title: Longitudinal associations between caregiver burden and patient and spouse distress in couples coping with lung cancer.
abstract: OBJECTIVE
  While spouses play a vital role in the care of cancer patients, caregiving exerts a physical and psychological toll. Caregiving burden may not only compromise spouses' quality of life but also the quality of care and support they are able to provide. Consequently, spousal caregiving burden may also negatively impact patients' psychological adjustment. However, the effect of caregiving burden on patients' psychological distress is unknown. Thus, this 6-month longitudinal study examined the associations between caregiving burden and distress in both lung cancer patients and their spouses.
  
  
  METHODS
  Patients and their spouses individually completed questionnaires within 1 month of treatment initiation (baseline) and at 3- and 6-month follow-up. Distress was measured with the Brief Symptom Inventory and caregiving burden with the Caregiver Reaction Assessment.
  
  
  RESULTS
  Multilevel modeling of data from 158 couples revealed that baseline spouses' reports of caregiving-related health problems were significantly associated with 3-month (p < 0.001) and 6-month (p = 0.01) follow-up distress in both patients and spouses even when controlling for baseline distress and dyadic adjustment. Furthermore, there was evidence that baseline spouses' reports of schedule disruption (p = 0.05) predicted 3-month patients' distress and baseline spouses' reports of financial strain (p < 0.05) and lack of support (p < 0.10) predicted their own distress at 6 month.
  
  
  CONCLUSIONS
  Caregiving burden is problematic for both patients and spouses. Couples in which spouses report caregiving-related health problems may be at particular high risk of long-term elevated distress. Targets of future couple-focused interventions such as self-care and use of social support are discussed.
authors.affiliation: Department of General Oncology, Unit 642, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Houston, TX 77030-4006, USA. kmilbury@mdanderson.org
authors.forename: Kathrin
authors.initials: K
authors.lastname: Milbury
authors.forename: Hoda
authors.initials: H
authors.lastname: Badr
authors.forename: Frank
authors.initials: F
authors.lastname: Fossella
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Pisters
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Carmack
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000342:Affective Symptoms / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003142:Communication; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012944:Social Support; D018454:Spouses / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires
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