title: Distress is Interdependent in Patients and Caregivers with Newly Diagnosed Incurable Cancers.
abstract: BACKGROUND
  Individuals with advanced, incurable cancer often experience high physical and psychological symptom burden. Family and friend caregivers are at risk for emotional distress.
  
  
  OBJECTIVE
  The aim of the study is to investigate the interrelationship of distress in patient-caregiver dyads at the time of newly diagnosed incurable cancer.
  
  
  METHODS
  From May 2011 to July 2015, within 8 weeks of diagnosis of advanced lung or noncolorectal gastrointestinal cancer, 350 patients and 275 family caregivers were enrolled in a randomized controlled trial of early palliative care. Actor-partner interdependence modeling was used to examine relationships between dyad's self-reported anxiety and depressive symptoms on the Hospital Anxiety and Depression Scale at baseline.
  
  
  RESULTS
  Comparing patients with caregivers, patients reported more depressive symptoms (Mdiff= .84; t[274] = 3.17, p = .002, d = .22) and caregivers reported more anxiety symptoms (Mdiff=1.62, t[274] = 4.91, p < .001, d = .39). Dyads' anxiety symptoms were positively associated, as were depressive symptoms (rs = .21, ps ≤ .001). Actor-partner interdependence modeling showed that patients' anxiety symptoms were positively associated with their own depressive symptoms, with an equal effect for caregivers (actor effect βs = 0.52, ps < .001). Patients' own anxiety was concurrently positively associated with their caregivers' depressive symptoms, with an equal effect for caregivers to patients (partner effect βs=0.08, ps=.008).
  
  
  CONCLUSIONS
  In the context of newly diagnosed incurable cancer, caregivers experience more pronounced anxiety, while patients report greater depressive symptoms. Findings indicate that anxiety and depressive symptoms are interrelated among dyads facing newly diagnosed incurable disease. Results emphasize the importance of addressing distress in both patients and caregivers. Future research should discern when dyadic versus individual psychosocial interventions would be optimal.
  
  
  BACKGROUND
  The trial was registered with the ClinicalTrials.gov database (NCT02349412) https://clinicaltrials.gov/ct2/show/NCT02349412 .
authors.affiliation: Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center & Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 10B, Boston, MA, 02114, USA. jjacobs@mgh.harvard.edu.|Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA. jjacobs@mgh.harvard.edu.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Jacobs
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.|Department of Psychology, University of Miami, Coral Gables, FL, USA.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Shaffer
authors.affiliation: Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Nipp
authors.affiliation: Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center & Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 10B, Boston, MA, 02114, USA.
authors.forename: Joel N
authors.initials: JN
authors.lastname: Fishbein
authors.affiliation: Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center & Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 10B, Boston, MA, 02114, USA.
authors.forename: James
authors.initials: J
authors.lastname: MacDonald
authors.affiliation: Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.
authors.forename: Areej
authors.initials: A
authors.lastname: El-Jawahri
authors.affiliation: Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Pirl
authors.affiliation: Department of Medicine, Division of Palliative Care, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Jackson
authors.affiliation: Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center & Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 10B, Boston, MA, 02114, USA.|Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.
authors.forename: Elyse R
authors.initials: ER
authors.lastname: Park
authors.affiliation: Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
authors.affiliation: Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center & Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 10B, Boston, MA, 02114, USA.|Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Greer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000451:nursing / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D008175:Lung Neoplasms / Q000451:nursing / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*
keywords: Advanced cancer; Anxiety; Caregiver; Depression; Dyadic modeling