Lapid, M.I., Atherton, P.J., Kung, S., Sloan, J.A., Shahi, V., Clark, M.M., & Rummans, T.A. (2015). Cancer caregiver quality of life: Need for targeted intervention. Psycho-Oncology. Advance online publication.

To evaluate the effects of a structured, in-person, group multidisciplinary approach on several domains of quality of life (QOL) for patients with advanced cancer and their caregivers

The four-week intervention, tested previously in eight sessions, included six 90-minute sessions. Patients were invited to all six sessions, and caregivers were invited to four. Structured sessions targeted emotional, cognitive, physical, spiritual, and social domains of QOL. Every session opened with 15 minutes of physical therapy and closed with 15 minutes of relaxation therapy. Weekly topics included strategies to deal with health behavior and mood changes, radiation and chemotherapy effects, spirituality, social needs, record keeping, coping, exercise, quality of life, spiritual dimensions of disease, and communication with healthcare and support teams. Healthcare providers with diverse roles delivered the intervention. Ten brief telephone counseling sessions over a period of 20 weeks followed the four-week intervention. Patient/caregiver dyads were evaluated at baseline, four weeks postintervention, 27 weeks postintervention, and 52 weeks postintervention.

• N = 131  
• AGE = Not stated
• MALES: Not stated, FEMALES: Not stated
• KEY DISEASE CHARACTERISTICS: Caregivers and patients with newly diagnosed (within past 12 months) advanced cancer receiving radiation therapy.  
• OTHER KEY SAMPLE CHARACTERISTICS: In total, 88% of caregivers were married, 75% were spouses, 62% were employed, and 66% or more had some college education.

• SITE: Single site    
• SETTING TYPE: Outpatient    
• LOCATION: Suburban cancer center in Minnesota

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Palliative care 

Randomized, controlled trial

• Caregiver Quality of Life Index–Cancer (CQQOL)
• Linear Analog Self-Assessment (LASA)
• Profile of Mood States (POMS)

At four weeks postintervention, statistically significant differences in favor of the intervention arm were found for the LASA spiritual well-being domain (p = 0.0.048), the POMS vigor and activity subscale (p = 0.02), the POMS fatigue and inertia subscale (p = 0.02), the POMS total score (p = 0.02), and the CQOLC adaptation domain (p = 0.02). Durability was found at 27 weeks only for improvements in the POMS fatigue and inertia subscale (p = 0.01). At 27 weeks postintervention, the intervention group showed improvement over the standard care group in the CQOLC disruptiveness domain (p = 0.049) and the CQOLC financial concerns domain (p = 0.02). Although levels of significance did not appear, study results were similar at 52 weeks.

Although caregivers showed improvements in a few specific QOL domains assessed in this study, this comprehensive multidisciplinary intervention did not affect overall ​caregiver QOL. Continued study to identify and evaluate specific, tailored interventions focused on improving cancer caregiver QOL is needed.

• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Findings not generalizable
• Subject withdrawals ≥ 10% 
• Other limitations/explanation: The results at 52 weeks postintervention were not provided. Limited information was listed about caregiver demographics, which may have influenced study findings.  Recruitment methods and phone call intervention specifics did not appear to interpret study findings. There was a lack of information on the usefulness of intervention for improving caregiver QOL.  

Continued research focused on dyadic (patient/caregiver) versus individualized caregiver interventions may offer insight into optimal ways to meet caregiver QOL needs. Conceptually defined and structured mixed methods approaches (qualitative and quantitative) could define components of tailored interventions to minimize caregiver burden and emotional distress that affect caregiver well-being.