title: Factors influencing the health-related quality of life of Chinese advanced cancer patients and their spousal caregivers: a cross-sectional study.
abstract: BACKGROUND
  Cancer and its treatment have a major impact on the lives of patients and their intimate partners, such as on their health-related quality of life (HRQOL). The aims of this study are to: (i) assess the HRQOL of advanced cancer patients and spousal caregivers, and explore the relationship between the HRQOL of cancer patients and that of their spousal caregivers; (ii) detect factors influencing the HRQOL of cancer patients and spousal caregivers; and (iii) explore the impact of anxiety and depression on the HRQOL of couples.
  
  
  METHODS
  A total of 131 couples where one of the partners was hospitalized for advanced cancer were invited to complete a survey to assess their demographic and background information, HRQOL, and anxiety and depression. HRQOL was measured using the SF-12, while anxiety and depression were measured using the Hospital Anxiety and Depression Scale. Data were analyzed using a T-test, Pearson correlations, multiple linear regressions, and structural equation modeling.
  
  
  RESULTS
  In general, the spousal caregivers had higher levels of HRQOL (seven out of eight SF-12 domains and two SF-12 dimensions) p = 0.038-0.000, anxiety (p = 0.002), and depression (p = 0.011) than patients. Correlations of HRQOL between patients and spouses were small to moderate (r = 0.193-0.398). Multiple independent factors influencing the physical component summary (PCS), mental component summary (MCS), vitality (VT), and role emotional (RE) sections of the SF-12 were identified, including: gender, time since diagnosis, levels of education, working status, the extent to which spousal caregivers were informed about the disease, improved marital relationship after the diagnosis of cancer, and anxiety and depression. For both patients and spousal caregivers, the strongest independent factor influencing HRQOL (SF-12 PCS, MCS, VT, and RE) was anxiety and depression. Anxiety and depression may have both actor and partner effects on the HRQOL of couples to various degrees.
  
  
  CONCLUSIONS
  The findings of this study call attention to the HRQOL of couples and its influencing factors. Individual characteristics of cancer patients and spouses, marital relationship, and anxiety and depression are highlighted as areas in which couples coping with cancer could benefit from interventions to improve their HRQOL.
authors.affiliation: Wuxi Medical School, Jiangnan University, Wuxi, Jiangsu Province, China.
authors.forename: Qiuping
authors.initials: Q
authors.lastname: Li
authors.affiliation: Wuxi People's Hospital, Wuxi, Jiangsu Province, China.
authors.forename: Yinghua
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Wuxi People's Hospital, Wuxi, Jiangsu Province, China.
authors.forename: Huiya
authors.initials: H
authors.lastname: Zhou
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China. alice.yuen.loke@polyu.edu.hk.
authors.forename: Alice Yuen
authors.initials: AY
authors.lastname: Loke
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D044466:Asian People / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D002681:China; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D011788:Quality of Life; D012944:Social Support; D012959:Socioeconomic Factors; D018454:Spouses / Q000523:psychology*; D019452:Terminally Ill / Q000523:psychology*
keywords: Advanced cancer; Anxiety; Caregiver-patient dyads; Chinese; Depression; Health-related quality of life; SF-12; Spousal caregivers