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Cited by 526Nursing care and researchCancer survivorship and careAttachment and Relationship Dynamics

Hidden morbidity in cancer: spouse caregivers

Open access
Braun, Michal, Mikulincer, Mario, Rydall, Anne, Walsh, Andrew, Rodin, Gary·2007·Journal of Clinical Oncology
DOI 10.1200/jco.2006.10.0909
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Abstract

PURPOSE: This study assesses psychological distress among advanced cancer patients and their spouse caregivers, while examining the relative contribution of caregiving burden and relational variables (attachment orientation and marital satisfaction) to depressive symptoms in the spouse caregivers. METHODS: A total of 101 patients with advanced GI or lung cancer and their spouse caregivers were recruited for the study. Measures included Beck Depression Inventory-II (BDI-II), Caregiving Burden scale, Experiences in Close Relationships scale, and ENRICH Marital Satisfaction scale. RESULTS: A total of 38.9% of the caregivers reported significant symptoms of depression (BDI-II > or = 15) compared with 23.0% of their ill spouses (P < .0001). In a hierarchical regression predicting caregiver's depression, spouse caregiver's age and patient's cancer site were entered in the first step, objective caregiving burden was entered in the second step, subjective caregiving burden was entered in the third step, caregiver's attachment scores were entered in the fourth step, and caregiver's marital satisfaction score was entered in the fifth step. The final model accounted for 37% of the variance of caregiver depression, with subjective caregiving burden (beta = .38; P < .01), caregiver's anxious attachment (beta = .21; P < .05), caregiver's avoidant attachment (beta = .20; P < .05), and caregiver's marital satisfaction (beta = -.18; P < .05) making significant contributions to the model. CONCLUSION: Spouse caregivers of patients with advanced cancer are a high-risk population for depression. Subjective caregiving burden and relational variables, such as caregivers' attachment orientations and marital dissatisfaction, are important predictors of caregiver depression.

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  • Family caregivers of cancer patients exhibit high levels of stress and depression, lower subjective well-being, worse physical health, and higher mortality compared to non-caregivers.

    “Family caregivers of cancer patients exhibit high levels of stress and depression, lower subjective well-being, worse physical health, and higher mortality compared to non-caregivers [2–8, 19–25], yet few studies focus on improving outcomes for caregivers [26].”

    From Being present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers (2018) · cites this paper as [2]

    The Introduction says spouse caregivers of cancer patients are adversely affected physically and psychologically, and the Discussion reports clinically significant depressive symptoms in almost 40% of spouse caregivers of patients with advanced cancer. The paper does not establish lower subjective well-being, worse physical health, or higher mortality compared with non-caregivers; its depression comparison is with patients, not non-caregivers. The indexed passages provide section labels but no page numbers. (LLM, conf=0.87)

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  • A cancer diagnosis is associated with high levels of distress, leading to frequent anxiety, depression, fear of recurrence/progression, sleep disturbance, and fatigue in both patients and caregivers.

    “A cancer diagnosis is associated with high levels of distress, leading to frequent anxiety, depression, fear of recurrence/progression, sleep disturbance, and fatigue in both patients and caregivers [1–8].”

    From Being present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers (2018) · cites this paper as [2]

    The Introduction says cancer affects patients and their spouses and that spouse caregivers’ distress may be as high as patients’. The Discussion reports clinically significant depressive symptoms in almost 40% of spouse caregivers of patients with advanced cancer, compared with a lower prevalence in their partners. The paper does not establish frequent anxiety, fear of recurrence or progression, sleep disturbance, or fatigue in both groups; its mention of attachment anxiety is not evidence of frequent anxiety symptoms. (LLM, conf=0.87)

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  • The negative effects of caregiving, including a higher mortality rate, are most pronounced in caregivers of patients with advanced cancer, particularly when patients have a protracted disease course and are receiving palliative care.

    “Conversely, longer survival comes at a cost for caregivers: the negative effects of caregiving, including a higher mortality rate, are most pronounced in caregivers of patients with advanced cancer [2, 3, 20], particularly when patients have a protracted disease course [25] and are receiving palliative care [4, 21].”

    From Being present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers (2018) · cites this paper as [2]

    The Discussion (page not specified) reports a high prevalence of depression among spouse caregivers of patients with advanced cancer, supporting negative effects in that group. It does not establish that those effects are most pronounced in this group or report a higher caregiver mortality rate. The protracted-disease and palliative-care qualifications are attached to other citations in the citing sentence. (LLM, conf=0.87)

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  • Distress in caregivers contributes to distress in patients, in addition to negatively impacting the health of caregivers themselves, and likely other family members.

    “Distress in caregivers contributes to distress in patients [24], in addition to negatively impacting the health of caregivers themselves [2–4, 20, 21, 25], and likely other family members (e.g. many of our participants had young children).”

    From Being present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers (2018) · cites this paper as [2]

    The Introduction says that helping spouse caregivers may benefit patients and that spousal support can buffer patients’ distress. It does not establish the stronger claim attached to this citation—that caregivers’ distress itself contributes to patients’ distress. The statements about caregivers’ health and other family members have different citations or are the citing authors’ own observation. (LLM, conf=0.82)

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  • A metastatic cancer diagnosis is associated with high levels of distress in patients and caregivers.

    “A metastatic cancer diagnosis is associated with high levels of distress in patients and caregivers.”

    From Being present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers (2018) · cites this paper as [2]

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Cites

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Research works printed but not linked: 4

  1. Baider L, Cooper CL, De-Nour AK: Cancer and the Family (ed 2). New York, NY, John Wiley, 2000, pp 257-269
  2. Ainsworth MDS: Attachment and other affec- tional bonds across the life cycle, in Parkes CM, Stevenson-Hinde J, Marris P (eds): Attachment Across the Life Cycle. New York, NY, Routledge, 1991, pp 33-51
  3. Manne S: Cancer in the marital context: A review. Cancer Invest 16:188-202, 1998
  4. Fraley RC, Waller NG: Adult attachment pat- terns: A test of typological model, in Simpson JA, Rholes WS (eds): Attachment Theory and Close Relationships. New York, NY, Guilford Press, 1998, pp 77-114

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Authors
Braun, M., Mikulincer, M., Rydall, A., Walsh, A., & Rodin, G.
Affiliations
University Health Network (CA)
ORCID
Venue
Journal of Clinical Oncology
Publisher
American Society of Clinical Oncology (ASCO)
Published
2007-10-20
Volume
25
Issue
30
Pages
4829-4834
ISSN
  • 0732-183X (ISSN-L)
  • 1527-7755
DOI
10.1200/jco.2006.10.0909
OpenAlex
W2132645593
Cited by
526
References
58
Citations by year
2026: 7 · 2025: 8 · 2024: 26 · 2023: 20 · 2022: 32 · 2021: 30 · 2020: 41 · 2019: 30 · 2018: 35 · 2017: 26 · 2016: 30 · 2015: 32 · 2014: 40 · 2013: 44 · 2012: 43
FWCI
55.01
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Oncology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Princess Margaret Hospital Foundation
  • Canadian Institutes of Health Research
Topics
  • Health Sciences › Health Professions › Pharmacy › Nursing care and research
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
Keywords
spousal caregivers, caregiver depression, advanced cancer, caregiver burden, attachment orientation, marital satisfaction, gastrointestinal cancer, lung cancer, psychological distress, marital relationships
MeSH terms
Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Depression, Emotions, Female, Humans, Male, Middle Aged, Morbidity, Neoplasms, Palliative Care, Risk Factors, Terminal Care, Caregivers

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