• Neuro-oncology
• Subarachnoid Hemorrhage (SAH)
• Caregiver

• Stress and Aging: Caregiver Outcomes in Neuro-oncology
• The Costs of Cancer Care
• Biobehavioral Interactions in Neuro-Oncology Caregivers

Sherwood, P.

05/01/05 - 04/30/06

Cancer & Aging Program

Stress and Aging: Caregiver Outcomes in Neuro-oncology

Approximately 17,000 people are diagnosed with a primary malignant brain tumor (PMBT) in the United States each year and about 68% of those will die within five years of diagnosis.  Individuals with a PMBT often suffer severe physical and neurological dysfunction throughout the disease trajectory resulting from tumor resection, chemotherapy, radiation, radiation necrosis, tumor recurrence, and/or cerebral edema.  Neurological and functional impairments reduce the ability to perform usual activities and meet occupational, financial, familial, and social obligations.  Responsibilities for meeting obligations, then, often fall to family members, who not only struggle with their loves one’s bleak prognosis, but may experience persistent distress as they transition from family ‘member’ to family ‘caregiver’. 

Research has shown that caregivers for persons with other diseases develop negative psychological and behavioral (psycho-behavioral) responses as a result of providing care, such as depressive symptoms, caregiver burden, and altered sleep patterns.  Negative psycho-behavioral responses may lead to negative biologic responses such as hypertension and immune and endocrine dysfunction resulting in poor overall health.  In turn, negative consequences from providing care may vary according to the caregiver’s age, life experiences, and social roles (e.g. the variation in nature of competing demands for older versus younger caregivers).

Our data suggest that family caregivers of persons with a PMBT are at particular risk for distress, as they face both oncological and neurological issues.  In addition, the majority of caregivers of persons with a PMBT are over 50 years of age, which can be particularly distressing life stages in which to provide care to a family member with an illness due to multiple competing occupational and familial demands.  However, most neuro-oncolgy research focuses on shrinking the tumor and preventing recurrence; few studies have examined distress in caregivers of persons with a PMBT.  In addition, most caregiver studies focus on behavioral markers of distress, such as burden and depression, and less attention is paid to biologic markers or the interplay between behavioral and biologic markers, particularly in the cancer caregiving literature.  The proposed study is unique in that it will examine the interplay between biological and behavioral markers of distress in an under-researched population, middle aged and older (50 years of age and older) caregivers of persons with a PMBT.

This application represents a multidisciplinary effort to gather pilot data to support an R01 application aimed at examining psychological, behavioral, and biologic responses and overall health in middle aged and older persons who provide care to persons with a PMBT.  The purposes of the larger study are to use an integrative model, the Pittsburgh Mind Body Center Model to (1) explore psycho-behavioral and subsequent biologic responses and overall health of family members of persons with a PMBT at the time of diagnosis, and (2) to explore how relationships within the model vary over time in response to changes in the care recipient’s illness trajectory as the family member becomes a caregiver. 

The specific aims of this pilot program project are to:

1) Observe caregivers 50 years of age and over to determine their willingness to actively participate in a longitudinal bio-behavioral research study

2) Collect preliminary data to estimate effect sizes regarding relationships in the model, in particular the relationships between:

a) PMBT characteristics and psycho-behavioral responses

b) Chronic burdens and resources (e.g. age of the caregiver and care recipient) and psycho-behavioral responses

c) Psycho-behavioral responses and biologic responses

d) Biologic responses and overall health

Sherwood, P.

2005-2006

CRE Pilot Study

The Costs of Cancer Care

Despite work in quantifying and comparing the direct costs of cancer care, little is known about how indirect and out of pocket costs influence financial hardship and individual outcomes for patients receiving adjuvant therapy for the treatment of cancer.  The purpose of this cross-sectional pilot study is to further explore the study and measurement of financial hardship in persons with cancer. 

The specific aims of this pilot study are to (1) explore the feasibility of recruiting persons who are receiving adjuvant chemotherapy for a diagnosis of breast, ovarian, colorectal, or brain cancer to actively participate in a research study involving financial hardship, (2) collect preliminary data to estimate effect sizes regarding relationships among indirect/out of pocket costs, financial hardship, and outcomes (adherence to treatment regimens, mood, symptom severity, and quality of life), (3) explore whether income level influences the relationship between indirect/out of pocket costs and financial hardship, and (4) explore perceptions of the ways in which costs have affected the lives of persons with cancer.  A total of 60 participants will be recruited for this cross sectional descriptive pilot study; 15 participants with each of the following diagnoses – breast, ovarian, colorectal, and brain.  Quota sampling will be used with each cancer site-specific subgroup to yield 5 participants in each of the following categories – low income, middle income, and high income.  A one time telephone interview will be performed during which the following information will be collected: indirect and out of pocket costs (Modified Indirect and Nonmedical Costs Scale), perceptions of financial hardship due to the costs of cancer care (Financial Hardship), adherence to treatment regimens (clinic record review), mood (depressive symptoms [Center for Epidemiologic Studies-Depression] and anxiety (Spielberger State Anxiety Subscale]), symptom severity (MD Anderson Symptom Interference Subscale), and quality of life(SF-36).  In addition, four open ended questions will be asked regarding the impact of finances on the patient’s life.  Descriptive and correlational analyses will be used to address specific aims #1-#3.  Content analysis will be used to address specific aim #4.

Sherwood, P.

03/15/06 – 03/15/07

Oncology Nursing Society          

Biobehavioral Interactions in Neuro-Oncology Caregivers

Approximately 17,000 people are diagnosed with a primary malignant brain tumor (PMBT) in the United States each year and about 68% of those will die within a five years of diagnosis.  Individuals with a PMBT often suffer severe physical and neurological dysfunction throughout the disease trajectory resulting  from tumor resection, chemotherapy, radiation, radiation necrosis, tumor recurrence, and/or cerebral edema [2] [3], [4] [5].  Neurological and functional impairments reduce the ability to perform usual activities and meet occupational, financial, familial, and social obligations.  Responsibilities for meeting obligations, then, often fall to family members, who not only struggle with their loved one’s bleak prognosis, but may experience persistent distress as they transition from family ‘member’ to ‘caregiver’.

Research has shown that caregivers for persons with cancer or persons with dementia may develop negative psychological and behavioral (psycho-behavioral) responses as a result of providing care, such as depressive symptoms, caregiver burden, and altered sleep patterns.  Negative psycho-behavioral responses may lead to negative biologic responses such as hypertension and immune and endocrine dysfunction resulting in poor overall health [6] [7-13].  Our data suggest that family caregivers of persons with a PMBT are at particular risk for distress, as they face both cancer and dementia related issues [14-16].  However, few studies have examined distress in caregivers of persons with a PMBT. In addition, most caregiver studies that exist focus on behavioral markers of distress, such as burden and depression, and less attention is paid to biologic markers of distress or the interplay between behavioral and biologic markers of distress, particularly in the cancer caregiving literature.  The proposed study is innovative in that it will examine the interplay between biological and behavioral markers of distress in an under-researched population-caregivers of persons with a PMBT.  The purpose of the proposed study is to gather pilot data to support an R01 application aimed at examining the psychological, behavioral, and biologic responses and overall health in family members who provide care to persons with a PMBT.