Caregiving burden, stress, and health effects among family caregivers of adult cancer patients.

Unlike professional caregivers such as physicians and nurses, informal caregivers, typically family members or friends, provide care to individuals with a variety of conditions including advanced age, dementia, and cancer. This experience is commonly perceived as a chronic stressor, and caregivers often experience negative psychological, behavioral, and physiological effects on their daily lives and health. In this report, we describe the experience of a 53-year-old woman who is the sole caregiver for her husband, who has acute myelogenous leukemia and was undergoing allogeneic hematopoietic stem cell transplantation. During his intense and unpredictable course, the caregiver's burden is complex and complicated by multiple competing priorities. Because caregivers are often faced with multiple concurrent stressful events and extended, unrelenting stress, they may experience negative health effects, mediated in part by immune and autonomic dysregulation. Physicians and their interdisciplinary teams are presented daily with individuals providing such care and have opportunity to intervene. This report describes a case that exemplifies caregiving burden and discusses the importance of identifying caregivers at risk of negative health outcomes and intervening to attenuate the stress associated with the caregiving experience.

[1]  R. Schulz,et al.  Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. , 1999, JAMA.

[2]  J. Fries,et al.  The Patient-Reported Outcomes Measurement Information System (PROMIS): Progress of an NIH Roadmap Cooperative Group During its First Two Years , 2007, Medical care.

[3]  K. Schumacher,et al.  Symptom experience of family caregivers of patients with cancer. , 2008, Oncology Nursing Forum.

[4]  Andrew P. Smith,et al.  Psychological stress and susceptibility to the common cold. , 1991, The New England journal of medicine.

[5]  D. Fairclough,et al.  Understanding Economic and Other Burdens of Terminal Illness: The Experience of Patients and Their Caregivers , 2000, Annals of Internal Medicine.

[6]  Esther M. Sternberg,et al.  Elevated Neuroimmune Biomarkers in Sweat Patches and Plasma of Premenopausal Women with Major Depressive Disorder in Remission: The POWER Study , 2008, Biological Psychiatry.

[7]  Brandon G. King,et al.  Intensive meditation training, immune cell telomerase activity, and psychological mediators , 2011, Psychoneuroendocrinology.

[8]  G. Chrousos,et al.  Interactions of the circadian CLOCK system and the HPA axis , 2010, Trends in Endocrinology & Metabolism.

[9]  L. Williams Whatever it takes: informal caregiving dynamics in blood and marrow transplantation. , 2007, Oncology nursing forum.

[10]  Joshua Hauser,et al.  Supporting family caregivers at the end of life: "they don't know what they don't know". , 2004, JAMA.

[11]  S. Bhatia,et al.  Discharge and unscheduled readmissions of adult patients undergoing hematopoietic stem cell transplantation: implications for developing nursing interventions. , 2005, Oncology nursing forum.

[12]  P. Björntorp,et al.  Neuroendocrine abnormalities in visceral obesity , 2000, International Journal of Obesity.

[13]  T. Phillips Multi-analyte analysis of biological fluids with a recycling immunoaffinity column array. , 2001, Journal of biochemical and biophysical methods.

[14]  R. Holle,et al.  Salivary cortisol in a middle-aged community sample: results from 990 men and women of the KORA-F3 Augsburg study. , 2010, European journal of endocrinology.

[15]  L. Jonasson,et al.  Inflammation and cortisol response in coronary artery disease , 2009, Annals of medicine.

[16]  C. Bennett,et al.  Lack of caregivers limits use of outpatient hematopoietic stem cell transplant program , 2002, Bone Marrow Transplantation.

[17]  S. Salloway,et al.  EVIDENCE FOR THE VALIDITY OF THE AMERICAN MEDICAL ASSOCIATION'S CAREGIVER SELF‐ASSESSMENT QUESTIONNAIRE AS A SCREENING MEASURE FOR DEPRESSION , 2010, Journal of the American Geriatrics Society.

[18]  B. Given,et al.  Depression and physical health among family caregivers of geriatric patients with cancer--a longitudinal view. , 2004, Medical science monitor : international medical journal of experimental and clinical research.

[19]  C. Kirschbaum,et al.  Decreased hair cortisol concentrations in generalised anxiety disorder , 2011, Psychiatry Research.

[20]  C. Kirschbaum,et al.  Salivary alpha-amylase stress reactivity across different age groups. , 2010, Psychophysiology.

[21]  Rosanna Abbate,et al.  Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. , 2010, The American journal of clinical nutrition.

[22]  Andrew H. Miller,et al.  Cytokine-effects on glucocorticoid receptor function: Relevance to glucocorticoid resistance and the pathophysiology and treatment of major depression , 2007, Brain, Behavior, and Immunity.

[23]  P. Vitaliano,et al.  Is caregiving hazardous to one's physical health? A meta-analysis. , 2003, Psychological bulletin.

[24]  B. Given,et al.  Guiding research in family care: a new approach to oncology caregiving , 2008, Psycho-oncology.

[25]  R. Schulz,et al.  Family Caregivers' Strains , 2008, Journal of aging and health.

[26]  G. Wallen,et al.  Distress screening in allogeneic hematopoietic stem cell (HSCT) caregivers and patients , 2011, Psycho-oncology.

[27]  G. Colditz,et al.  Caregiving and risk of coronary heart disease in U.S. women: a prospective study. , 2003, American journal of preventive medicine.

[28]  E. Epel,et al.  Accelerated telomere shortening in response to life stress. , 2004, Proceedings of the National Academy of Sciences of the United States of America.

[29]  M. Bevans,et al.  The symptom experience in the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT) , 2008, Supportive Care in Cancer.

[30]  J. Luce,et al.  Chemotherapy-induced vomiting in women treated for breast cancer. , 2004, Oncology nursing forum.

[31]  Maria L. Jibaja-Weiss,et al.  Caregiver symptom burden: The risk of caring for an underserved patient with advanced cancer , 2011, Cancer.

[32]  D. Hellhammer,et al.  The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders , 2000, Psychoneuroendocrinology.

[33]  J. Kiecolt-Glaser,et al.  Stress-induced immune dysfunction: implications for health , 2005, Nature Reviews Immunology.

[34]  Survival of Patients who have Undergone Allogeneic Bone Marrow Transplantation , 2005 .

[35]  Steve W. Cole,et al.  Neuroendocrine modulation of cancer progression , 2009, Brain, Behavior, and Immunity.

[36]  J. Beaumont,et al.  Late effects of cancer and hematopoietic stem-cell transplantation on spouses or partners compared with survivors and survivor-matched controls. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[37]  J. Thayer,et al.  Neural aspects of immunomodulation: Focus on the vagus nerve , 2010, Brain, Behavior, and Immunity.

[38]  J. Kiecolt-Glaser,et al.  Immune Dysregulation and Chronic Stress among Older Adults: A Review , 2008, Neuroimmunomodulation.

[39]  Cornelia M Ruland,et al.  Review of the literature on the effects of caring for a patient with cancer , 2010, Psycho-oncology.

[40]  D. Lucini,et al.  Evidence of autonomic dysregulation in otherwise healthy cancer caregivers: a possible link with health hazard. , 2008, European journal of cancer.

[41]  Lixin Song,et al.  Interventions with Family Caregivers of Cancer Patients: Meta‐Analysis of Randomized Trials , 2010, CA: a cancer journal for clinicians.

[42]  E. Sternberg Neural regulation of innate immunity: a coordinated nonspecific host response to pathogens , 2006, Nature Reviews Immunology.

[43]  S. Lebel,et al.  The experience of caregivers of hematological cancer patients undergoing a hematopoietic stem cell transplant: a comprehensive literature review , 2011, Psycho-oncology.

[44]  B. Mausbach,et al.  Increased Framingham Coronary Heart Disease Risk Score in Dementia Caregivers Relative to Non-Caregiving Controls , 2008, Gerontology.

[45]  C. Carver,et al.  Benefit Finding in the Cancer Caregiving Experience , 2007, Psychosomatic medicine.

[46]  G. Macfarlane,et al.  A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers. , 2005, Social science & medicine.

[47]  I. Christie,et al.  Measurement of cytokines in sweat patches and plasma in healthy women: validation in a controlled study. , 2006, Journal of immunological methods.

[48]  B. Mausbach,et al.  Effects of Alzheimer Caregiving on Allostatic Load , 2011, Journal of health psychology.

[49]  G. Miller,et al.  Biologic cost of caring for a cancer patient: dysregulation of pro- and anti-inflammatory signaling pathways. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[50]  B. McEwen,et al.  Allostatic load biomarkers of chronic stress and impact on health and cognition , 2010, Neuroscience & Biobehavioral Reviews.