Interventions Yield QOL Improvements in Advanced Cancer Caregivers

"In this systematic review and meta-analysis, caregiver interventions resulted in improvements in QOL and mental health outcomes for caregivers of patients with advanced cancer," according to the study authors.

Interventions offering support to caregivers of patients with advanced cancer produced improvements in quality of life (QOL) and mental wellbeing, according to findings from a meta-analysis published in Journal of the National Cancer Institute.

Implementing the experimental intervention correlated with a statistically significant impact on overall QOL at 1 to 3 months (standardized mean differences [SMD] = 0.24; 95% CI, 0.10-0.39; I2 = 52.0%), although investigators noted a high risk of potential publication bias. There were no statistically significant improvements in QOL with intervention at 4 to 6 months, and there were no differences among subgroups based on intervention target or risk of bias.

Investigators observed no statistically significant impact on physical wellbeing with the intervention at 1 to 3 months (SMD = –0.02; 95% CI, –0.12 to 0.08; I2 = 0.2%), and there were no differences among subgroups based on intervention target or by risk of bias. Intervention did not yield any significant impact on physical wellbeing at 4 to 6 months.

The intervention demonstrated a statistically significant effect with respect to mental wellbeing at 1 to 3 months (SMD = 0.14; 95% CI, 0.02-0.25; I2 = 0.0%). There were no significant effects with intervention at 4 to 6 months, and there was no significant impact among subgroups.

Investigators noted a statistically significant effect on anxiety with intervention at 1 to 3 months (SMD, 0.27; 95% CI, 0.06-0.49; I2 = 74.0%). Additionally, the intervention yielded no significant impact on depression at 4 to 6 months or in subgroups.

With respect to depression, there was a significant effect with intervention at 1 to 3 months (SMD = 0.34; 95% CI = 0.16-0.52; I2 = 64.4%). Additionally, the greatest improvements in depression were observed when intervention was directed at patient-caregiver dyads (SMD = 0.48; 95% CI, 0.13-0.83; I2 = 70.3); notably, the difference between subgroups did not appear to be statistically significant (P = .12). Investigators highlighted a high risk of bias in most trials assessing the effect of intervention on depression; this larger group also had the most significant improvement in depression (P = .03).

“In this systematic review and meta-analysis, caregiver interventions resulted in improvements in QOL and mental health outcomes for caregivers of patients with advanced cancer. Further trials with large samples and longer follow-up are needed to substantiate these data and to delineate which interventions are most effective,” the study authors wrote. “Although no specific intervention can be recommended over another at this time, cancer centers should ensure that interventions for caregivers are available; these could be in the form of psychoeducational or problem-solving interventions, couple-based counseling, or referral to an interdisciplinary palliative care team.”

The meta-analysis’ investigators collected data on randomized clinical trials from sources including Ovid MEDLINE, EMBASE, Cochrane CENTRAL Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature up to June 2021. Eligible studies included those with caregivers 18 years and older to adult patients with advanced stage III or IV cancer. Interventions that included psychoeducation, skills training, counseling, or team-based measures focused on direct or indirect support with caregiving or coping needed to be components of trials to be eligible for inclusion in the meta-analysis.

The primary end points of this meta-analysis were QOL, physical wellbeing, mental wellbeing, anxiety, and depression from baseline to 1 to 3 months of follow-up. Secondary end points included the aforementioned measures at 4 to 6 months, additional caregiver burden, self-efficacy, family functioning, and bereavement outcomes.

Investigators analyzed 56 articles that reported on 49 trials with a collective population of 8554 caregivers. Of these trials, 69% included caregivers of patients with mixed solid tumor malignancies, 12% with lung cancer, 2% with breast cancer, and 2% with pancreatic cancer. Most trials were conducted in an outpatient setting (65%) followed by a mixed setting (16%), a home setting (10%), and an inpatient setting (8%). Overall, 33% of trials reported on interventions directed at caregivers, 39% on interventions directed toward patient-caregiver dyads, and 29% on interventions directed at patients and/or their families.

The intervention yielded a significant impact on caregiver burden, with 8 of 20 trials reporting on this outcome, including 2 with a low risk of bias, 2 that were directed at caregivers, 5 at dyads, and 1 at patients and/or their families. Additionally, intervention produced significant effects on caregiver self-efficacy in 9 of 15 relevant trials, including 2 with a low risk of bias, 5 directed at caregivers, and 4 at dyads.

With respect to family functioning, 3 of 7 trials reported improvements following intervention, all of which were all at high risk of bias and directed at dyads. Additionally, 2 of 5 trials reporting on bereavement outcomes of depression or grief highlighted improvements with intervention; there were no improvements in depression following bereavement.

Reference

Chow R, Mathews JJ, Cheng EY, et al. Interventions to improve outcomes for caregivers of patients with advanced cancer: a meta-analysis. J Natl Can Inst. 2023;115(8):896-908. doi:10.1093/jnci/djad075