Haj Mohammad N, Walter A W, van Oijen M G H, Hulshof M C C M, Bergman J J G H M, Anderegg M C J, van Berge Henegouwen M I, Henselmans I, Sprangers M A G, van Laarhoven H W M
Department of Medical Oncology, Academic Medical Center, University of Amsterdam, F4-222, Meibergdreef 9, PO box 22600, 1100 DD, Amsterdam, The Netherlands.
Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Support Care Cancer. 2015 Dec;23(12):3589-98. doi: 10.1007/s00520-015-2727-4. Epub 2015 Apr 18.
The aim of this study is to examine caregiver burden of spousal caregivers of patients with esophageal cancer after curative treatment with neoadjuvant chemoradiation followed by resection and to assess factors associated with caregiver burden.
In this exploratory, cross-sectional study, spousal caregivers and patients were eligible if the caregiver was the patient's spouse and the patient had been treated with chemoradiation followed by surgery after esophageal carcinoma diagnosis. Forty-seven couples were included. Spousal caregivers completed a questionnaire, examining caregivers' burden (Self-Perceived Pressure from Informal Care (SPPIC, Dutch)), caregiver unmet needs (SCNS-P&S), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), and marital satisfaction (Maudsley Marital Questionnaire (MMQ)). Patients completed the latter two questionnaires and a cancer specific quality of life questionnaire (EORTC-QLQ C30 and OES18 (oesophageal module). Logistic regression analysis was performed to identify correlates for caregiver burden.
The median time after esophagectomy was 38 months. Thirty-four percent of the spousal caregivers reported moderate or high burden. Spousal caregivers most frequently reported unmet needs were managing concerns about the cancer coming back (43%), dealing with others not acknowledging the impact on your life of caring for a person with cancer (38%), and balancing the needs of the person with cancer and one's own needs. A comparable proportion of spousal caregivers and patients showed symptoms of anxiety (23 vs 17%) and depression (17 vs 17%). Spousal caregivers reported significantly more dissatisfaction than patients on the marital scale (p < 0.01). Factors independently associated with higher caregiver burden were fatigue of the patient (OR = 1.66, 95% CI 1.12-2.47) and depression of the spousal caregiver (OR = 1.44, 95% CI 1.11-1.86).
More than a third of the spousal caregivers of patients with esophageal cancer treated with curative intent report moderate or high burden 3 years after treatment. Fatigue of the patient and depression of the spousal caregiver are associated with caregiver burden. To improve clinical care, identification of spousal caregivers at risk for experiencing higher caregiver burden and implementation of specific interventions is needed.
本研究旨在探讨新辅助放化疗后行手术切除的食管癌患者的配偶照顾者的照顾负担，并评估与照顾负担相关的因素。
在这项探索性横断面研究中，如果照顾者为患者的配偶且患者在食管癌诊断后接受了放化疗及手术治疗，则配偶照顾者和患者符合纳入标准。共纳入47对夫妇。配偶照顾者完成一份问卷，调查照顾者的负担（来自非正式照顾的自我感知压力（SPPIC，荷兰语））、照顾者未满足的需求（SCNS-P&S）、焦虑和抑郁（医院焦虑抑郁量表（HADS））以及婚姻满意度（莫兹利婚姻问卷（MMQ））。患者完成后两份问卷以及一份癌症特异性生活质量问卷（欧洲癌症研究与治疗组织生活质量问卷C30和OES18（食管模块））。进行逻辑回归分析以确定照顾负担的相关因素。
食管切除术后的中位时间为38个月。34%的配偶照顾者报告有中度或高度负担。配偶照顾者最常报告的未满足需求是处理对癌症复发的担忧（43%）、应对他人不承认照顾癌症患者对自己生活的影响（38%）以及平衡癌症患者的需求和自身需求。配偶照顾者和患者出现焦虑症状的比例相当（23%对17%），出现抑郁症状的比例也相当（17%对17%）。在婚姻量表上，配偶照顾者报告的不满明显多于患者（p<0.01）。与较高照顾负担独立相关的因素是患者的疲劳（OR=1.66，95%CI 1.12-2.47）和配偶照顾者的抑郁（OR=1.44，95%CI 1.11-1.86）。
超过三分之一的接受根治性治疗的食管癌患者的配偶照顾者在治疗3年后报告有中度或高度负担。患者的疲劳和配偶照顾者的抑郁与照顾负担相关。为改善临床护理，需要识别有较高照顾负担风险的配偶照顾者并实施特定干预措施。
