T, Wood LD, Itoi T, Takaori K (2016) Pancreatic cancer. The Lancet 388(10039):73–85 source
    • cites [2] Mizrahi JD, Surana R, Valle JW, Shroff RT (2020) Pancreatic cancer. Lancet 395(10242):2008–2020 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Patients with pancreatic cancer tend to deteriorate rapidly and up to 90% have died within a year of diagnosis.

    “Patients tend to deteriorate rapidly and up to 90% have died within a year of diagnosis, demonstrating the aggressiveness of the condition [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Bauer MR, Bright EE, MacDonald JJ, Cleary EH, Hines OJ, Stanton AL (2018) Quality of life in patients with pancreatic cancer and their caregivers: a systematic review. Pancreas 47(4):368–375 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Quality appraisal was undertaken independently by two authors (EC and LC).

    “Quality appraisal was undertaken independently by two authors (EC and LC).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The adverse effects of informal caregiving are increasingly appreciated in various diseases including cancer.

    “The adverse effects of informal caregiving are increasingly appreciated in various diseases including cancer [9, 10].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [9] Gerhardt S, Dengso KE, Herling S, Thomsen T (2020) From bystander to enlisted carer - a qualitative study of the experiences of caregivers of patients attending follow-up after curative treatment for cancers in the pancreas, duodenum and bile duct. Eur J Oncol Nurs : Official J Eur Oncol Nurs Soc 44:101717 source
    • cites [10] Schulz R, O’Brien AT, Bookwala J, Fleissner K (1995) Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. Gerontologist 35(6):771–791 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Assessment of full-text papers for eligibility was performed independently by two authors (EC and LC).

    “Assessment of the full-text papers for eligibility was performed independently by two authors (EC and LC).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    High-quality cancer care is now recognised as not limited to the delivery of appropriate treatment but also includes ensuring patients' supportive care needs are met.

    “High-quality cancer care is now recognised as not limited to the delivery of appropriate treatment but also includes ensuring patients’ supportive care needs are met [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Harrison JD, Young JM, Price MA, Butow PN, Solomon MJ (2009) What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer 17(8):1117–1128 source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Narrative synthesis of data was undertaken because the limited number of eligible papers and heterogeneity in methods and outcomes precluded meta-synthesis.

    “Narrative synthesis of data was undertaken [25]; the limited number of eligible papers and heterogeneity in methods and outcomes precluded meta-synthesis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M et al (2006) Guidance on the conduct of narrative synthesis in systematic reviews. A Prod ESRC Methods Program Version 1(1):b92

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Patients with pancreatic cancer have notably worse quality-of-life and psychological wellbeing compared to people without cancer and those with other forms of cancer.

    “patients’ quality-of-life and psychological wellbeing are notably worse compared to people without cancer and those with other forms of cancer [17].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Bauer MR, Bright EE, MacDonald JJ, Cleary EH, Hines OJ, Stanton AL (2018) Quality of life in patients with pancreatic cancer and their caregivers: a systematic review. Pancreas 47(4):368–375 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Data were extracted by two authors (EC and LC).

    “Data were extracted by two authors (EC and LC).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Cancer patients tend to experience severe symptoms more frequently and have a sharper decline in quality-of-life compared to other chronic diseases, particularly in pancreatic cancer.

    “Cancer patients tend to experience severe symptoms more frequently and to have a sharper decline in quality-of-life when compared to other chronic diseases [29]; this is particularly true in pancreatic cancer [2].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [29] Sherman DW, McGuire DB, Cheon JY, Free D (2014) A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach. J Pain Symptom Manage 48(3):385 source
    • cites [2] Mizrahi JD, Surana R, Valle JW, Shroff RT (2020) Pancreatic cancer. Lancet 395(10242):2008–2020 source

  • May combine two claims.

    Premisecitation

    Health institutes' policies increasingly push for shorter length of hospital stay and more outpatient care, thus placing greater responsibility on partners and families to supplement care received from professionals.

    “Furthermore, health institutes’ policies also increasingly push for shorter length of hospital stay and more outpatient care thus placing greater responsibility on partners and families to supplement care received from professionals [29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Sherman DW, McGuire DB, Cheon JY, Free D (2014) A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach. J Pain Symptom Manage 48(3):385 source

  • Classified as probably not a substantial claim.

    Interpretationcitation

    The correlation between patient and caregiver anxiety and depression suggests the possibility that interventions which support caregiver quality-of-life or psychological wellbeing may also yield benefits for patients, or vice versa.

    “This suggests the possibility that interventions which support caregiver quality-of-life or psychological wellbeing may also yield benefits for patients (or vice versa).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Healthcare policies and reforms in many countries now prioritize patients taking a more active role in self-managing their illness; to effectively self-manage, patients need support, and that support often comes from a family member or friends.

    “Healthcare policies and reforms in many countries now prioritize patients taking a more active role in (self-)managing their illness [29]; to effectively self-manage, patients need support, and that support often comes from a family member or friends [29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Sherman DW, McGuire DB, Cheon JY, Free D (2014) A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach. J Pain Symptom Manage 48(3):385 source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    This neglect has been studied by many researchers.

    “This neglect has been studied by many researchers [42–44].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [42] Brown M-A, Stetz K (1999) The labor of caregiving: a theoretical model of caregiving during potentially fatal illness. Qual Health Res 9(2):182–197 source
    • cites [43] Waldrop DP, Meeker MA, Kerr C, Skretny J, Tangeman J, Milch R (2012) The nature and timing of family-provider communication in late-stage cancer: a qualitative study of caregivers’ experiences. J Pain Symptom Manage 43(2):182–194 source
    • cites [44] Gilbert E, Ussher JM, Perz J, Hobbs K, Kirsten L (2010) Positive and negative interactions with health professionals: a qualitative investigation of the experiences of informal cancer carers. Cancer Nurs 33(6):E1–E9 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A single author undertook the initial screening process of title and abstract.

    “A single author undertook the initial screening process of title and abstract.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    It is likely that caregivers' roles across different phases of the illness trajectory evolve with the changing tangible and intangible demands imposed on them.

    “It is likely that caregivers’ role(s) across different phases of the illness trajectory evolve(s) with the changing tangible and intangible demands imposed on them.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Cancer care delivery is complex, and patients may encounter multiple specialties including surgery, oncology, palliative, and occasionally emergency services across their disease course.

    “Cancer care delivery is complex, and patients may encounter multiple specialties including surgery, oncology, palliative, and occasionally emergency services across his/her disease course.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Suboptimal interaction with informal caregivers may lead to caregiver distress and less competency in dealing with uncertainty and problem solving, thus potentially adversely impacting on the patient.

    “Suboptimal interaction with informal caregivers may lead to caregiver distress and less competency in dealing with uncertainty and problem solving [42], thus potentially adversely impacting on the patient.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42] Brown M-A, Stetz K (1999) The labor of caregiving: a theoretical model of caregiving during potentially fatal illness. Qual Health Res 9(2):182–197 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The review protocol was not registered a priori with PROSPERO or another external database.

    “We did not register the review protocol a priori with PROSPERO or another external database.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Restricting inclusion to English-language studies risked missing important evidence.

    “Restricting inclusion to English-language studies also risked missing important evidence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Despite the importance of informal caregivers to the modern health system, they report being seldom acknowledged, that health professionals rarely show interest in them and their health and ability to cope, and that health professionals spend insufficient time informing them about specific aspects of a disease such as symptoms and side effects.

    “Despite the importance of informal caregiver to the modern health system, they report being seldom acknowledged, that health professional rarely show interest in them (and their health and ability to cope) and that health professionals spend insufficient time informing them about specific aspects of a disease such as symptoms and side effects [45].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [45] Lund L, Ross L, Petersen MA, Groenvold M (2015) The interaction between informal cancer caregivers and health care professionals: a survey of caregivers’ experiences of problems and unmet needs. Support Care Cancer 23(6):1719–1733 source
69 of 69

  • The paper relies on this without support.

    The systematic search identified all relevant studies on informal caregivers of pancreatic cancer patients.

    “PubMed, Medline, CINAHL and Embase databases were systematically searched on 31 August 2021.”
    “Manual searches of reference list of included studies did not return any further articles that met the inclusion criteria.”

  • The paper relies on this without support.

    The included studies are representative of informal caregivers of pancreatic cancer patients generally.

    “Nine studies (five qualitative, four quantitative), including 6023 informal caregivers, were included in the review.”
    “Informal caregivers were predominantly spouses to patients with pancreatic cancer (98.6%, 6058/6142) [5, 6, 28, 33, 34].”
2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Demographic caregiver counts exceed the review's total

    Minor

    The demographic statement gives 6,058 spouses and a gender denominator of 6,178 caregivers, both exceeding the review's stated total of 6,023 informal caregivers.

  • Sherman MINORS total exceeds its item scores

    Minor

    The twelve item scores in Table 3 sum to 6, not the reported 7.

    Reported 7 · recomputed 6

  • Janda MINORS total exceeds its item scores

    Minor

    The twelve item scores in Table 3 sum to 7, not the reported 8.

    Reported 8 · recomputed 7

  • Gooden's CASP score conflicts with the narrative grouping

    Minor

    The narrative places reference [30] among the studies scoring 17, but Table 2 gives Gooden et al. [30] a score of 18.

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M et al (2006) Guidance on the conduct of narrative synthesis in systematic reviews. A Prod ESRC Methods Program Version 1(1):b92
  2. Janda M, Neale RE, Klein K, O’Connell DL, Gooden H, Goldstein D et al (2017) Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology 17(2):321–327 · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
Chong, E., Crowe, L., Mentor, K., Pandanaboyana, S., & Sharp, L.
Affiliations
  • University of Auckland (NZ)
  • Newcastle University (GB)
  • Freeman Hospital (GB)
Corresponding author
Sharp, Linda
ORCID
Venue
Supportive Care in Cancer
Publisher
Springer Science and Business Media LLC
Published
2022-12-22
Volume
31
Issue
1
Pages
74-74
ISSN
  • 0941-4355 (ISSN-L)
  • 1433-7339
DOI
10.1007/s00520-022-07468-7
PMC
PMC9771849
OpenAlex
W4312128955
Semantic Scholar
d6f3d4162bb26f9e08b5a1e26313db0a7dfcf009
Cited by
86
References
46
Citations by year
2026: 25 · 2025: 28 · 2024: 21 · 2023: 12
FWCI
3.96
Type
journal article
Language
en
Open access
Licence
Locations
  • Supportive Care in Cancer (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
Funders
  • Macmillan Cancer Support
  • Pancreatic Cancer UK
Topics
  • Health Sciences › Health Professions › Pharmacy › Nursing care and research
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
Keywords
informal caregivers, pancreatic cancer, caregiver burden, unmet needs, quality of life, symptom management, anxiety, depression, clinical communication, caregiver support, health care navigation, supportive care
MeSH terms
Caregiver Burden, Humans, Pancreatic Neoplasms, Prospective Studies, Quality of Life, Caregivers

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-14.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-14.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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