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Cited by 45Palliative Care and End-of-Life IssuesPalliative and Oncologic CareCancer survivorship and care

Family Caregivers' Subjective Caregiving Burden, Quality of Life, and Depressive Symptoms Are Associated With Terminally Ill Cancer Patients' Distinct Patterns of Conjoint Symptom Distress and Functional Impairment in Their Last Six Months of Life

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Wen, Fur-Hsing, Chen, Jen-Shi, Chou, Wen-Chi, Chang, Wen-Cheng, Shen, Wen Chi, Hsieh, Chia-Hsun, Tang, Siew Tzuh·2019·Journal of Pain and Symptom Management
DOI 10.1016/j.jpainsymman.2018.09.009
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Abstract

Context Family caregivers constitute a critical component of the end-of-life care system with considerable cost to themselves. However, the joint association of terminally ill cancer patients' symptom distress and functional impairment with caregivers' subjective caregiving burden, quality of life (QOL), and depressive symptoms remains unknown. Objectives/methods We used multivariate hierarchical linear modeling to simultaneously evaluate associations between five distinct patterns of conjoint symptom distress and functional impairment (symptom-functional states) and subjective caregiving burden, QOL, and depressive symptoms in a convenience sample of 215 family caregiver-patient dyads. Data were collected every 2 to 4 weeks over patients' last 6 months. Results Caregivers of patients in the worst symptom-functional states (States 3-5) reported worse subjective caregiving burden and depressive symptoms than those in the best two states, but the three outcomes did not differ between caregivers of patients in State 3 and States 4-5. Caregivers of patients in State 5 endured worse subjective caregiving burden and QOL than those in State 4. Caregivers of patients in State 4 suffered worse subjective caregiving burden and depressive symptoms but comparable QOL to those in State 2. Conclusion Patients' five distinct, conjoint symptom-functional states were significantly and differentially associated with their caregivers' worse subjective caregiving burden, QOL, and depressive symptoms while caring for patients over their last 6 months.

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  • La carga del cuidador fue mayor en pacientes con peores estados funcionales, y una peor calidad de vida estuvo directa y proporcionalmente relacionada con estos dos factores.

    “La CdC fue mayor en los pacientes con peores estados funcionales, observándose además, una peor CdV directa y proporcionalmente relacionada con estos dos factores”

    From Sobrecarga de trabajo en cuidadores de pacientes en cuidados paliativos oncológicos: Una revisión bibliográfica (2023) · cites this paper as Wen et al., 2019

    The Results and Discussion (page numbers unavailable) report greater caregiver burden for several worse patient symptom-functional states and poorer caregiver quality of life in several comparisons. They do not establish a direct, proportional relationship: quality of life did not differ significantly between caregivers of patients with mild versus severe functional impairment when symptom distress was moderate. The measured burden and quality of life were the caregivers’, not the patients’. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • La carga del cuidador es proporcional a peores estados funcionales y una peor calidad de vida.

    “En un estudio longitudinal de 215 participantes se concluyó que la CdC fue proporcional a peores estados funcionales y una peor CdV (Wen et al., 2019)”

    From Sobrecarga de trabajo en cuidadores de pacientes en cuidados paliativos oncológicos: Una revisión bibliográfica (2023) · cites this paper as Wen et al., 2019

    The paper studied 215 caregiver–patient dyads and reports in the Results that caregivers of patients in worse symptom-functional states generally had greater burden and poorer quality of life. It does not establish a proportional relationship: some states did not differ significantly in burden or quality of life, and quality of life was comparable between states with mild and severe functional impairment (Results; Discussion). (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Se registraron síntomas depresivos en los cuidadores sobre todo en los peores 4 estados funcionales de los pacientes.

    “también se registraron síntomas depresivos sobre todo en sus peores 4 estados funcionales.”

    From Sobrecarga de trabajo en cuidadores de pacientes en cuidados paliativos oncológicos: Una revisión bibliográfica (2023) · cites this paper as Wen et al., 2019

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Research works printed but not linked: 34

  1. Northouse L, Williams AI, Given B, McCorkle R. Psycho- social care for caregivers of patients with cancer. J Clin On- col 2012;30:1227e1234.
  2. Funk LM, Chappell NL, Liu G. Associations between fil- ial responsibility and caregiver well-being are there differ- ences by cultural group? Res Aging 2013;35:78e95.
  3. Gardiner C, Brereton L, Frey R, Wilkinson-Meyers L, Gott M. Exploring the financial impact of caring for family members receiving palliative and end-of-life care: a system- atic review of the literature. Palliat Med 2014;28:375e390.
  4. Rowland C, Hanratty B, Pilling M, van den Berg B, Grande G. The contributions of family care-givers at end of life: a national post-bereavement census survey of cancer carers hours of care and expenditures. Palliat Med 2017;31: 346e355.
  5. Goren A, Gilloteau I, Lees M, daCosta DiBonaventura M. Quantifying the burden of informal caregiving for patients with cancer in Europe. Support Care Cancer 2014;22: 1637e1646.
  6. Rumpold T, Schur S, Amering M, et al. Informal care- givers of advanced-stage cancer patients: every second is at risk for psychiatric morbidity. Support Care Cancer 2016; 24:1975e1982.
  7. Andrews SC. Caregiver burden and symptom distress in people with cancer receiving hospice care. Oncol Nurs Forum 2001;28:1469e1474.
  8. Kurtz ME, Kurtz JC, Given CW, Given B. Relationship of caregiver reactions and depression to cancer patients' symp- toms, functional states and depression-a longitudinal view. Soc Sci Med 1995;40:837e846.
  9. Lee KC, Chang WC, Chou WC, et al. Longitudinal changes and predictors of caregiving burden while providing end-of-life care for terminally ill cancer patients. J Palliat Med 2013;6:632e637.
  10. Kim Y, Loscalzo MJ, Wellisch DK, Spillers RL. Gender differences in caregiving stress among caregivers of cancer survivors. PsychoOncol 2006;15:1086e1092.
  11. Fletcher B, Miaskowski C, Given B, Schumacher K. The cancer family caregiving experience: an updated and expanded conceptual model. Eur J Oncol Nurs 2012;16: 387e398.
  12. Given B, Wyatt G, Given C, et al. Burden and depression among caregivers of patients with cancer at the end of life. Oncol Nurs Forum 2004;31:1105e1117.
  13. Grunfeld E, Coyle D, Whelan T, et al. Family caregiver burden: results of a longitudinal study of breast cancer pa- tients and their principal caregivers. CMAJ 2004;170: 1795e1801.
  14. Lyons KS, Bennett JA, Nail LM, et al. The role of patient pain and physical function on depressive symptoms in cou- ples with lung cancer: a longitudinal dyadic analysis. J Fam Psychol 2014;28:692e700.
  15. Tang ST, Chang WC, Chen JS, et al. Course and predic- tors of depressive symptoms among caregivers of terminally ill cancer patients until their death. PsychoOncol 2013;22: 1312e1318.
  16. Northouse LL, Mood D, Kershaw T, et al. Quality of life of women with recurrent breast cancer and their family members. J Clin Oncol 2002;20:4050e4064.
  17. Tang ST, Li CY, Chen CCH. Trajectory and determinants of the quality of life of caregivers of terminally ill cancer pa- tients in Taiwan. Qual Life Res 2008;17:387e395.
  18. Sutradhar R, Atzema C, Seow H, et al. Is performance status associated with symptom scores? A population-based longitudinal study among cancer outpatients. J Palliat Care 2014;30:99e107.
  19. Reese JB, Blackford A, Sussman J, et al. Cancer patients' function, symptoms and supportive care needs: a latent class analysis across cultures. Qual Life Res 2015;24:135e146.
  20. Buckner TW, Wang J, DeWalt DA, et al. Patterns of symp- toms and functional impairments in children with cancer. Pediatr Blood Cancer 2014;61:1282e1288.
  21. Wen FH, Chen JS, Chou WC, et al. Distinct patterns of conjoint symptom distress and functional impairment in the last year of life predict terminally ill cancer patients' sur- vival. J Pain Symptom Manage 2018;55:1443e1451.
  22. Wen FH, Chen JS, Chou WC, et al. Quality of life and psychological distress are differentially associated with distinct symptom-functional states in terminally ill cancer pa- tients' last year of life. Psychooncology 2018;27:2111e2118.
  23. Lo C, Hales S, Braun M, et al. Couples facing advanced cancer: examination of an interdependent relational system. PsychoOncol 2013;22:2283e2290.
  24. Ko SC, Chou WC, Hou MM, et al. Changes in and modi- fiable patient-and family caregiver-related factors associated with cancer patients' high self-perceived burden to others at the end of life: a longitudinal study. Eur J Cancer Care. Epub 01 October 2018. https://doi.org/10.1111/ecc.12942. · DOI
  25. McCorkle R, Young K. Development of a symptom distress scale. Cancer Nurs 1978;1:373e378.
  26. Benoliel JQ, McCorkle R, Young K. Development of a so- cial dependency scale. Res Nurs Health 1980;3:3e10.
  27. Given CW, Given B, Stommel M, et al. The Caregiver Re- action Assessment (CRA) for caregivers to persons with chronic physical and mental impairments. Res Nurs Health 1992;15:271e283.
  28. Weitzner MA, Jacobsen PB, Wagner H Jr, Friedland J, Cox C. The Caregiver Quality of Life Index-Cancer (CQOLC) Scale: development and validation of an instru- ment to measure quality of life of the family caregiver of pa- tients with cancer. Qual Life Res 1999;8:55e63.
  29. Radloff LS. The CES-D: scale a self-report depression scale for researching the general population. Appl Psychol Meas 1977;1:385e401.
  30. Tate RL, Pituch KA. Multivariate hierarchical linear modeling in randomized field experiments. J Experience Educ 2007;75:317e337.
  31. Garson GD. Introductory guide to HLM with HLM 7 software. In: Garson GD, ed. Hierarchical Linear Modeling: Guide and Applications. Los Angeles, CA: SAGE, 2013: 55e96.
  32. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical co- morbidity index for use with ICD-9-CM administrative data- bases. Clin Epidemiol 1992;45:613e619.
  33. Axelsson B, Sj€ od en PO. Quality of life of cancer patients and their spouses in palliative home care. Palliat Med 1998; 12:29e39.
  34. Burridge LH, Barnett AG, Clavarino AM. The impact of perceived stage of cancer on carers' anxiety and depression during the patients' final year of life. PsychoOncol 2009;18: 615e623.

Cited by

Sorted by citations

Authors
Wen, F.-H., Chen, J.-S., Chou, W.-C., Chang, W.-C., Shen, W. C., Hsieh, C.-H., & Tang, S. T.
Affiliations
  • Soochow University (TW)
  • Chang Gung University (TW)
Corresponding author
Tang, Siew Tzuh
ORCID
Venue
Journal of Pain and Symptom Management
Publisher
Elsevier BV
Published
2019-01
Volume
57
Issue
1
Pages
64-72
ISSN
0885-3924 (ISSN-L)
DOI
10.1016/j.jpainsymman.2018.09.009
OpenAlex
W2894195636
Cited by
45
References
6
Citations by year
2026: 2 · 2025: 3 · 2024: 6 · 2023: 7 · 2022: 8 · 2021: 7 · 2020: 10 · 2019: 1 · 2018: 1
FWCI
4.55
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Pain and Symptom Management (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Ministerio de Ciencia y Tecnología
  • National Health Research Institutes (NHRI-EX107-10704PI)
  • Chang Gung Memorial Hospital (BMRP888)
  • Ministry of Science and Technology of the People's Republic of China (104-2314-B-182-027-MY3)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords
family caregivers, caregiver quality of life, depressive symptoms, terminal cancer patients, symptom distress, functional disability, end-of-life care, patient-caregiver dyads, last six months of life
MeSH terms
Depression, Disability Evaluation, Family, Female, Humans, Longitudinal Studies, Male, Middle Aged, Neoplasms, Quality of Life, Stress, Psychological, Caregivers, Cost of Illness, Terminally Ill

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