Anxiety and Depression in Caregivers of Terminally Ill Cancer Patients: Impact on Their Perspective of the Patients' Symptom Burden

Background and Objective: Given the important role caregivers play in palliative care planning and decision making, anxiety and depression in caregivers of terminally ill cancer patients and their impact on the caregivers' evaluation of the patients' physical and psychological symptom burden were analyzed. Design and subjects: Thirty-three patients and their caregivers were recruited through the University Medical Center palliative care inpatient ward <24h after admission. Measurements: Patients completed the Memorial Symptom Assessment Scale (MSAS). Caregivers were instructed to evaluate the symptom burden of the patient. Anxiety and depression were measured in caregivers using the PHQ-9 and the GAD-7. Results: Fifty-five percent of male caregivers and 36% of female caregivers showed moderate or severe anxiety; 36% of male caregivers compared to 14% of female caregivers had moderate or severe depression. Caregivers' anxiety was associated with a discrepancy in the patients' symptom evaluation for shortness of breath (p<0.05); nausea (p<0.05); and frequency, intensity, and distress due to anxiety (p<0.01). Depression was associated with a discrepancy in the patients' evaluation of distress due to constipation (p<0.05), as well as intensity and distress due to anxiety (p<0.05). Both the caregivers' anxiety and depression were not significantly associated with an underestimation of symptoms. There was a trend towards a higher risk of overestimation in caregivers with higher levels of anxiety (r=0.32) (p=0.07) and depression (r=0.33) (p=0.06). Conclusion: Integrative palliative care should offer psychooncological care for the caregivers on a routine basis to avoid misleading perspectives possibly influencing end-of-life treatment decisions.