Top

27-04-2017 | CNS metastases | Article

Cognitive dysfunction in patients with brain metastases: influences on caregiver resilience and coping

Journal: Supportive Care in Cancer

Authors: Marlon Garzo Saria, Natasia Courchesne, Lorraine Evangelista, Joshua Carter, Daniel A. MacManus, Mary Kay Gorman, Adeline M. Nyamathi, Linda R. Phillips, David Piccioni, Santosh Kesari, Sally Maliski

Publisher: Springer Berlin Heidelberg

Abstract

Purpose

Neurologic deficits that may be manifested as cognitive impairment contribute to the challenges faced by caregivers of patients with brain metastases. To better address their needs, we examined how caregivers respond to these challenges and explore the relationship between the patient’s cognitive impairment and caregiver resilience and coping.

Methods

We conducted a descriptive, cross-sectional study using self-reported data from 56 caregivers of patients with brain metastases. Study participants from a comprehensive cancer center were asked to complete a series of instruments that measured their perception of the patient’s cognitive dysfunction (revised memory and behavior problems checklist, RMBC), their own personal resilience (Resilience Scale, RS), and their utilization of a broad range of coping responses (COPE inventory and Emotional-Approach Coping scale).

Results

Caregivers reported that memory-related problems occurred more frequently in the patients they cared for compared to depression and disruptive behavior (mean scores 3.52 vs 2.34 vs. 1.32, respectively). Coping strategies most frequently used by caregivers were acceptance (3.28), planning (3.08), and positive reinterpretation and growth (2.95). Most caregivers scored moderate to high on the RS (77%). The coping strategy acceptance correlated significantly with the memory and disruptive behavior subscales of the RMBC.

Conclusions

Given the protective effect of problem-focused coping and the high rate of caregivers utilizing less effective coping strategies in instances of worsening cognitive dysfunction, healthcare professionals need to systematically assess the coping strategies of caregivers and deliver a more personalized approach to enhance effective coping among caregivers of patients with brain metastases.

Mariotto AB et al (2011) Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst 103(2):117–128CrossRef

Hutter A et al (2003) Brain neoplasms: epidemiology, diagnosis, and prospects for cost-effective imaging. Neuroimaging Clin N Am 13(2):237–250 x-xiCrossRef

Levin VA, Leibel SA, Gutin PH (2001) Neoplasms of the central nervous system. In: DeVita Jr VT, Hellman S, Rosenberg SA (eds) Cancer: principles and practice of oncology. Lippincott Williams & Wilkins, Philadelphia, pp. 2100–2160

National Cancer Institute (2010) Adult brain tumors treatment (PDQ). [cited 2010 August 21]; Available from: http://www.cancer.gov/cancertopics/pdq/treatment/adultbrain/HealthProfessional/page2#Reference2.11.

Saria MG et al (2015) Current perspectives in the management of brain metastases. Clin J Oncol Nurs 19(4):475–479CrossRef

Warren JL et al (2008) Current and future utilization of services from medical oncologists. J Clin Oncol 26(19):3242–3247CrossRef

Sherwood PR et al (2008) Guiding research in family care: a new approach to oncology caregiving. Psychooncology 17(10):986–996CrossRef

Munoz C et al (2008) The quality of life of patients with malignant gliomas and their caregivers. Soc Work Health Care 47(4):455–478CrossRef

Locke DE et al (2008) Cognitive rehabilitation and problem-solving to improve quality of life of patients with primary brain tumors: a pilot study. J Support Oncol 6(8):383–391PubMed

10.

Klein M et al (2003) The prognostic value of cognitive functioning in the survival of patients with high-grade glioma. Neurology 61(12):1796–1798CrossRef

11.

Farace E (2008) Role of neuropsychological assessment in cancer patients. In: Meyers CA, Perry JR (eds) Cognition and cancer. Cambridge University Press, New York, pp. 33–43CrossRef

12.

Meriggi F et al (2015) Assessing cancer caregivers’ needs for an early targeted psychosocial support project: the experience of the oncology Department of the Poliambulanza Foundation. Palliat Support Care 13(4):865–873CrossRef

13.

Maqbool T et al. (2016) Informational and supportive care needs of brain metastases patients and caregivers: a systematic review. J Cancer Educ

14.

Del-Pino-Casado R et al (2011) Coping and subjective burden in caregivers of older relatives: a quantitative systematic review. J Adv Nurs 67(11):2311–2322CrossRef

15.

Raggi A et al (2015) The burden of distress and related coping processes in family caregivers of patients with Alzheimer’s disease living in the community. J Neurol Sci 358(1–2):77–81CrossRef

16.

Scott CB (2013) Alzheimer’s disease caregiver burden: does resilience matter? J Hum Behav Soc Environ 23(8):879–892CrossRef

17.

Rosenberg AR et al (2013) Promoting resilience among parents and caregivers of children with cancer. J Palliat Med 16(6):645–652CrossRef

18.

Earvolino-Ramirez M (2007) Resilience: a concept analysis. Nurs Forum 42(2):73–82CrossRef

19.

Foster K (2010) ‘You’d think this roller coaster was never going to stop’: experiences of adult children of parents with serious mental illness. J Clin Nurs 19(21–22):3143–3151CrossRef

20.

Harmell AL et al (2011) A review of the psychobiology of dementia caregiving: a focus on resilience factors. Curr Psychiatry Rep 13(3):219–224CrossRef

21.

O’Rourke N et al (2010) Psychological resilience predicts depressive symptoms among spouses of persons with Alzheimer disease over time. Aging Ment Health 14(8):984–993CrossRef

22.

Wilks SE (2008) Psychometric evaluation of the shortened resilience scale among Alzheimer’s caregivers. Am J Alzheimers Dis Other Demen 23(2):143–149CrossRef

23.

Wilks SE, Croom B (2008) Perceived stress and resilience in Alzheimer’s disease caregivers: testing moderation and mediation models of social support. Aging Ment Health 12(3):357–365CrossRef

24.

Wilks SE et al (2011) Alzheimer’s aggression: influences on caregiver coping and resilience. J Gerontol Soc Work 54(3):260–275CrossRef

25.

Zauszniewski JA, Bekhet AK, Suresky MJ (2010) Resilience in family members of persons with serious mental illness. Nurs Clin North Am 45(4):613–626 viiCrossRef

26.

Taylor SE, Stanton AL (2007) Coping resources, coping processes, and mental health. Annu Rev Clin Psychol 3:377–401CrossRef

27.

Chen HM et al (2015) Effectiveness of coping strategies intervention on caregiver burden among caregivers of elderly patients with dementia. Psychogeriatrics 15(1):20–25CrossRef

28.

Nyamathi A (1989) Comprehensive health seeking and coping paradigm. J Adv Nurs 14(4):281–290CrossRef

29.

Pearlin LI et al (1990) Caregiving and the stress process: an overview of concepts and their measures. Gerontologist 30(5):583–594CrossRef

30.

Lazarus RS, Folkman S (1984) Stress, appraisal, and coping. Springer Pub. Co., New York xiii, 445 p

31.

Schlotfeldt R (1975) The need for conceptual framework. Nursing research. Little & Brown, Boston

32.

Berg J et al (2005) Predictors of screening results for depressive symptoms among homeless adults in Los Angeles with latent tuberculosis. Res Nurs Health 28(3):220–229CrossRef

33.

Nyamathi AM, Stein JA, Bayley LJ (2000) Predictors of mental distress and poor physical health among homeless women. Psychol Health 15(4):483–500CrossRef

34.

Nyamathi AM et al (2010) Perceptions of women living with AIDS in rural India related to the engagement of HIV-trained accredited social health activists for care and support. J HIV AIDS Soc Serv 9(4):385–404CrossRef

35.

Washington OG, Moxley DP, Taylor JY (2009) Enabling older homeless minority women to overcome homelessness by using a life management enhancement group intervention. Issues Ment Health Nurs 30(2):86–97CrossRef

36.

Saria MG et al. (2016) An exploratory study of caregiver burden among caregivers of cancer patients with brain metastasis. Unpublished raw data

37.

Roth DL et al (2003) Psychometric analysis of the revised memory and behavior problems checklist: factor structure of occurrence and reaction ratings. Psychol Aging 18(4):906–915CrossRef

38.

Teri L et al (1992) Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist. Psychol Aging 7(4):622–631CrossRef

39.

Wagnild GM, Young HM (1993) Development and psychometric evaluation of the resilience scale. J Nurs Meas 1(2):165–178PubMed

40.

Carver CS, Scheier MF, Weintraub JK (1989) Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol 56(2):267–283CrossRef

41.

Stanton AL et al (2000) Coping through emotional approach: scale construction and validation. J Pers Soc Psychol 78(6):1150–1169CrossRef

42.

Hanly P et al (2015) Examining the role of subjective and objective burden in carer health-related quality of life: the case of colorectal cancer. Support Care Cancer 23(7):1941–1949CrossRef

43.

Hartnett J, Thom B, Kline N (2016) Caregiver burden in end-stage ovarian cancer. Clin J Oncol Nurs 20(2):169–173CrossRef

44.

Herman MA et al (2003) Neurocognitive and functional assessment of patients with brain metastases: a pilot study. Am J Clin Oncol 26(3):273–279PubMed

45.

Robinson KM, Adkisson P, Weinrich S (2001) Problem behaviour, caregiver reactions, and impact among caregivers of persons with Alzheimer’s disease. J Adv Nurs 36(4):573–582CrossRef

46.

Sherwood PR et al (2006) Predictors of distress in caregivers of persons with a primary malignant brain tumor. Res Nurs Health 29(2):105–120CrossRef

47.

Pinquart M, Sorensen S (2003) Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. J Gerontol B Psychol Sci Soc Sci 58(2):P112–P128CrossRef

48.

Weller M (2011) Neurocognitive function: an emerging surrogate endpoint for neuro-oncology trials. Neuro-Oncology 13(6):565CrossRef

49.

Wagnild GM (2009) A review of the resilience scale. J Nurs Meas 17(2):105–113CrossRef

50.

Wagnild GM, Collins JA (2009) Assessing resilience. J Psychosoc Nurs Ment Health Serv 47(12):28–33CrossRef

51.

Snyder CM et al (2015) Dementia caregivers’ coping strategies and their relationship to health and well-being: the Cache County study. Aging Ment Health 19(5):390–399CrossRef

52.

Tschanz JT et al (2013) Caregiver coping strategies predict cognitive and functional decline in dementia: the Cache County dementia progression study. Am J Geriatr Psychiatry 21(1):57–66CrossRef

53.

Joling KJ et al (2015) What are the essential features of resilience for informal caregivers of people living with dementia? A Delphi consensus examination. Aging Ment Health 21:1–9