Behind every patient with cancer, there are caregivers.  In the medical literature, this caregiving is referred to as “informal caregiving,” which simply means that it is not paid caregiving from a home care agency or care provided in a skilled nursing facility.  Informal caregiving provides the majority of care to patients in this country; if informal caregivers were paid, their value would exceed that of all home care agencies and skilled nursing facilities combined.

What do caregivers do?

The better question is, what are they not doing?  In a 2010 study from the University of Minnesota and NCI, caregivers of lung and colon cancer patients were surveyed regarding their activities and stress and resources; these were caregivers who provided 50% or more of their loved one’s care.  What they found was that caregivers, without formal training, were having to monitor for treatment side effects, manage troublesome symptoms like pain and nausea, administer medication, and decide on when to call a doctor or give medication.  This is evident here at GRACE with the very thoughtful questions and discussions that caregivers have on behalf of their loved ones.  Half of the time, these caregivers were also working their own jobs; 1 in 5 had health problems.  In studies of caregivers not specific to cancer, caregiver stress leads to more healthcare, both for themselves and for the loved ones for whom they care.  In comparing caregivers to people who don’t do caregiving, caregivers of patients with cancer have a higher incidence of mood disorders, i.e. depression and anxiety, as well as stress-related health problems.  Compared to caregivers of patients with Alzheimer’s, a disease known to carry significant caregiver burden, caregivers of cancer patients experience the same amount of psychological stress. Read the rest of this entry »

It has been a while since I’ve posted here, and it is nice to be back again! I have been compiling a list of some interesting topics (to me) for future posts, so hopefully we can have some good discussions in the comments section. This particular topic is not specific to lung cancer, but certainly applies to lung cancer patients as much as any other malignancy so I think it will still be of interest.

For many years there has been a consistent observation made among cancer patients that married individuals tend to live significantly longer than do unmarried individuals. This observation holds true across different types of cancer including prostate, breast, and lung. For some reason, the warm support of the spouse at your side seems to be a broadly positive prognostic factor, in addition to the other numerous benefits…

There are any number of reasons for exactly why this might be so. Patients who are married tend to have better financial resources and also have better social support, two elements that independently seem to predict for patients doing better. Marriage also frequently results in children (although marriage not required), which can provide additional support at trying times for elderly patients. There are also reasons to think that patients who are NOT married may have problems that contribute to poor outcomes including psychological problems such as depression, substance abuse, and poor health for reasons other than their cancer. Loneliness is a big problem for my unmarried, elderly patients and I can see first hand that their lives are much harder during treatment than those with big families at their sides.

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   Any oncologist can testify to the difficulties facing family members of patients with cancer.  A recent study out of Canada examines the “biologic cost” of caring for a patient with cancer.  This was a small study in which the researchers compared saliva and blood samples from 18 primary caregivers of people who had just been diagnosed with brain tumors with those from 19 volunteers.  They also used questionnaires to measure perceived stress and depressive symptoms in the caregivers and the volunteers, who were all followed for one year.

   Salivary amylase was used as a proxy for studying activation of the sympathetic nervous system (a.k.a. adrenaline, responsible for the “fight or flight” response).  Normally, this enzyme in saliva declines sharply after awakening and then rises throughout the day.  As expected, this diurnal rhythm was preserved over time in the healthy volunteers.  Caregivers, on the other hand, experienced loss of this normal rhythm over time and then gradual recovery.  C-reactive protein is a measure of systemic inflammation and high levels are a well-documented risk factor for cardiovascular disease.  At the study entry, levels were similar in caregivers and volunteers; however, over time, the caregivers demonstrated increase in CRP.  In fact, half of them developed CRP levels >3 mg/L, a level considered to be a marker for high risk of cardiovascular disease.  CRP levels did not reach a plateau but continued to increase over the year of the study. Over time, caregivers also demonstrated lower expression of anti-inflammatory signaling molecules.

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