A Prospective Biopsychosocial Investigation Into Head and Neck Cancer Caregiving

Abstract

Purpose Head and neck cancer (HNC) patients suffer from significant morbidity, which may introduce challenging care demands and subsequent stress-induced mind–body interactions for informal caregivers. This prospective study evaluated patient and caregiver predictors of diurnal cortisol rhythm among HNC caregivers during radiation treatment. Method Patient–caregiver dyads completed measures at radiation treatment start (T1; n = 32) and 5 weeks into treatment (T2; n = 29). Measures included the Functional Assessment of Cancer Therapy–Head and Neck, the Caregiver Quality of Life (QOL) Index–Cancer, the Caregiver Reaction Assessment, the Medical Outcomes Social Support Survey, and the Eating Assessment tool. Patients also received a clinical swallowing evaluation using the Functional Assessment of Oral Intake Scale. Caregiver cortisol concentrations were assessed from salivary samples at T1 and T2. Results Caregiver cortisol slope became significantly flatter during radiation treatment. Greater caregiver schedule burden was associated with a flatter cortisol slope (β = .35, p = .05) in caregivers at T1. Lower patient functional QOL (β = −.41, p = .05) and lower overall caregiver QOL at T1 (β = −.39, p = .04) were each separately associated with a flatter cortisol slope in caregivers over treatment. Conclusions Results suggest the presence of a mind-body interaction in HNC caregivers. Dysregulation in diurnal cortisol rhythm in caregivers was significantly associated with increased caregiver schedule burden and lower patient and caregiver QOL. Targeted interventions developed for HNC caregivers may help to prevent negative health outcomes associated with dysregulated cortisol.

The Role of Biomarkers in Research on Caregivers for Cancer Patients: A Scoping Review

“…Thomas and colleagues (2012) assessed CAR among spouses whose partners had prostate cancer and found that, although caregivers had a CAR of 13% compared with a CAR of 39% in control subjects, this difference was nonsignificant. In addition, diurnal cortisol slope became flatter (more dysregulation in cortisol rhythm) in caregivers in comparison to controls (Miller et al, 2002) and at 5 weeks postradiotherapy compared to the start of radiotherapy (Nightingale et al, 2017). When examining the relationships between cortisol levels and health outcomes in caregivers, Thomas et al (2012) found that lower cortisol levels were associated with the presence of post-traumatic stress disorder symptoms.…”

“…Miller 2014Longitudinal; T1 ¼ baseline, T2-T4 ¼ 2, 4, and 8 months; saliva collected upon awakening and 0.5, 1, 4, 9, and 14 hr after awakening quality of life (Nightingale et al, 2017) and depressive symptoms (Thomas et al, 2012). Cortisol was used as a biomarker to monitor the efficacy of interventions in five studies (Fancourt et al, 2016;Laudenslager et al, 2015;Lengacher et al, 2012;Pinar & Afsar, 2015;Walsh et al, 2007).…”

Fatores associados à sobrecarga em cuidadores familiares na radioterapia

“…There was a predominance of randomized clinical trials 4, 12-15 cross-sectional 4 and prospective studies 4. 20-3 The journal Cancer Nursig stood out, with three (20.0%) productions, 16,19,22 the language English, with 15 (100.0%) [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] and 2014, with five (33.0%). 12,15,[21][22]24 It was observed, as to the level of evidence, that most of the analyzed productions 8 (53.3%) presented evaluation 2C.…”

“…12,15,[21][22]24 It was observed, as to the level of evidence, that most of the analyzed productions 8 (53.3%) presented evaluation 2C. [16][17][18][19][20][21][22][23][24][25][26] It was evidenced that the factors associated with the overload were related both to the clinical and cognitive conditions of the patients and the caregivers, being self-care deficit, care dependence, sleep alteration and psychosocial pressures prevalent. Among the manifestations of overload, stress, fatigue, exhaustion and intensification of depressive and anxious symptoms were identified.…”

“…It is evident from the literature consulted that the dependence on a caregiver represents a condition that generates morbidity for the family member, due to the overload that threatens the balance and personal functioning, considering that radiotherapy treatment is performed in most cases, sometimes in an outpatient setting, requiring long-term care that can lead to adverse events, leading to the need to manage home care. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] In this segment, it is highlighted that chronic diseases such as cancer require intense action by caregivers, whether for food, leisure activities, medication administration, hygiene, follow-up consultations and clinical evaluations, requiring time and dedication of the caregiver to maintain clinical stability and the support needed for adequate rehabilitation. 31 DISCUSSION https://periodicos.ufpe.br/revistas/revistaenfermagem/index From this perspective, it is observed that different conditions related to the prioritization of patients' needs over those of caregivers, as well as the lack of information about the disease and treatment, were determinant to establish the degree of overload, since the routine of the treatment.…”