Unmet needs hurt emotional wellbeing of caregivers of cancer patients

Having unmet daily needs harms the emotional state of family cancer caregivers (FCC), especially during the intermediate and chronic treatment phases of the disease, according to a recent Singapore study.

“This study highlights the vulnerability and risk of unmet needs and negative emotional states in FCCs during critical periods of their care recipient’s cancer journey,” the researchers said. “Although causal links and directions are still unclear, the study highlights the need for greater attention to FCCs needs.”

The cross-sectional study included 237 FCCs of patients in ambulatory cancer clinics at the National University Cancer Institute Singapore. Participants were made to complete sociodemographic and medical questionnaires, as well as validated measures of emotional outcomes such as the Depression Anxiety Stress Scale (DASS-21) and Needs Assessment of Family Caregivers-Cancer (NAFC-C) Scale.

FCC participants were distributed across four treatment phases of their care recipients: <6 months (n=77), 6–9 months (n=42), >9 months (n=34), and completed treatment (n=84). One-way analysis of variance showed  no significant differences in the FCCs’ personal needs and DASS-21 outcomes across these groups. [PLoS One 2021;16:e0255901]

Hierarchical linear regression was then performed to assess the impact of each predictor at each step of the analysis of DASS total score, depression, anxiety, and stress. The first step included only the sociodemographic covariates and revealed that the participants’ characteristics were unrelated to DASS-21 scores. The only exception was age, such that those aged 51–60 years were more likely to report anxiety than counterparts aged 21–30 (b, 1.45; p=0.042).

The variables of interest such as personal care, role management, and treatment phase of the care recipient were all included in the second regression step.

The addition of these variables led to a significant model change for DASS total score (R² change, 0.19; p<0.001), as well as for its depression (R² change, 0.19; p<0.001), anxiety (R² change, 0.13; p<0.001), and stress (R² change, 0.18; p<0.001) subscales.

According to the researchers, such changes indicated that having greater unmet personal care needs correlated with higher DASS-21 scores. In particular, unmet needs heightened stress in caregivers whose recipients had been undergoing treatment for 6–9 vs <6 months, and aggravated both stress and anxiety in those with care recipients under treatment for >9 vs <6 months. In both cases, DASS-21 total scores were likewise elevated.

“Our data raises several implications for clinicians and healthcare administration. First, given that the intermediate treatment phase is critical for a healthy mental state, there is an immediate need to promote or encourage FCCs to allocate some personal time for themselves before the burden and distress accumulates and transfers into the chronic stage,” the researchers said.

Moreover, physicians could also informally assess caregiver wellbeing during their patient visits and help introduce them to strategies and potential interventions to alleviate distress.

“Lastly, it is important to emphasize the need for FCCs to prioritize self-care and learn to identify and attend to their own needs during the caregiving journey,” the researchers added.