Psychoneurological symptoms in cancer survivors and their caregivers: a longitudinal pilot study

Abstract In cancer patients, stress is associated with a psychoneurologic symptom cluster of depressed mood, anxiety, pain, fatigue, and sleep disturbance. The stress of caregiving may trigger similar symptoms among caregivers and warrants investigation. The purpose of this analysis was to characterize correlates of psychoneurologic symptoms in cancer caregivers. Cancer survivor-caregiver dyads (n=29) provided eight weekly symptom reports using a web-based assessment system. Symptom burden was calculated as the sum of symptom severity (mean=7.5, SD=8.1, range=0-41). Primary and secondary stressors of caregiving were also assessed. Mixed modeling was used, accounting for repeated measures. Models controlled for person-mean of time varying covariates, as well as sociodemographic, clinical, and care-related covariates. A secondary analysis assessed interdependence in survivor and caregiver symptoms using Actor-Partner Interdependence Models. In descriptive analyses, caregivers most frequently reported feeling anxious (44% on average across timepoints), sleep problems (31%), fatigue (25%), depressed mood (24%), and feeling irritable/angry (24%). Within caregivers, greater hours of care (beta=0.11, p<.01) and more patient symptoms (beta=0.10, p<.01) were associated with greater symptom burden. Between caregivers, higher baseline perceived stress was associated with greater symptom burden (beta=0.38, p=.04) and coresidence with the survivor was associated with lower symptom burden (beta=-12.8, p<.01). Caregivers experienced higher symptoms when patients specifically reported anxiety, lack of appetite, or pain (beta=1.4, 2,4, and 3.0, p<.05). Cross-lagged Actor-Partner Interdependence Models indicated interdependence among survivor and caregiver symptom burden. The findings provide preliminary evidence of the interrelationship of psychoneurologic symptoms in survivors and patients, with implications for symptom management and supportive care practice.