Nurse-led survivorship care programs (SCPs) may improve the health and resiliency of caregivers of patients with advanced head and neck cancer (HNC), according to data from a recently published randomized controlled trial (Lee L-Y, et al. Semin Oncol Nurs. 2023 Apr 11. Epub ahead of print). Effective SCPs have been shown to positively influence health outcomes in patients with cancer, but there has been insufficient research regarding the effects of SCPs on caregiver health and resilience.
After 6 months, primary caregivers who participated in the nurse-led SCP group showed greater improvements than the control group in terms of emotional distress, social support, physical health, mental health, and resilience, including the resilience aspects of equanimity (composure) and perseverance. Although the resilience aspects of self-reliance, meaningfulness, and existential aloneness were not improved, the researchers asserted that improvement in several aspects of resilience will support the health of primary caregivers and advance their ability to provide care.
“An SCP may feasibly help alleviate emotional distress, improve social support, increase physical and mental health, and strengthen resilience in the primary caregivers of patients with head and neck cancer,” the investigators wrote. “Healthcare providers should encourage primary caregivers to join an SCP.”
HNCs rank fifth among the most common cancers worldwide, accounting for more than 200,000 deaths each year, with approximately 15,000 of those deaths occurring in the United States. More than one-half of HNC cases are diagnosed at an advanced stage, with a 5-year survival rate of approximately 40% to 50%.
Patients with HNC rely heavily on their caregivers, due to significant physical and psychosocial deterioration resulting from their cancer and its treatment. Most of these caregivers are spouses, live with the patient, and provide care for an extended period of time. As a result, the primary caregivers of these patients often experience emotional distress, social impairment, and declines in physical health. These poor outcomes generally arise from inadequate coping mechanisms, maladaptation, and diminished resilience (an individual’s ability to cope with stressful events and return to normal functioning), as well as a tendency of caregivers to neglect their own physical and mental health.
The study included 100 patient-primary caregiver dyads who were randomized to either a nurse-led SCP group or usual care for a 6-month period after treatment completion (a critical time during which patients and their caregivers adjust to life after HNC). All participants completed self-reported questionnaires before and after the intervention, and they were all informed of their grouping assignment.
The experimental group met monthly during the 6-month nurse-led SCP; personalized tutoring in caregiving tasks was provided to primary caregivers during a 1-hour visit at the clinic after the patient had completed his or her initial HNC treatment. Subsequent trainings were provided during the patient’s monthly clinic follow-up visits, and follow-up calls to discuss any problems and concerns of the primary caregivers were made twice weekly. The control group received usual care, including caregiving information regarding symptom management, daily care, and medical appointments. After the research period ended, the nurse-led SCP was provided to the primary caregivers in the control group.
The researchers noted that nurse-led SCPs can even be applied before patients complete treatment, which may increase the positive effect on physical health and adaptation of caregivers. They also recommended that the results of their study be used to aid in the development of more optimal SCPs for primary caregivers of patients with HNC.
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