Cited by 29Nursing care and researchCancer survivorship and careBrain Metastases and Treatment

The Hidden Morbidity of Cancer

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Saria, Marlon Garzo, Nyamathi, Adeline, Phillips, Linda R., Stanton, Annette L., Evangelista, Lorraine, Kesari, Santosh, Maliski, Sally·2017·Nursing Clinics of North America

Abstract

Caregiving is a highly individualized experience. Although numerous articles have been published on caregiver burden from a variety of diagnoses and conditions, this article presents the unique features of caregiving in patients with brain metastases. Improved long-term survival, concerns about disease recurrence or progression, the cancer experience (initial diagnosis, treatment, survivorship, recurrence, progression, and end of life), and the increasing complexity of cancer treatments add to the demands placed on the caregivers of patients with brain metastases. Health care professionals must identify caregiver burden and administer the appropriate interventions, which must be as unique and individualized as the caregivers' experiences.

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Crossref · 10.1016/j.cnur.2016.10.002

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  • Earlier reports in neuro-oncology often describe moderate-to-severe burden levels and identify patient functional dependence and neuropsychiatric symptoms as key correlates.

    “When considering caregiver burden, earlier reports in neuro-oncology often describe moderate-to-severe burden levels and identify patient functional dependence and neuropsychiatric symptoms as key correlates.26,27”

    From Caregiver burden, quality of life, and psychosocial outcomes among informal caregivers of patients with glioma: A systematic review and meta-analysis (2026) · cites this paper as [26]

    In “Primary Demands of Caregiving” (page unavailable), the paper reports that functional status affected one caregiver-burden subscale in a study of primary brain tumors, while neuropsychiatric status affected every subscale. It does not establish the claimed moderate-to-severe burden levels in neuro-oncology; searches for that severity description found no supporting passage. (LLM, conf=0.84)

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  1. [1]Hutter A, Schwetye KE, Bierhals AJ, Brain neoplasms: epidemiology, diagnosis, and prospects for cost-effective imaging. Neuroimaging Clin North Am 2003; 13(2): 237– 50, x–xi. 13677804
  2. [2]Levin VA, Leibel SA, Gutin PH. Neoplasms of the central nervous system. In: DeVita VT Jr, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. 6th edition. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 2100– 60.
  3. [4]Saria MG, Piccioni D, Carter J, Current perspectives in the management of brain metastases. Clin J Oncol Nurs 2015; 19(4): 475– 9. 26207714
  4. [5]Leone JP, Leone BA. Breast cancer brain metastases: the last frontier. Exp Hematol Oncol 2015; 4: 33. 26605131 PMC4657380
  5. [6]Kent EE, Rowland JH, Northouse L, Caring for caregivers and patients: research and clinical priorities for informal cancer caregiving. Cancer 2016; 122(13): 1987– 95. 26991807 PMC5597246
  6. [7]Dionne-Odom JN, Hull JG, Martin MY, Associations between advanced cancer patients’ survival and family caregiver presence and burden. Cancer Med 2016; 5: 853– 62. 26860217 PMC4864814
  7. [8]Etters L, Goodall D, Harrison BE. Caregiver burden among dementia patient caregivers: a review of the literature. J Am Acad Nurse Pract 2008; 20(8): 423– 8. 18786017
  8. [10]Grunfeld E, Coyle D, Whelan T, Family caregiver burden: results of a longitudinal study of breast cancer patients and their principal caregivers. CMAJ 2004; 170(12): 1795– 801. 15184333 PMC419766
  9. [11]Mausbach BT, Harmell AL, Moore RC, Influence of caregiver burden on the association between daily fluctuations in pleasant activities and mood: a daily diary analysis. Behav Res Ther 2011; 49(1): 74– 9. 21130981 PMC3025044
  10. [12]McLennon SM, Habermann B, Rice M. Finding meaning as a mediator of burden on the health of caregivers of spouses with dementia. Aging Ment Health 2011; 15(4): 522– 30. 21500019
  11. [13]Moller-Leimkuhler AM, Wiesheu A. Caregiver burden in chronic mental illness: the role of patient and caregiver characteristics. Eur Arch Psychiatry Clin Neurosci 2011; 262: 157– 66. 21538092
  12. [15]Rafiyah I, Sutharangsee W. Review: burden on family caregivers caring for patients with schizophrenia and its related factors. Nurse Media Journal of Nursing 2011; 1(1): 29– 41.
  13. [16]Rha SY, Park Y, Song SK, Caregiving burden and the quality of life of family caregivers of cancer patients: the relationship and correlates. Eur J Oncol Nurs 2015; 19(4): 376– 82. 25795160
  14. [17]van Ryn M, Sanders S, Kahn K, Objective burden, resources, and other stressors among informal cancer caregivers: a hidden quality issue? Psychooncology 2011; 20(1): 44– 52. 20201115 PMC4479404
  15. [18]Zarit SH, Reever KE, Bach-Peterson J. Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist 1980; 20(6): 649– 55. 7203086
  16. [19]Chou KR. Caregiver burden: a concept analysis. J Pediatr Nurs 2000; 15(6): 398– 407. 11151480
  17. [20]Hoffmann RL, Mitchell AM. Caregiver burden: historical development. Nurs Forum 1998; 33(4): 5– 11. 10205484
  18. [21]Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.
  19. [22]Connell CM, Janevic MR, Gallant MP. The costs of caring: impact of dementia on family caregivers. J Geriatr Psychiatry Neurol 2001; 14(4): 179– 87. 11794446
  20. [23]Luchetti L, Uhunmwangho E, Dordoni G, The subjective feeling of burden in caregivers of elderly with dementia: how to intervene? Arch Gerontol Geriatr 2009; 49(Suppl 1): 153– 61. 19836629
  21. [24]Nguyen M. Nurse’s assessment of caregiver burden. Medsurg Nurs 2009; 18(3): 147– 51 [quiz: 152]. 19591360
  22. [25]Stinson JM, Collins RL, Maestas KL, Dependency aspect of caregiver burden is uniquely related to cognitive impairment in veterans. J Rehabil Res Dev 2014; 51(8): 1177– 88. 25625824
  23. [27]Kim Y, Schulz R. Family caregivers’ strains: comparative analysis of cancer caregiving with dementia, diabetes, and frail elderly caregiving. J Aging Health 2008; 20(5): 483– 503. 18420838
  24. [28]Whisenant M. Informal caregiving in patients with brain tumors. Oncol Nurs Forum 2011; 38(5): E373– 81. 21875834 PMC12266670
  25. [29]Ampalam P, Gunturu S, Padma V. A comparative study of caregiver burden in psychiatric illness and chronic medical illness. Indian J Psychiatry 2012; 54(3): 239– 43. 23226847 PMC3512360
  26. [30]Garlo K, O’Leary JR, Van Ness PH, Burden in caregivers of older adults with advanced illness. J Am Geriatr Soc 2010; 58(12): 2315– 22. 21087225 PMC3058825
  27. [31]Burton AM, Sautter JM, Tulsky JA, Burden and well-being among a diverse sample of cancer, congestive heart failure, and chronic obstructive pulmonary disease caregivers. J Pain Symptom Manage 2012; 44(3): 410– 20. 22727950 PMC3432705
  28. [32]Sautter JM, Tulsky JA, Johnson KS, Caregiver experience during advanced chronic illness and last year of life. J Am Geriatr Soc 2014; 62(6): 1082– 90. 24803020 PMC4070184
  29. [33]Ankri J, Andrieu S, Beaufils B, Beyond the global score of the Zarit Burden Interview: useful dimensions for clinicians. Int J Geriatr Psychiatry 2005; 20(3): 254– 60. 15717336
  30. [34]Jeong YG, Jeong YJ, Kim WC, The mediating effect of caregiver burden on the caregivers’ quality of life. J Phys Ther Sci 2015; 27(5): 1543– 7. 26157260 PMC4483438
  31. [35]Sherwood PR, Given BA, Given CW, Predictors of distress in caregivers of persons with a primary malignant brain tumor. Res Nurs Health 2006; 29(2): 105– 20. 16532486
  32. [36]Chappell NL, Dujela C. Caregiving: predicting at-risk status. Can J Aging 2008; 27(2): 169– 79. 18845512
  33. [38]Sherwood PR, Donovan HS, Given CW, Predictors of employment and lost hours from work in cancer caregivers. Psychooncology 2008; 17(6): 598– 605. 17957756 PMC4846278
  34. [39]Khalili Y. Ongoing transitions: the impact of a malignant brain tumour on patient and family. Axone 2007; 28(3): 5– 13. 17682686
  35. [40]Kim Y, Given BA. Quality of life of family caregivers of cancer survivors: across the trajectory of the illness. Cancer 2008; 112(11 Suppl): 2556– 68. 18428199
  36. [41]Zwaanswijk M, Peeters JM, van Beek AP, Informal caregivers of people with dementia: problems, needs and support in the initial stage and in subsequent stages of dementia: a questionnaire survey. Open Nurs J 2013; 7: 6– 13. 23346266 PMC3551235
  37. [42]Grov EK, Valeberg BT. Does the cancer patient’s disease stage matter? A comparative study of caregivers’ mental health and health related quality of life. Palliat Support Care 2012; 10(3): 189– 96. 22436126
  38. [43]Sherwood PR, Given B, Given C, Caregivers of persons with a brain tumor: a conceptual model. Nurs Inq 2004; 11(1): 43– 53. 14962346
  39. [45]Hunt CK. Concepts in caregiver research. J Nurs Scholarsh 2003; 35(1): 27– 32. 12701523
  40. [46]Kruithof WJ, Post MW, Visser-Meily JM. Measuring negative and positive caregiving experiences: a psychometric analysis of the Caregiver Strain Index Expanded. Clin Rehabil 2015; 29(12): 1224– 33. 25652441
  41. [47]Davis ME, Stoiber AM. Glioblastoma multiforme: enhancing survival and quality of life. Clin J Oncol Nurs 2011; 15(3): 291– 7. 21624864
  42. [48]Wefel JS, Cloughesy T, Zazzali JL, Neurocognitive function in patients with recurrent glioblastoma treated with bevacizumab. Neuro Oncol 2011; 13(6): 660– 8. 21558074 PMC3107095
  43. [49]Weller M. Neurocognitive function: an emerging surrogate endpoint for neuro-oncology trials. Neuro Oncol 2011; 13(6): 565. 21636704 PMC3107105
  44. [50]Witgert ME, Meyers CA. Neurocognitive and quality of life measures in patients with metastatic brain disease. Neurosurg Clin North Am 2011; 22(1): 79– 85, vii. 21109152
  45. [51]Khuntia D, Mathew BS, Meyers CA, Brain metastases. In: Meyers CA, Perry JR, editors. Cognition and cancer. New York: Cambridge University Press; 2008. p. 170– 86.
  46. [52]Schagen SB, Klein M, Reijneveld JC, Monitoring and optimising cognitive function in cancer patients: present knowledge and future directions. EJC Suppl 2014; 12(1): 29– 40. 26217164 PMC4250534
  47. [53]Shen C, Bao WM, Yang BJ, Cognitive deficits in patients with brain tumor. Chin Med J (Engl) 2012; 125(14): 2610– 7. 22882948
  48. [55]Ikeda C, Terada S, Oshima E, Difference in determinants of caregiver burden between amnestic mild cognitive impairment and mild Alzheimer’s disease. Psychiatry Res 2015; 226(1): 242– 6. 25631688
  49. [56]Dauphinot V, Ravier A, Novais T, Relationship between comorbidities in patients with cognitive complaint and caregiver burden: a cross-sectional study. J Am Med Dir Assoc 2016; 17(3): 232– 7. 26620070
  50. [58]Germain S, Adam S, Olivier C, Does cognitive impairment influence burden in caregivers of patients with Alzheimer’s disease? J Alzheimers Dis 2009; 17(1): 105– 14. 19494435
  51. [59]Sherwood PR, Given CW, Given BA, Caregiver burden and depressive symptoms: analysis of common outcomes in caregivers of elderly patients. J Aging Health 2005; 17(2): 125– 47. 15750048
  52. [60]Rosdinom R, Zarina MZ, Zanariah MS, Behavioural and psychological symptoms of dementia, cognitive impairment and caregiver burden in patients with dementia. Prev Med 2013; 57(Suppl): S67– 9. 23313789
  53. [61]Lillo P, Mioshi E, Hodges JR. Caregiver burden in amyotrophic lateral sclerosis is more dependent on patients’ behavioral changes than physical disability: a comparative study. BMC Neurol 2012; 12: 156. 23216745 PMC3541170
  54. [62]Russell B, Collins A, Dally M, Living longer with adult high-grade glioma: setting a research agenda for patients and their caregivers. J Neurooncol 2014; 120(1): 1– 10. 24980038
  55. [63]Northfield S, Nebauer M. The caregiving journey for family members of relatives with cancer: how do they cope? Clin J Oncol Nurs 2010; 14(5): 567– 77. 20880815
  56. [64]Given BA, Given CW. Family caregiving for the elderly. In: Fitzpatrick JJ, Taunton RL, Jacox AK, editors. Annual review of nursing research, vol. 9. New York: Springer; 1991. p. 77– 101. 1756094
  57. [65]Mochari-Greenberger H, Mosca L. Caregiver burden and nonachievement of healthy lifestyle behaviors among family caregivers of cardiovascular disease patients. Am J Health Promot 2012; 27(2): 84– 9. 23113777 PMC4041363
  58. [66]Vaingankar JA, Subramaniam M, Abdin E, “How much can I take?”: predictors of perceived burden for relatives of people with chronic illness. Ann Acad Med Singap 2012; 41(5): 212– 20. 22760719
  59. [67]Abernethy A, Burns C, Wheeler J, Defining distinct caregiver subpopulations by intensity of end-of-life care provided. Palliat Med 2009; 23(1): 66– 79. 18996981
  60. [68]Rodriguez-Sanchez E, Perez-Penaranda A, Losada-Baltar A, Relationships between quality of life and family function in caregiver. BMC Fam Pract 2011; 12: 19. 21496270 PMC3089776
  61. [70]Beattie S, Lebel S. The experience of caregivers of hematological cancer patients undergoing a hematopoietic stem cell transplant: a comprehensive literature review. Psychooncology 2011; 20(11): 1137– 50. 21425389
  62. [71]Guetin S, Portet F, Picot MC, Impact of music therapy on anxiety and depression for patients with Alzheimer’s disease and on the burden felt by the main caregiver (feasibility study). Encephale 2009; 35(1): 57– 65 [in French]. 19250995
  63. [72]Choice Picot S. and social exchange theory and the rewards of African American caregivers. J Natl Black Nurses Assoc 1995; 7(2): 29– 40. 9128531
  64. [73]Picot SJ. The relationship between the rewards, costs, and coping strategies of black family caregivers [Doctoral dissertation - research]. Baltimore (MD): University of Maryland; 1991.
  65. [74]Picot SJ, Youngblut J, Zeller R. Development and testing of a measure of perceived caregiver rewards in adults. J Nurs Meas 1997; 5(1): 33– 52. 9505468
  66. [75]Dias R, Santos RL, Sousa MF, Resilience of caregivers of people with dementia: a systematic review of biological and psychosocial determinants. Trends Psychiatry Psychother 2015; 37(1): 12– 9. 25860562
  67. [76]Li Q, Loke AY. The positive aspects of caregiving for cancer patients: a critical review of the literature and directions for future research. Psychooncology 2013; 22(11): 2399– 407. 23712938
  68. [78]Sherwood PR, Cwiklik M, Donovan HS. Neuro-oncology family caregiving: review and directions for future research. CNS Oncol 2016; 5(1): 41– 8. 26675885 PMC6078154
  69. [79]Sherwood PR, Price TJ, Weimer J, Neuro-oncology family caregivers are at risk for systemic inflammation. J Neurooncol 2016; 128: 109– 18. 26907491 PMC4865431
  70. [81]Collins LG, Swartz K. Caregiver care. Am Fam Physician 2011; 83(11): 1309– 17. 21661713
  71. [83]Family Caregiver Alliance. Family caregiving: state of the art, future trends. Report from a national conference. San Francisco (CA): 2007.
  72. [84]Schulz R, Beach SR. Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA 1999; 282(23): 2215– 9. 10605972
  73. [86]Hanzawa S, Bae JK, Bae YJ, Psychological impact on caregivers traumatized by the violent behavior of a family member with schizophrenia. Asian J Psychiatr 2013; 6(1): 46– 51. 23380317
  74. [88]Mazzotti E, Sebastiani C, Antonini Cappellini GC, Predictors of mood disorders in cancer patients’ caregivers. Support Care Cancer 2013; 21(2): 643– 7. 23203651
  75. [89]Papastavrou E, Charalambous A, Tsangari H, The burdensome and depressive experience of caring: what cancer, schizophrenia, and Alzheimer’s disease caregivers have in common. Cancer Nurs 2012; 35(3): 187– 94. 22538260
  76. [90]Tang ST, Chang WC, Chen JS, Course and predictors of depressive symptoms among family caregivers of terminally ill cancer patients until their death. Psychooncology 2012; 22(6): 1312– 8. 22836818
  77. [92]Mosher CE, Champion VL, Azzoli CG, Economic and social changes among distressed family caregivers of lung cancer patients. Support Care Cancer 2013; 21(3): 819– 26. 22945881 PMC3560318
  78. [93]Mazanec SR, Daly BJ, Douglas SL, Work productivity and health of informal caregivers of persons with advanced cancer. Res Nurs Health 2011; 34(6): 483– 95. 21953274 PMC4381346
  79. [94]Giovannetti ER, Wolff JL, Frick KD, Construct validity of the work productivity and activity impairment questionnaire across informal caregivers of chronically ill older patients. Value Health 2009; 12(6): 1011– 7. 19402853 PMC3040443
  80. [95]Reinhard S, Given B, Petlick N, Supporting family caregivers in providing care. In: Hughes R, editor. Patient safety and quality: an evidence-based handbook for nurses. Rockville (MD): Agency for Healthcare Research and Quality; 2008. p. 341– 404. 21328765
  81. [96]Beach SR, Schulz R, Williamson GM, Risk factors for potentially harmful informal caregiver behavior. J Am Geriatr Soc 2005; 53(2): 255– 61. 15673349
  82. [97]Johannesen M, Logiudice D. Elder abuse: a systematic review of risk factors in community-dwelling elders. Age Ageing 2013; 42: 292– 8. 23343837
  83. [98]Fulmer T, Paveza G, VandeWeerd C, Dyadic vulnerability and risk profiling for elder neglect. Gerontologist 2005; 45(4): 525– 34. 16051915
  84. [99]Heath JM, Kobylarz FA, Brown M, Interventions from home-based geriatric assessments of adult protective service clients suffering elder mistreatment. J Am Geriatr Soc 2005; 53(9): 1538– 42. 16137284
  85. [100]Otis-Green S, Juarez G. Enhancing the social well-being of family caregivers. Semin Oncol Nurs 2012; 28(4): 246– 55. 23107182 PMC3729043
  86. [102]Chamberlain MC. Brain metastases: a medical neuro-oncology perspective. Expert Rev Neurother 2010; 10(4): 563– 73. 20367208
  87. [103]Lorger M, Felding-Habermann B. Capturing changes in the brain microenvironment during initial steps of breast cancer brain metastasis. Am J Pathol 2010; 176(6): 2958– 71. 20382702 PMC2877856
  88. [106]Stavas M, Arneson K, Friedman J, From whole brain to hospice: patterns of care in radiation oncology. J Palliat Med 2014; 17(6): 662– 6. 24673495
  89. [107]Oliver DP, Demiris G, Washington KT, Challenges and strategies for hospice caregivers: a qualitative analysis. Gerontologist 2016. [Epub ahead of print]. PMC5881722 27048707
  90. [108]Wright AA, Keating NL, Ayanian JZ, Family perspectives on aggressive cancer care near the end of life. JAMA 2016; 315(3): 284– 92. 26784776 PMC4919118
  91. [109]Guo G, Phillips LR, Reed PG. End-of-life caregiver interactions with health care providers: learning from the bad. J Nurs Care Qual 2010; 25(4): 334– 43. 20375703
  92. [110]Phillips LR, Reed PG. End-of-life caregiver’s perspectives on their role: generative caregiving. Gerontologist 2010; 50(2): 204– 14. 19651667 PMC2838409

Cited by

Sorted by citations

Authors
Saria, M. G., Nyamathi, A., Phillips, L. R., Stanton, A. L., Evangelista, L., Kesari, S., & Maliski, S.
Affiliations
  • University of California, Los Angeles (US)
  • University of California, Irvine (US)
  • Saint John's Health Center (US)
Corresponding author
Saria, Marlon Garzo
Venue
Nursing Clinics of North America
Publisher
Elsevier BV
Published
2017-03
Volume
52
Issue
1
Pages
159-178
ISSN
0029-6465 (ISSN-L)
OpenAlex
W2586488084
Cited by
29
References
13
Citations by year
2026: 3 · 2025: 5 · 2023: 2 · 2022: 4 · 2021: 5 · 2020: 6 · 2019: 2 · 2018: 2
FWCI
0.54
Type
journal article
Language
en
Open access
Locations
  • Nursing Clinics of North America (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
National Institute on Aging (R21AG053162)
Topics
  • Health Sciences › Health Professions › Pharmacy › Nursing care and research
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Brain Metastases and Treatment
Keywords
caregiver burden, brain metastases, cancer caregiving, caregiver experiences, cancer survivorship, end-of-life care, recurrence, caregiver interventions
MeSH terms
Adaptation, Psychological, Brain Neoplasms, Female, Humans, Male, Neoplasm Metastasis, Neoplasm Recurrence, Local, Quality of Life, Stress, Psychological, Caregivers

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