Sherwood Paula R, Price Thomas J, Weimer Jason, Ren Dianxu, Donovan Heidi S, Given Charles W, Given Barbara A, Schulz Richard, Prince Jennifer, Bender Catherine, Boele Florien W, Marsland Anna L
School of Nursing, University of Pittsburgh, 336 Victoria Bldg, 3500 Victoria St., Pittsburgh, PA, 15261, USA.
Department of Family Medicine, Michigan State University, Clinical Ctr, Tower B, 788 Service Road, Room B120, East Lansing, MI, 48824, USA.
J Neurooncol. 2016 May;128(1):109-118. doi: 10.1007/s11060-016-2083-3. Epub 2016 Feb 23.
Prolonged periods of family caregiving can induce stress levels that may negatively influence caregiver health. However, the physiologic effect of psychological distress in oncology family caregivers has received little attention. Therefore we aimed to determine longitudinal profiles of inflammatory cytokines (IL-6 and IL-1ra) in neuro-oncology caregivers and identify associations between psychological distress and cytokine levels. Depressive symptoms, anxiety, caregiver burden and blood were collected from 108 adult caregivers at adult patients' diagnosis, 4-, 8-, and 12-months. Trajectory analyses of log transformed cytokine levels were performed. Multiple logistic regression analyses evaluated the impact of psychological distress on cytokine levels. For both cytokines, two distinct populations were identified, neither of which changed over time. High IL-1ra was associated with male caregivers with anxiety (OR = 1.7; 95 %CI 1.06-2.83) and obese caregivers (BMI = 40) who felt burdened due to disrupted schedules (OR = 1.3; 95 %CI 1.02-1.77). Conversely, caregivers with a healthy weight (BMI = 25) who felt burdened due to disrupted schedules were less likely to have high IL-1ra (OR = 0.71; 95 %CI 0.54-0.92). Caregivers ≤30 years old with lower self-esteem from caregiving were 1.16 times (95 %CI 1.04-1.30) more likely to have high IL-6. Analysis demonstrated groups of family caregivers with high and low levels of systemic inflammation and these levels did not change longitudinally over the care trajectory. Poor physical health in family caregivers may have a negative impact on the burden placed on the healthcare system in general and on the well-being of neuro-oncology patients in particular.
长期的家庭护理会导致压力水平升高，这可能会对护理者的健康产生负面影响。然而，肿瘤学家庭护理者心理困扰的生理影响却很少受到关注。因此，我们旨在确定神经肿瘤护理者炎症细胞因子（IL-6和IL-1ra）的纵向变化情况，并确定心理困扰与细胞因子水平之间的关联。在成年患者确诊时、4个月、8个月和12个月时，收集了108名成年护理者的抑郁症状、焦虑、护理负担和血液样本。对经对数转换的细胞因子水平进行轨迹分析。多元逻辑回归分析评估了心理困扰对细胞因子水平的影响。对于这两种细胞因子，均识别出两个不同的群体，且这两个群体随时间均无变化。高IL-1ra水平与伴有焦虑的男性护理者（OR = 1.7；95%CI 1.06 - 2.83）以及因日程安排被打乱而感到负担沉重的肥胖护理者（BMI = 40）相关（OR = 1.3；95%CI 1.02 - 1.77）。相反，因日程安排被打乱而感到负担沉重但体重正常（BMI = 25）的护理者，其IL-1ra水平较高的可能性较小（OR = 0.71；95%CI 0.54 - 0.92）。年龄≤30岁且因护理导致自尊较低的护理者，其IL-6水平较高的可能性是其他人的1.16倍（95%CI 1.04 - 1.30）。分析表明，家庭护理者存在全身炎症水平高和低的不同群体，且这些水平在护理过程中纵向未发生变化。家庭护理者的身体健康状况不佳可能会对整个医疗系统造成的负担产生负面影响，尤其会对神经肿瘤患者的福祉产生负面影响。
