Mahmood Asos, Kim Hyunmin, Kedia Satish, Boykins Alexandria, Goldsmith Joy V
Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
Department of Medicine-General Internal Medicine, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA.
Support Care Cancer. 2025 Jan 7;33(2):75. doi: 10.1007/s00520-024-09133-7.
There are over 18 million cancer survivors in the U.S., with a projected increase of 24.4% over the next decade. Currently, little is known about the relationship between a cancer survivor's caregiving responsibility and their psychological distress. This study examines whether cancer survivors who assume the role of informal caregivers (surviving caregivers) experience greater psychological distress than cancer survivors without caregiving responsibilities.
Data were drawn from the National Cancer Institute's Health Information National Trends Survey (HINTS5, Cycles 1 through 4, 2017-2020). The analytical sample included 2,579 U.S. cancer survivors. Caregiving responsibility was self-reported, and psychological distress was assessed through the Patient Health Questionnaire-4 (PHQ-4). Accounting for the complex design features of HINTS and jackknife replicate weights, a multivariable multinomial logistic regression model was fit to compute adjusted odds ratios (aORs) and their associated 95% confidence intervals (CIs).
Overall, 19.3% of cancer survivors had mild psychological distress, and 10.9% had moderate to severe psychological distress. Approximately 19.1% of the cancer survivors self-reported caregiving responsibilities. Compared to cancer survivors with no caregiving responsibilities, surviving caregivers had more than twofold greater odds of experiencing mild (aOR = 2.25; 95% CI: 1.17, 4.29) and moderate to severe (aOR = 2.18; 95% CI: 1.07, 4.46) psychological distress. Other factors associated with greater psychological distress among cancer survivors included female sex, lower perceived health status, and having one or more chronic diseases.
Our findings indicate that caregiving among cancer survivors has a substantial adverse impact on their mental and emotional well-being. Cancer surviving caregivers are a distinct subgroup that navigates both survivorship and caregiving burdens at the same time. There is a need to identify and develop tailored interventions, programs, and resources for this vulnerable group of cancer survivors.
美国有超过1800万癌症幸存者，预计在未来十年将增加24.4%。目前，对于癌症幸存者的护理责任与其心理困扰之间的关系知之甚少。本研究旨在探讨承担非正式护理者角色的癌症幸存者（幸存护理者）是否比没有护理责任的癌症幸存者经历更大的心理困扰。
数据来自美国国立癌症研究所的健康信息国家趋势调查（HINTS5，2017 - 2020年第1至4轮）。分析样本包括2579名美国癌症幸存者。护理责任通过自我报告获得，心理困扰通过患者健康问卷 - 4（PHQ - 4）进行评估。考虑到HINTS的复杂设计特征和折刀法重复权重，拟合了多变量多项逻辑回归模型以计算调整后的优势比（aORs）及其相关的95%置信区间（CIs）。
总体而言，19.3%的癌症幸存者有轻度心理困扰，10.9%有中度至重度心理困扰。约19.1%的癌症幸存者自我报告有护理责任。与没有护理责任的癌症幸存者相比，幸存护理者经历轻度（aOR = 2.25；95% CI：1.17，4.29）和中度至重度（aOR = 2.18；95% CI：1.07，4.46）心理困扰的几率高出两倍多。与癌症幸存者中更大心理困扰相关的其他因素包括女性、较低的感知健康状况以及患有一种或多种慢性病。
我们的研究结果表明，癌症幸存者中的护理工作对其心理和情感健康有重大不利影响。癌症幸存护理者是一个独特的亚组，同时承受着生存和护理的负担。有必要为这一脆弱的癌症幸存者群体确定并开发量身定制的干预措施、项目和资源。
