Tumors, for family members of patients the risk of psychiatric disorders is higher than average

The psychological distress that accompanies a cancer diagnosis is considerable. Sometimes scary. And not just for those who receive the diagnosis: the emotional burden of cancer weighs heavily on those who care for those with cancer as well. Men and women who suddenly find themselves having to support their life partner both on a practical level, i.e. in the daily management of the oncological disease, and on an emotional one.

A study published in Jama Network Open: “Our goal – reports Qianwei Liu, epidemiologist researcher at the Karolinska Institutet in Stockholm, and one of the authors of the publication – was to evaluate the overall burden of psychiatric disorders among a group of fellow cancer patients and to describe the possible changes of this load over time”.

I study

The study involved 546,321 spouses of patients diagnosed with cancer from 1986 to 2016 in Denmark and from 1973 to 2014 in Sweden, and 2,731,574 men and women living with people without cancer (general population cohort), all with a average age of about 60 years. From the analysis of the data it was found that over the course of 8.4 years, 7 out of 100 spouses of cancer patients developed a psychiatric disorder compared with 5 in partners of people without cancer.

In the 12 months following diagnosis, caregivers’ risk of developing psychiatric disorders is 30% higher than that found in the general population, and was 14% higher during the observed period. In the first case, the increased risk mainly concerned depression and stress-related disorders, in the second also the use of substances. In the event of a worse prognosis, advanced stage disease or death, the phenomenon is more pronounced. Furthermore, among caregivers with pre-existing psychiatric problems, the risk of experiencing mental health problems that they had never suffered before is 23% higher than that found in the control sample.

Shifting attention: from the patient to the family

How to use this data? According to the authors they should stimulate doctors to shift attention to the family and not focus only on the patient. “This just published is an interesting work, well done and which lends itself to many reflections”, he comments a Health Massimo Di Maio, National Secretary of the Italian Association of Medical Oncology (Aiom) and Oncology Director of the Mauriziano Hospital, University of Turin. “Most published studies on mental health of caregivers investigate the level of depression using questionnaires ad hoc administered in a timely manner, that is lump sum. Instead, in this case the authors conducted a population study: they calculated the risk in the first year of illness and during the follow-up, i.e. they went to see what happens over time”.

It is certainly not the first time that the subject has been treated. As of October 2022 they had been posted on Psycho-Oncology the results of a review of 35 studies (for a total of 11,396 participants) on the depression of caregivers of cancer patients. “In that case – continues the oncologist – the conclusion was reached that the psychiatric problem was clearly greater in female caregivers than in men. Here, however, the opposite emerges: compared to the general population, the risk of depression is higher in men, and it is anything but negligible”.

Multiple myeloma: 10,000 euros in annual costs for patients and caregivers

by Simone Valesini

November 15, 2022

Prognosis, economic burden, fatigue and isolation

The causes of the phenomenon are different. There is a strictly psychological aspect – reflects the expert – linked to the prognosis. And there is also a socio-economic burden that affects the emotional state of both the patient and the caregiver. If the person who falls ill is a freelancer or in any case an unsecured worker, the economic damage is immediate and weighs on the whole family, spouses and children: cancer can impoverish. “Of course, this is the case, and it is also very probable that a portion of the psychological burden that the caregiver has to bear, and which the study just published has brought to light, is attributable to this phenomenon – reasons the expert – as well as, of course, to the physical and organizational commitment which, especially in some phases of the disease, favors the sense of loneliness and isolation”.

The psychological support that is still missing

Today in Italy we do not guarantee adequate psychological support to patients and those who take care of them: there are structures that have a psycho-oncology service in the ward, there are some with a psychology service that covers various wards and there are also structures in which a service is completely missing, and it is often the associations that make up for it. “Anyone who deals with cancer today is aware that there is a need for psychological support also for the caregiver, as Aiom and the Aiom Foundation have repeatedly emphasized on various occasions – concludes the oncologist – But the feeling is that our welfare fabric and society is still weak compared to this need: many caregivers risk isolation, loneliness due to the burden due to family management, living their condition of psychological suffering themselves as if it were almost inevitable, a destiny. But it shouldn’t be like this, we need a support network to protect the caregiver’s mental health, because it’s right for the caregiver, and also for the patient.”