Waldron, E.A., Janke, E.A., Bechtel, C.F., Ramirez, M., & Cohen, A. (2012). A systematic review of psychosocial interventions to improve cancer caregiver quality of life. Psycho-Oncology. [Epub ahead of print]

To evaluate randomized, controlled caregiver-focused intervention studies intended to improve quality of life (QOL) in caregivers of adult patients with cancer

• Databases used for the search were MEDLINE, PsycINFO, EMBASE, CINAHL, and Cochrane Database Library.
• Studies were included that focused on patients with cancer and had presence of a caregiver (both age 18 or older); reported on a caregiver-targeted QOL measure; used randomization for intervention group assignment; reported on an intervention targeted to meet caregiver needs; and were English language.
• Studies were excluded if the full text of the article was unavailable; they reported on an uncontrolled, nonrandomized, patient-only targeted intervention; QOL was not measured; they included pediatric patients; and were qualitative or descriptive only.

• A total of 1,066 references was retrieved.
• A pair of independent raters first reviewed all abstracts for evidence of inclusion criteria, followed by final review for inclusion by the project leader.
• A second review again used two raters to assess each citation using an 11-item PEDro coding strategy, a Delphi method for randomized controlled trials (RCTs).

• Six studies were included.
• Sample (N = 1,115) range across studies was 30–329 caregivers.
• Study attrition rates were reported as 10.6%–54.7%.
• Mean caregiver age was 56.5 years.
• Approximately 82% of the caregivers were female (where reported).
• Patient cancer types included prostate, breast, or multiple cancer diagnoses across patients in one study.

Multiple phases of care

A variety of measurement instruments was used across the six studies, including the Caregiver QOL Index–Cancer in three studies, Functional Assessment of Cancer Therapy (version 3) and Short Form-36 Health Survey administered together in two studies, and Profile of Mood States–Short Form and Caregiver Strain Index administered together in one study. Two of six studies showed a statistically significant improvement in caregiver QOL at the first measurement interval. Effect sizes were available in four studies, with two showing no effect and two illustrating a small effect on caregiver QOL (Cohen’s d  = 0.264 [Northouse et al., 2007] and 0.271  [Walsh et al., 2007]). The Northouse et al. (2007) study also illustrated a small effect on caregiver coping (d = 0.392), self-efficacy (0.261), and negative appraisal (-0.191). Studies with interventions to improve caregiver ability to communicate and provide education on coping and specific care skills had the most impact.

High attrition rates in studies of the caregiver population were again noted, as are seen in other studies and reviews. The review included an evaluation of the effect of attrition on results and noted no significant impact on results, but it should be noted that the six studies included in this review were selected for their rigor.

The small sample was limited to RCTs of which there are few in the literature (not a fault of this study’s methodology).

More and larger controlled intervention studies are needed to clarify not only which interventions support QOL improvements, but under what circumstances and timing. The authors noted that different approaches may be needed when providing intervention to female versus male spousal caregivers to significantly improve depression. Attention to the optimal format and timing of interventions during phases when distress and need for support may be high, as well as attrition rates due to scheduling and general caregiving burden, is needed.