Cancer survivors whose spouses reported depressed mood were more likely to be depressed after about a year. However, cancer survivors whose spouses reported better mental and physical health-related quality of life (HRQoL) were less likely to be depressed after about a year.
There are an estimated 14.5 million cancer survivors in the United States. Family members, especially spouses, often provide multiple types of support for cancer survivors, including attending medical appointments, helping with care, and sharing financial responsibilities. Understanding how cancer survivors and their families influence one another can provide directions in improving the health care they all receive and their outcomes in terms of health and well-being, Litzelman explained. Previous studies have shown that depressed mood in cancer survivors is associated with poor health outcomes, including worse treatment adherence and premature mortality, she said.
Litzelman and colleagues used data from 910 cancer patients and their spouses from the Medical Expenditures Panel Survey. The researchers used statistical models to look at how each spouse's quality of life or depressed mood at one time point was associated with his or her partner's risk of depressed mood around 11 months later. They also looked at a comparison group of 910 couples without any kind of cancer-related health problem, in order to determine whether the relationships they saw among couples with cancer were different from what one would expect to see in the general population without cancer.
The researchers found that when the spouses reported feeling depressed, cancer survivors were 4 times more likely to report depressed mood 11 months later, even after taking into account the survivors' previously reported mood, demographic characteristics, and other factors. This association was especially strong in couples when the wife had cancer. Survivors whose spouses reported better HRQoL had a 30 percent decrease in depressed mood 11 months later.
The researchers also found that cancer survivors' mood did not have an appreciable impact on their spouses' risk of depressed mood at a later date. Further, they did not see these associations in couples that did not have any cancer-related health problems.
In an interview, Litzelman said, "We were surprised that the effects of the spouses on the survivors were so much larger in this study than the effect of the survivors on their spouses. We expected to see a more reciprocal relationship. This finding certainly needs to be backed up by other studies, but it highlights the importance of family well-being in cancer survivor outcomes.Our research highlights that spouses need to take care of themselves not just for their own sake, but also for the sake of the cancer survivor," Litzelman noted. "Our findings also suggest that when caring for cancer survivors, clinicians may want to assess the well-being of spousal caregivers. Future research could test whether including caregivers in the survivorship care plan might help to improve outcomes for both caregivers and for cancer survivors."
This study was funded by the Cancer Prevention Fellowship Program of the NCI. The findings and conclusions in this report are those of the authors and do not represent the official position of the NCI. Litzelman declares no conflicts of interest.