Interventions to improve outcomes for caregivers of patients with advanced cancer: a meta-analysis
Open accessAbstract
BACKGROUND: Family caregivers of patients with advanced cancer often have poor quality of life (QOL) and mental health. We examined the effectiveness of interventions offering support for caregivers of patients with advanced cancer on caregiver QOL and mental health outcomes. METHODS: We searched Ovid MEDLINE, EMBASE, Cochrane CENTRAL, and Cumulative Index to Nursing and Allied Health Literature databases from inception through June 2021. Eligible studies reported on randomized controlled trials for adult caregivers of adult patients with advanced cancer. Meta-analysis was conducted for primary outcomes of QOL, physical well-being, mental well-being, anxiety, and depression, from baseline to follow-up of 1-3 months; secondary endpoints were these outcomes at 4-6 months and additional caregiver burden, self-efficacy, family functioning, and bereavement outcomes. Random effects models were used to generate summary standardized mean differences (SMD). RESULTS: Of 12 193 references identified, 56 articles reporting on 49 trials involving 8554 caregivers were eligible for analysis; 16 (33%) targeted caregivers, 19 (39%) patient-caregiver dyads, and 14 (29%) patients and their families. At 1- to 3-month follow-up, interventions had a statistically significant effect on overall QOL (SMD = 0.24, 95% confidence interval [CI] = 0.10 to 0.39); I2 = 52.0%), mental well-being (SMD = 0.14, 95% CI = 0.02 to 0.25; I2 = 0.0%), anxiety (SMD = 0.27, 95% CI = 0.06 to 0.49; I2 = 74.0%), and depression (SMD = 0.34, 95% CI = 0.16 to 0.52; I2 = 64.4) compared with standard care. In narrative synthesis, interventions demonstrated improvements in caregiver self-efficacy and grief. CONCLUSIONS: Interventions targeting caregivers, dyads, or patients and families led to improvements in caregiver QOL and mental health. These data support the routine provision of interventions to improve well-being in caregivers of patients with advanced cancer.
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NPIs designed for both patients and caregivers often focus primarily on patients' needs, whereas caregivers receive less attention.
“NPIs designed for both patients and caregivers often focus primarily on patients' needs, whereas caregivers receive less attention. 25”
From Nonpharmacologic interventions for managing distress, anxiety, and depression for patients with cancer and their family caregivers: A systematic review and meta‐analysis (2026) · cites this paper as [25]
The introductory passage (indexed under Abstract > Conclusions; page unavailable) says that patient-centered care has led to unintended neglect of caregivers. The Methods distinguish interventions for patient–caregiver dyads from those directed at patients, but the paper does not say that interventions designed for both typically prioritize patients’ needs. (LLM, conf=0.85)
Experimental — accuracy not yet measuredInterventions specifically addressing the needs of advanced LC caregivers in the outpatient setting remain limited.
“While numerous interventions have been tested for cancer caregivers, interventions specifically addressing the needs of advanced LC caregivers in the outpatient setting remain limited.21”
From Multisite Randomized Controlled Trial of CareSTEPS: A Supportive Care Intervention for the Family Caregivers of Patients With Advanced Lung Cancer (2024) · cites this paper as [21]
The effect sizes for CareSTEPS are comparable to and exceed those reported in the broader literature on cancer caregivers.
“These effect sizes are comparable to and exceed those reported in the broader literature on cancer caregivers,21,40”
From Multisite Randomized Controlled Trial of CareSTEPS: A Supportive Care Intervention for the Family Caregivers of Patients With Advanced Lung Cancer (2024) · cites this paper as [21]
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Family Care before and after Bereavement
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“21 This highlights a signi fi cant gap in interventions tailored to the unique challenges faced by this group, who are managing palliative treatment rather than end-of-life care.”
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Self-citationCentering patients with advanced cancer includes supporting their caregivers
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“17,18 25 Although the number of randomized clinical trials (RCTs) has increased notably over the past 20 years, findings have been inconsistent because heterogeneity of NPIs, modes of delivery, and assessment time points.”
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- Authors
- Chow, R., Mathews, J. J., Cheng, E. Y., Lo, S., Wong, J., Alam, S., Hannon, B., Rodin, G., Nissim, R., Hales, S., Kavalieratos, D., Quinn, K. L., Tomlinson, G., & Zimmermann, C.
- Affiliations
- University Health Network (CA)
- Queen's University (CA)
- Sobell House (GB)
- Emory University (US)
- University of Toronto (CA)
- Corresponding author
- Zimmermann, Camilla
- ORCID
- Venue
- JNCI: Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2023-06-05
- Volume
- 115
- Issue
- 8
- Pages
- 896-908
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- PMC
- PMC10407714
- OpenAlex
- W4379598345
- Cited by
- 98
- References
- 102
- Citations by year
- 2026: 31 · 2025: 33 · 2024: 29 · 2023: 5
- FWCI
- 4.94
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (152996)
- Harold and Shirley Lederman Chair in Psychosocial Oncology and Palliative Care
- Chair among the University of Toronto, Princess Margaret Cancer Centre
- University Health Network
- Princess Margaret Cancer Foundation
- Topics
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- family caregivers, advanced cancer, caregiver interventions, quality of life, mental health, anxiety, depression, caregiver burden, self-efficacy, grief, patient-caregiver dyads, bereavement
- MeSH terms
- Adult, Anxiety, Humans, Mental Health, Neoplasms, Quality of Life, Caregivers
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