Cancer effects on the family

Cancer effects on the family

Cancer Effects On The Family

Introduction

Patients' preferences and economic considerations mean that most cancer patients receive their medical care as outpatients or within their own homes. The increasing reliance on informal carers to provide practical and emotional support has generated research into the demands and impact of the carer's role. This review considers the prevalence of psychological distress and psychiatric morbidity among carers, the factors related to distress and morbidity, and interventions designed to support carers.

Prevalence of psychiatric morbidity amongst carers—is there a problem?

Most cancer patients' carers adjust, but some report high levels of emotional distress or psychiatric morbidity (major depressive illness, anxiety or adjustment disorders.

Studies using self-report questionnaires have found that between 20 and 30% of carers are probable cases of psychiatric morbidity. Studies of patients with advanced disease or receiving palliative care report probable caseness rates amongst carers of between 30 and 50%.

The few studies that have used trained interviewers to administer standardised psychiatric interviews have found lower levels of morbidity (Baider 1998). These range from 10% amongst carers of newly diagnosed patients to 33% when patients are terminally ill.

Unfortunately, there are no period prevalence rates for affective disorders among carers that cover the lifetime of the patient's illness. Studies have usually assessed psychological adjustment at a single time point or only over a short time period.

How chronic are carers' psychological problems?

Some studies suggest that carers' distress reduces over time after diagnosis, but others show it increases. There is evidence that, for some carers, psychological difficulties are prolonged. In a longitudinal study of breast patients and their husbands, Northouse and colleagues found that the husbands' emotional distress after diagnosis predicted their distress a year later. Haddad found that in 40% of partners who developed an affective disorder, the episode lasted over 6 months. Psychological difficulties may become prolonged because carers disregard their own problems in order to focus exclusively on patients' needs. Carers are less likely than patients to disclose their concerns and worries and only half of those with serious psychological problems will seek help (Schumacher 1993).

factors are associated with psychological distress

Individual and systemic models have been investigated. The way carers appraise cancer-related events and the demands placed upon them, and how they cope with these issues have been considered important mediators of their subsequent psychological adjustment. In systemic models, the marital dyad or family has been the focus for investigation.

Vulnerability factors

Demographic factors

Female gender, young age and lower social class have been associated with depression in the general population. The same associations have been found in carers of cancer patients, but findings have not been so consistent. Female carers are more likely to be emotionally distressed and develop affective disorders than males. Hagedoorn and colleagues found that 35% of female partners compared with 12% of male partners scored over the cut-off for depression on the Center for Epidemiologic Studies Depression Scale (CES-D). In Haddad's study, 23% of female carers developed affective disorders over the 2 years after the ...