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Factors associated with psychological distress in caregivers of patients with malignant gliomas

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Abstract

Purpose

Caregivers of patients with malignant gliomas are at risk for psychological distress. However, factors associated with distress in this population have not been well described. We conducted a prospective study evaluating psychological distress in patients with malignant gliomas and their caregivers and exploring factors associated with caregiver distress.

Methods

We enrolled patients with newly diagnosed malignant gliomas (N = 77) and their caregivers (N = 61). At baseline and 3, 6, and 9 months after diagnosis, we administered the Hospital Anxiety and Depression Scale to assess psychological distress and the Caregiver Reaction Assessment to evaluate caregiver burden. We performed multivariable regression analyses to investigate caregiver-related, patient-related, and tumor-related factors associated with caregivers’ distress.

Results

At baseline, 48.3% (29/60) and 26.2% (16/61) of caregivers reported clinically significant anxiety and depression symptoms, respectively. Anxiety and depression symptoms persisted over time. Greater caregiver depression was associated with male gender (B = 1.48, 95% CI 0.16–2.81, p = 0.03), higher caregiver burden (B = 0.08, 95% CI 0.01–0.15, p = 0.02), caregiver anxiety (B = 0.53, 95% CI 0.38–0.68, p < 0.0001), patient depression (B = 0.34, 95% CI 0.13–0.55, p = 0.002), and caring for a younger patient (B =  −0.07, 95% CI −0.15 to 0.00, p = 0.049). Factors associated with greater caregiver anxiety symptoms were caregiver depression (B = 0.91, 95% CI 0.71–1.12, p < 0.0001) and younger patient age (B =  −0.15, 95% CI −0.24 to −0.05, p = 0.003).

Conclusion

Male gender, higher caregiver burden, greater patient depression symptoms, and younger patient age are associated with increased distress among caregivers of patients with malignant gliomas, underscoring the need for tailored supportive care interventions targeting caregivers at highest risk for psychological distress.

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Data availability

The data that supports the findings of this study are available within the article, with any additional supporting data available from the corresponding author upon request.

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Funding

This study was supported by the Pappas Center for Neuro-Oncology and the Cancer Outcomes Research and Education Program at the Massachusetts General Hospital Cancer Center. Dr. El-Jawahri is a Scholar in Clinical Research for the Leukemia and Lymphoma Society.

Author information

Authors and Affiliations

  1. Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA

    Deborah A. Forst & Jorg Dietrich

  2. Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA

    Alyx F. Podgurski, Kit M. Quain, Sophia L. Landay, Maya Anand, Emilia Kaslow-Zieve, Michelle M. Mesa, Vicki A. Jackson, Areej El-Jawahri & Jennifer S. Temel

  3. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Jamie M. Jacobs, Michael W. Parsons & Joseph A. Greer

  4. Massachusetts General Hospital Biostatistics Center, Boston, MA, USA

    Nora Horick

  5. Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA

    Tracy T. Batchelor

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  1. Deborah A. Forst
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  2. Alyx F. Podgurski
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  3. Kit M. Quain
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Contributions

Deborah Forst: conceptualization, formal analysis, investigation, methodology, writing — original draft and writing — review and editing. Alyx Podgurski: formal analysis, writing — review and editing. Kit Quain: investigation, data curation, writing — review and editing. Sophia Landay: investigation, data curation, writing — review and editing. Maya Anand: investigation, data curation, writing — review and editing. Emilia Kaslow-Zieve: formal analysis, writing — review and editing. Michelle Mesa: formal analysis, writing — review and editing. Jamie Jacobs: methodology, writing — review and editing. Michael Parsons: methodology, writing — review and editing. Jorg Dietrich: conceptualization, writing — review and editing. Nora Horick: formal analysis, writing — review and editing. Joseph Greer: methodology, writing — review and editing. Tracy Batchelor: conceptualization, writing — review and editing. Vicki Jackson: conceptualization, writing — review and editing. Areej El-Jawahri: methodology, supervision, formal analysis, writing — review and editing. Jennifer Temel: conceptualization, methodology, supervision, writing — review and editing.

Corresponding author

Correspondence to Deborah A. Forst.

Ethics declarations

Ethics approval

This study was approved by The Dana-Farber/Harvard Cancer Center Institutional Review Board and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki.

Consent to participate

All participants provided written informed consent prior to enrollment.

Consent for publication

All authors have approved the final version of this manuscript.

Conflict of interest

Dr. Forst: ownership interest in Eli Lilly. Dr. Parsons: consultant fees from Agios Pharmaceuticals and Gamaka Biotechnology, royalties from the American Psychological Association Press. Dr. Greer: research funding from Blue Note Therapeutics, royalties from Humana Press/Springer. Dr. El-Jawahri: consultant fees from AIM Specialty and Blue Note Therapeutics. Dr. Batchelor: Genomicare scientific advisory board. Remaining authors: no disclosures.

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Supplementary Information

Below is the link to the electronic supplementary material.

520_2022_6989_MOESM1_ESM.pdf

Supplementary file1 (PDF 36 KB) Online Resource 1. CRA Subscale Scores and Correlation with Caregiver Depression and Anxiety. Analyses of the correlation between caregiver burden as measured by the CRA subscale scores and caregiver distress (depression and anxiety) as measured by the HADS demonstrate that caregiver burden as related to impact on schedule, lack of family support, impact on health and impact on finances was significantly correlated with caregiver depression and caregiver anxiety

520_2022_6989_MOESM2_ESM.pdf

Supplementary file2 (PDF 66 KB) Online Resource 2. Multivariable analyses of patient-related factors associated with caregivers’ depression symptoms at baseline. In the multivariable model, younger patient age and higher patient depression symptoms were significantly associated with caregiver depression at baseline

520_2022_6989_MOESM3_ESM.pdf

Supplementary file3 (PDF 67 KB) Online Resource 3. Multivariable analyses of patient-related factors associated with caregivers’ anxiety symptoms at baseline. In the multivariable analysis, younger patient age was significantly associated with higher caregiver anxiety symptoms at baseline

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Forst, D., Podgurski, A., Quain, K. et al. Factors associated with psychological distress in caregivers of patients with malignant gliomas. Support Care Cancer 30, 5811–5820 (2022). https://doi.org/10.1007/s00520-022-06989-5

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