title: Factors associated with depression and anxiety symptoms in family caregivers of patients with incurable cancer.
abstract: Family caregivers (FCs) are critically important for patients with cancer, yet they may experience psychological distress related to caregiving demands. We sought to describe rates of depression and anxiety in FCs of patients with incurable cancer and identify factors associated with these symptoms to determine those at greatest risk for psychological distress.
  
  
  
  We performed a cross-sectional analysis of baseline data from a randomized trial of early palliative care. We assessed depression and anxiety using the Hospital Anxiety and Depression Scale in patients within 8 weeks of diagnosis of incurable lung or gastrointestinal cancer and their FCs. We also assessed patients' quality of life (Functional Assessment of Cancer Therapy-General), coping strategies (Brief COPE), and their report of the primary goal of their cancer treatment. We used linear regression with purposeful selection of covariates to identify factors associated with FC depression and anxiety symptoms.
  
  
  
  We enrolled 78.6% (n = 275) of potentially eligible FCs. The majority were female (69.1%) and married to the patient (66.2%). While the proportion of FCs and patients reporting depression did not differ (16.4% versus 21.5%, P = 0.13), FCs were more likely to report anxiety compared with patients (42.2% versus 28.4%, P < 0.001). Patients' use of acceptance coping was associated with lower FC depression (B = -0.42, P < 0.001), while emotional support coping was associated with higher FC depression (B = 0.69, P = 0.001) and lower FC anxiety (B = -0.70, P < 0.001). Patient report that their primary goal of their treatment was to 'cure my cancer' was associated with higher FC depression (B = 0.72, P = 0.03).
  
  
  
  Patients with incurable cancer and their FCs report high levels of depression and anxiety symptoms. We demonstrated that patients' coping strategies and prognostic understanding were associated with FC depression and anxiety symptoms, underscoring the importance of targeting these risk factors when seeking to address the psychological distress experienced by FCs.
authors.affiliation: Department of Medicine, Division of Hematology and Oncology rnipp@mgh.harvard.edu.
authors.forename: R D
authors.initials: RD
authors.lastname: Nipp
authors.affiliation: Department of Medicine, Division of Hematology and Oncology.
authors.forename: A
authors.initials: A
authors.lastname: El-Jawahri
authors.affiliation: Department of Psychiatry.
authors.forename: J N
authors.initials: JN
authors.lastname: Fishbein
authors.affiliation: Department of Medicine, Division of Hematology and Oncology.
authors.forename: E R
authors.initials: ER
authors.lastname: Gallagher
authors.affiliation: Department of Psychiatry.
authors.forename: J M
authors.initials: JM
authors.lastname: Stagl
authors.affiliation: Department of Psychiatry.
authors.forename: E R
authors.initials: ER
authors.lastname: Park
authors.affiliation: Department of Medicine, Division of Palliative Care, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
authors.forename: V A
authors.initials: VA
authors.lastname: Jackson
authors.affiliation: Department of Psychiatry.
authors.forename: W F
authors.initials: WF
authors.lastname: Pirl
authors.affiliation: Department of Psychiatry.
authors.forename: J A
authors.initials: JA
authors.lastname: Greer
authors.affiliation: Department of Medicine, Division of Hematology and Oncology.
authors.forename: J S
authors.initials: JS
authors.lastname: Temel
mesh_terms: D000368:Aged; D001008:Anxiety Disorders / Q000503:physiopathology / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000503:physiopathology / Q000523:psychology*; D004644:Emotions / Q000502:physiology; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D008175:Lung Neoplasms / Q000503:physiopathology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: advanced cancer; anxiety; caregivers; depression; mood; palliative care