Effectiveness of family and caregiver interventions on patient outcomes in adults with cancer: a systematic review.
BACKGROUND
Family and caregiver interventions typically aim to develop family members' coping and caregiving skills and to reduce caregiver burden. We conducted a systematic review of published randomized controlled trials (RCTs) evaluating whether family-involved interventions improve patient outcomes among adults with cancer.


METHODS
RCTs enrolling patients with cancer were identified by searching MEDLINE, PsycInfo and other sources through December 2012. Studies were limited to subjects over 18 years of age, published in English language, and conducted in the United States. Patient outcomes included global quality of life; physical, general psychological and social functioning; depression/anxiety; symptom control and management; health care utilization; and relationship adjustment.


RESULTS
We identified 27 unique trials, of which 18 compared a family intervention to usual care or wait list (i.e., usual care with promise of intervention at completion of study period) and 13 compared one family intervention to another individual or family intervention (active control). Compared to usual care, overall strength of evidence for family interventions was low. The available data indicated that overall, family-involved interventions did not consistently improve outcomes of interest. Similarly, with low or insufficient evidence, family-involved interventions were not superior to active controls at improving cancer patient outcomes.


CONCLUSIONS
Overall, there was low or insufficient evidence that family and caregiver interventions were superior to usual or active care. Variability in study populations and interventions made pooling of data problematic and generalizing findings from any single study difficult. Most of the included trials were of poor or fair quality.
Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Mailstop 152, Minneapolis, MN, 55417, USA, Griffin.joan@mayo.edu.
Joan M
JM
Griffin
Laura A
LA
Meis
Roderick
R
MacDonald
Nancy
N
Greer
Agnes
A
Jensen
Indulis
I
Rutks
Timothy J
TJ
Wilt
D000328:Adult; D017028:Caregivers / Q000523:psychology; D061345:Early Medical Intervention / Q000379:methods*; D005190:Family / Q000523:psychology; D006801:Humans; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D010344:Patient Advocacy; D011368:Professional-Family Relations; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards; D016896:Treatment Outcome