Family caregivers have become increasingly responsible for providing home care for cancer patients. Research has documented the distress of family caregivers; however, little has been done to evaluate the broader impact of caregiving on quality of life (QoL). The objectives of this study were to evaluate the reliability and validity of the Caregiver Quality of Life Index-Cancer (CQOLC), a new self-report instrument. Two hundred and sixty-three family caregivers of patients with lung, breast or prostate neoplasms participated. Test-retest reliability was 0.95 and internal consistency was 0.91. As expected, there were moderate correlations with overall mental health (r = 0.64), emotional distress (r = -0.50 to -0.52), burden (r = -0.65) and patient's performance status (r = -0.47) and low correlations with overall physical health (r = 0.13), social support (r = 0.22) and social desirability (r = 0.08). These results show that increased overall mental health is associated with better QoL, while more emotional distress and worsening patient performance status are associated with poorer QoL. Thus, the CQOLC appears to possess adequate validity, test-retest reliability and internal consistency. Future directions include further evaluation of sensitivity to change and factor analysis to determine the principal health-related QoL domains evaluated by the CQOLC.

BACKGROUND.Family caregivers for cancer patients experience high levels of stress and burden and diminished quality of life (QOL). Interventions to improve coping skills of caregivers have been shown to be effective with other populations, but their impact has not been assessed in the difficult context of hospice care. The purpose of this study was to determine whether hospice plus a coping skill training intervention improved family caregivers' QOL, burden, coping, and mastery, compared with hospice plus emotional support, and usual hospice care. METHODS.A three group randomized controlled trial was conducted including baseline, 16 day, and 30 day assessments conducted from March 1999 to May 2003.The sample consisted of 354 family caregivers of community dwelling hospice patients with advanced cancer. Patient/caregiver dyads were randomly divided into three groups, including a control group (n ϭ 109) who received standard hospice care, a group (n ϭ 109) who received standard hospice care plus three supportive visits, and a group (n ϭ 111) who received standard care plus three visits to teach a coping skills intervention. Primary outcomes included caregiver QOL, caregiver burden due to patient symptoms, caregiver burden due to tasks, and caregiver mastery. RESULTS.At the 30-day follow-up, the coping skills intervention led to significantly greater improvement in caregiver QOL (estimate ϭ Ϫ0.16, standard error [SE] ϭ 0.07, P ϭ 0.03), burden of patient symptoms (estimate ϭ 0.28, SE ϭ 0.07, P Ͻ 0.001), and caregiving task burden (estimate ϭ Ϫ0.01, SE ϭ 0.01, P ϭ 0.038) than did the other two conditions. None of the groups showed significant change in overall caregiving mastery, caregiver mastery specific to caregiving tasks, problem-focused or emotion-focused coping. CONCLUSIONS.The coping skills intervention was effective in improving caregiver QOL, reducing burden related to patients' symptoms, and caregiving tasks compared with hospice care alone or hospice plus emotional support. Structured caregiver skill-training interventions for caregivers are promising even in the difficult environment of end-of-life care and for families already receiving benefits

Background. This report describes the development and validation of a brain subscale for the Functional Assessment of Cancer Therapy (FACT) scale, and the revalidation of the subscales of the general version (FACT‐G), which measure physical, social, family, emotional, and functional well‐being and the quality of the relationship with the physician. Methods. 101 patients with primary brain tumors, after giving informed consent, participated in the last two phases of a four‐phase validation process: item generation, item reduction, validation, and reliability testing. In the validation phase, FACT‐G subscale and total scores as well as the brain subscale scores were correlated with other tests of mood, response, bias, and quality of life (QOL). Test‐retest reliability testing was performed with 46 patients who had primary brain tumors. Results. Validity and reliability coefficients were high for the FACT‐G and brain subscale, except for the comparison with a second QOL measure (FP‐QLI) and the Karnofsky Performance Status (KPS). The lower scores were the result of inherent differences in the two QOL instruments and the relatively high performance status of the brain tumor patients, which restricted the KPS score range. Conclusion. The FACT‐G has good psychometric properties supporting its broad generalizability and the brain subscale tests substantially different QOL issues than the core instrument. Use of this scale with the addition of the brain subscale provides a well rounded view of the various aspects of QOL from the patient's perspective. With modifications and further psychometric testing, the brain subscale may have broader applicability to subpopulations of patients with other brain disorders. Cancer 1995;75:1151–61.

This study demonstrated improved patient function in the setting of a progressive neurologic illness. Methylphenidate should be more widely considered as adjuvant brain tumor therapy.

Pretransplant emotional and cognitive functioning are important determinants of long-term outcome and quality of life (QOL) in BMT patients. In addition, a few patients undergoing BMT develop short-term memory difficulties and mood disturbance that may persist. Pretransplant identification of patients at risk for neurobehavioral difficulties may guide early interventions during hospitalization. Posttransplant assessment may then be used to develop rehabilitation programs and other interventions for individuals with persisting complaints.

This study examined the prevalence and predictors of posttraumatic stress disorder (PTSD) symptoms in 70 men and women treated with bone marrow transplantation for cancer. Findings indicated that the number of symptoms present ranged from 0 to a possible high of 17 (M = 3.0, SD = 3.9). As predicted. lower social support and higher avoidance coping I month pretransplant predicted greater PTSD symptom severity an average of 7 months posttransplant. These variables remained significant predictors of symptom severity even after accounting for pretransplant levels of psychological distress. Additional analyses indicated the presence of a significant interaction between social support and avoidance coping, with patients high in avoidance coping and low in social support reporting the most severe symptoms. These findings identify patients at risk for psychological disturbance posttransplant and can serve to guide future intervention efforts.

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This study sought to compare the mood and quality of life (QOL) of breast cancer survivors with those observed in low-risk breast cancer screening patients. A group of long-term stage I-III breast cancer survivors (n = 60) was compared with low-risk breast cancer screening patients (n = 93) on measures of depression, anxiety, and QOL. Patients without a previous psychiatric history were studied. Although the groups differed in age and education, correlations performed between age, education, and the outcome measures showed no association of age and education with the outcome measures. Breast cancer patients with stage III disease showed significantly poorer functioning, in all areas except family than did other breast cancer patients; however, when compared with the breast cancer screening group, they showed higher QOL scores in several domains. Higher mood scores were correlated with poorer scores in all QOL areas except family functioning in the breast cancer group. Only significantly elevated depression scores correlated with poorer QOL areas in the breast cancer screening group. The psychological measures were found to be more robust predictors of QOL than the demographic variables in both the cancer and the screening patients. These results suggest that long-term survivors of breast cancer continue to experience significant stress and emotional distress, as evidenced by increased depression and lower QOL functioning.