Caregiver symptom burden: the risk of caring for an underserved patient with advanced cancer.
BACKGROUND
The growing diversity of the population of the United States and the high burden of cancer-related symptoms reflect the need for caregiver research within underserved groups. In this longitudinal study, the authors assessed changes in symptom severity in caregivers and underserved minority patients diagnosed with advanced solid tumors who were being treated at public hospitals.


METHODS
A total of 85 matched patient-caregiver dyads completed the M. D. Anderson Symptom Inventory 3 times during 20 weeks of chemotherapy. At each time point, symptom severity and interference with daily activities were assessed. Group-based trajectory modeling was used to classify caregivers into high-symptom or low-symptom burden groups.


RESULTS
Sadness and distress were more prevalent among caregivers (P = .005). Symptom burden remained stable among caregivers in the high-symptom group (40%), whereas the low-symptom group (60%) demonstrated a statistically significant decrease over time. Multivariate analysis found being a family-member caregiver (adjusted odds ratio [ADJ-OR], 4.1; 95% confidence interval [95% CI], 1.4-11.6) and caring for a highly symptomatic patient (ADJ-OR, 8.0; 95% CI, 1.5-41.4), rather than race, ethnicity, or sociodemographic characteristics, were significant predictors of the caregiver's membership in the high-symptom burden group.


CONCLUSIONS
Approximately 40% of the caregivers in the current study were found to be at an increased risk for moderate to severe sadness and distress, which remained severe throughout the patient's treatment course at public hospitals. To the authors' knowledge, this study marks the first time that the concept of symptom burden has been used to measure caregiver burden, and the first time that symptom burden has been measured and documented in dyads of caregivers and underserved minority patients. Cancer 2011. © 2010 American Cancer Society.
Department of Symptom Research, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. gpalos@mdanderson.org
Guadalupe R
GR
Palos
Tito R
TR
Mendoza
Kai-Ping
KP
Liao
Karen O
KO
Anderson
Araceli
A
Garcia-Gonzalez
Karin
K
Hahn
Arlene
A
Nazario
Lois M
LM
Ramondetta
Vicente
V
Valero
Garrett R
GR
Lynch
Maria L
ML
Jibaja-Weiss
Charles S
CS
Cleeland
D000223:Adaptation, Psychological / Q000502:physiology; D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data; D017281:Cost of Illness; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D018450:Disease Progression; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D012306:Risk; D012720:Severity of Illness Index; D014481:United States