Factors associated with depressive symptoms in cancer family caregivers of patients receiving chemotherapy.

As cancer in the USA transitions to a disease trajectory similar to other chronic illnesses, care has moved to outpatient settings where patients and their families are responsible for day-to-day management and treatment-related side effects [1]. The family member or friend who assumes the role of caregiver has little opportunity to acclimate to their new responsibilities, personal response to the diagnosis, or the healthcare system [2]. The caregiver’s focus and the primary focus of treatment is the patient [3, 4]. Our understanding of cancer family caregivers’ needs and consequences has grown in recent years as more research has been directed toward this population [5, 6]. The physical and psychological impact of cancer family caregiving is significant with many associated negative outcomes including depression, anxiety, decreased quality of life, fatigue, sleep disturbance, pain, and decline in health status [7–10]. In some studies, cancer family caregivers were found to have worse psychological and quality of life outcomes than the patients for whom they cared [7, 11, 12]. Depression has been widely studied in cancer family caregivers. Several factors have been associated with increased risk of depression related both to the cancer family caregiver and the care recipient. Commonly reported associations include female gender, younger age, spousal relationship to care recipient, high perceived caregiver burden, high impact of caregiving on schedule and finances, familial conflict, poor patient performance status, a longer time since diagnosis, lung cancer diagnosis, and palliative treatment intent [13–20]. Many of these reports were generated from cancer caregiver research samples predominately composed of people of white race, female gender, and those caring for patients with a variety of cancers. As cancer treatment and prognosis have improved, the disease has begun to be reframed within the chronic illness model. The Institute of Medicine’s Cancer Control Continuum includes prevention, early detection, diagnosis, treatment, survivorship, and end of life [21]. These phases are marked by unique experiences for both patients and caregivers, often with distinct stressors and needs. Current caregiver literature does not include longitudinal assessment of the caregiver experience across all phases of the cancer trajectory; most longitudinal studies include few time points or short periods of data collection [7, 8, 13, 17]. Until longitudinal studies across the cancer trajectory exist, it is of value to focus research within distinct phases so as to capture aspects of the caregiver experience unique to particular phases [5]. Phasespecific research informs interventions designed to meet caregiver needs throughout the cancer trajectory and ultimately will help clinicians identify caregivers at high risk for untoward consequences and offer timely psychosocial support [22, 23]. The purpose of our secondary analysis was to describe levels of depressive symptoms among a cohort of cancer family caregivers during a specific phase along the cancer trajectory, namely, curative treatment, and identify how caregiver characteristics relate to caregiver depressive symptoms. Our study adds to the existing literature because of the relatively sizeable number of men represented, participation by those who identify as having Latino ethnicity, as well as restriction to caregivers for patients with lung or colon cancer receiving chemotherapy with curative intent. A. Williams (*) Frank H. Netter MD School of Medicine, Quinnipiac University, 275 Mount Carmel Road, Hamden, CT 06518, USA e-mail: anna-leila.williams@quinnipiac.edu