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Objective Couples facing metastatic breast cancer (MBC) must learn to cope with stressors that can affect both partners' quality of life as well as the quality of their relationship. Common dyadic coping involves taking a “we” approach, whereby partners work together to maintain their relationship while jointly managing their shared stress. This study prospectively evaluated whether common dyadic coping was associated with less cancer-related distress and greater dyadic adjustment for female MBC patients and their male partners. Design Couples (N = 191) completed surveys at the start of treatment for MBC (baseline), and 3 and 6 months later. Main Outcome Measures Cancer-related distress was assessed with the Impact of Events Scale; dyadic adjustment was assessed using the short-form of the Dyadic Adjustment Scale. Results Multilevel models using the couple as the unit of analysis showed that the effects of common positive dyadic coping on cancer-related distress significantly differed for patients and their partners. Whereas partners experienced slightly lower levels of distress, patients experienced slightly higher levels of distress. Although patients and partners who used more common negative dyadic coping experienced significantly greater distress at all times, the association was stronger for patients. Finally, using more common positive dyadic coping and less common negative dyadic coping was mutually beneficial for patients and partners in terms of greater dyadic adjustment. Conclusion Our findings underscore the importance of couples working together to manage the stress associated with MBC. Future research may benefit from greater focus on the interactions between patients and their partners to address ways that couples can adaptively cope together.

Objective Informal caregivers (family and friends) of people with cancer are often unprepared for their caregiving role, leading to increased burden or distress. CHESS (Comprehensive Health Enhancement Support System) is a web-based lung cancer information, communication and coaching system for caregivers. This randomized trial reports the impact on caregiver burden, disruptiveness and mood of providing caregivers access to CHESS versus the Internet with a list of recommended lung cancer websites. Methods 285 informal caregivers of patients with advanced non-small cell lung cancer were randomly assigned to a comparison group that received Internet or a treatment group that received Internet and CHESS. Caregivers were provided a computer and Internet service if needed. Written surveys were completed at pretest and during the intervention period bimonthly for up to 24 months. ANCOVA analyses compared the intervention’s effect on caregivers’ disruptiveness and burden (CQOLI-C), and negative mood (combined Anxiety, Depression, and Anger scales of the POMS) at six months, controlling for blocking variables (site, caregiver’s race, and relationship to patient) and the given outcome at pretest. Results Caregivers randomized to CHESS reported lower burden [t (84) = 2.36, p = .021, d= .39] and negative mood [t (86) = 2.82, p = .006, d= .44] than those in the Internet group. The effect on disruptiveness was not significant. Conclusions Although caring for someone with a terminal illness will always exact a toll on caregivers, eHealth interventions like CHESS may improve caregivers’ understanding and coping skills and, as a result, ease their burden and mood.

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Results reinforce the need for rehabilitation management through the integration of psychologic and behavioral interventions in medical follow-up.

Purpose While spouses play a vital role in the care of cancer patients, caregiving exerts a physical and psychological toll. Caregiving burden may not only compromise spouses’ quality of life but also the quality of care and support they are able to provide. Consequently, spousal caregiving burden may also negatively impact patients’ psychological adjustment. However, the effect of caregiving burden on patients’ psychological distress is unknown. Thus, this 6-month longitudinal study examined the associations between caregiving burden and distress in both lung cancer patients and their spouses. Methods Patients and their spouses individually completed questionnaires within 1 month of treatment initiation (baseline) and at 3-month and 6-month follow-up. Distress was measured with the Brief Symptom Inventory and caregiving burden with the Caregiver Reaction Assessment. Results Multilevel modeling of data from 158 couples revealed that baseline spouses’ reports of caregiving-related health problems were significantly associated with 3-month (p<0.001) and 6-month (p=0.01) follow-up distress in both patients and spouses even when controlling for baseline distress and dyadic adjustment. Further, there was evidence that baseline spouses’ reports of schedule disruption (p=0.05) predicted 3-month patients’ distress and baseline spouses’ reports of financial strain (p<0.05) and lack of support (p<0.10) predicted their own distress at 6-months. Conclusion Caregiving burden is problematic for both patients and spouses. Couples in which spouses report caregiving-related health problems may be at particular high risk of long-term elevated distress. Targets of future couple-focused interventions such as self-care and use of social support are discussed.

Background Although mindfulness‐based interventions have been widely examined in patients with nonmetastatic cancer, the feasibility and efficacy of these types of programs are largely unknown for those with advanced disease. We pilot‐tested a couple‐based meditation (CBM) relative to a supportive‐expressive (SE) and a usual care (UC) arm targeting psychospiritual distress in patients with metastatic lung cancer and their spousal caregivers. Patients and Methods Seventy‐five patient‐caregiver dyads completed baseline self‐report measures and were then randomized to one of the three arms. Couples in the CBM and SE groups attended four 60‐minute sessions that were delivered via videoconference. All dyads were reassessed 1 and 3 months later. Results A priori feasibility benchmarks were met. Although attendance was high in both groups, dyads in the CBM group indicated greater benefit of the sessions than those in the SE group (patients, CBM mean = 2.63, SE mean = 2.20, p = .003; spouses, CBM mean = 2.71, SE mean = 2.00, p = .005). Compared with the UC group, patients in the CBM group reported significantly lower depressive symptoms (p = .05; d = 0.53) and marginally reduced cancer‐related stress (p = .07; d = 0.68). Medium effect sizes in favor of the CBM compared with the SE group for depressive symptoms (d = 0.59) and cancer‐related stress (d = 0.54) were found. Spouses in the CBM group reported significantly lower depressive symptoms (p < .01; d = 0.74) compared with those in the UC group. Conclusion It seems feasible and possibly efficacious to deliver dyadic interventions via videoconference to couples coping with metastatic lung cancer. Mindfulness‐based interventions may be of value to managing psychological symptoms in the palliative care setting. Clinical trial identification number. NCT02596490 Implications for Practice The current randomized controlled trial has established that a mindfulness approach to the management of patients’ and spouses’ psychospiritual concerns is acceptable and subjectively deemed more beneficial than a supportive‐expressive treatment for patients with metastatic non‐small cell lung cancer (NSCLC). We also revealed that videoconference delivery, here FaceTime, is an acceptable approach even for geriatric patients with metastatic NSCLC and that patients and their spousal caregivers prefer a dyadic delivery of this type of supportive care strategy. Lastly, this trial has laid the foundation for the role of mindfulness‐based interventions in the palliative care setting supporting patients with advanced NSCLC and their spousal caregivers.

Background This study examined the effectiveness of an online support system (CHESS) versus the Internet in relieving physical symptom distress in patients with nonsmall cell lung cancer (NSCLC). Methods 285 informal caregiver-patient dyads were randomly assigned to standard care plus the Internet or CHESS for up to 25 months. Caregivers agreed to use CHESS or the Internet and complete bimonthly surveys; for patients, these tasks were optional. The primary endpoint, patient symptom distress, was measured by caregiver reports using a modified Edmonton Symptom Assessment Scale (ESAS). Results Caregivers in the CHESS arm consistently reported lower patient physical symptom distress than caregivers in the Internet arm, with significant differences at 4 months (P = .031, Cohen’s d = .42) and 6 months (P = .004, d = .61). Similar but marginally significant effects were observed at 2 months (P = .051, d = .39) and 8 months (P = .061, d = .43). Exploratory analyses showed that survival curves did not differ significantly between the arms (log rank, P = .172), although a survival difference in an exploratory subgroup analysis suggests an avenue for further study. Conclusions An online support system may reduce patient symptom distress. The effect on survival bears further investigation.