Dyadic Study of Cancer Patients & Caregivers: Depressive ... · Kelly M. Shaffer, Armando Mendez,...
Transcript of Dyadic Study of Cancer Patients & Caregivers: Depressive ... · Kelly M. Shaffer, Armando Mendez,...
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Kelly M. Shaffer, Armando Mendez, Maria L. Llabre, Michael Antoni, Neil Schneiderman, Stephany Giraldo, & Youngmee Kim
SBM 2016 · Washington, D.C.
Dyadic Study of Cancer Patients & Caregivers: Depressive Symptoms and Stress Biomarkers
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Dyadic Study of Cancer Patients & Caregivers: Stress Biomarkers and
Depressive Symptoms
PAPER 1
Dyadic Study of Cancer Patients’ and Caregivers’ Depressive Symptoms with their Own and their Partners’ Inflammation and Endocrine Functioning
PAPER 2
Cancer Patients’ and their Caregivers’ Stress Biomarkers are Positively Related at the Early Phase of Survivorship
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SupportShaffer: NCI NRSA F31 CA189431-01A1
Kim: ACS 121909-RSG-12-042-01-CPPB
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Background
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StressPhysiological
ResponseCancer
Depressive Symptoms
Figure from: Miller et al., 2008
• Inflammation• Interleukin-6
• C-Reactive Protein
• HPA axis• Diurnal cortisol
variation
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StressPhysiological
ResponseCancer
Depressive Symptoms
Figure from: Grivennikov et al., 2010
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Physiological Response
Disease
Depressive Symptoms
Cancer
CaregiverStress
• 3 million cancer caregiver in 20151
• Provide care an average of 9 hours per day2
• 35-40% clinically significant depressive symptoms3-4
1 National Alliance for Caregiving, 2015; 2 Kim & Spillers, 2010; 3 Braun et al., 2007; 4 Rhee et al., 2008;
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Physiological Response
Disease
Depressive Symptoms
Cancer
CaregiverStress
• Elevated inflammation:• Hyperinflammatory response to
stress1
• Linear rise in CRP2
• Flatter cortisol slope1
• Greater risk for stroke and cardiovascular diseases3
1 Miller et al., 2002; 2 Rohleder et al., 2009; 3 Ji et al., 2012
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StressPhysiological
Response
Depressive Symptoms
Physiological Response
Disease
Depressive Symptoms
Stress
Patient
Caregiver
1 Antoni et al., 2006; 2 Spiegel & Giese-Davis, 20033 Miller et al., 2002; 4 Rohleder et al., 2009; 5 Ji et al., 2012
Cancer
6 Hagedoorn et al., 2008; 7 Hodges et al., 20058 Kim et al., 2014; 9 Beach et al., 2005
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Physiological Response
Depressive Symptoms
Physiological Response
Depressive Symptoms
Patient Stress
Biomarkers
Caregiver Stress
Biomarkers
Patient Depressive Symptoms
Caregiver Depressive Symptoms
Actor Partner Interdependence Model
Actor Effect
Actor Effect
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Patient Stress
Biomarkers
Caregiver Stress
Biomarkers
Patient Depressive Symptoms
Caregiver Depressive Symptoms
Actor Partner Interdependence Model
Paper 1 Paper 2
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Dyadic Study of Cancer Patients’ and Caregivers’ Depressive Symptomswith their Own and their Partners’ Inflammation and EndocrineFunctioningPAPER 1
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Participants
> 21 years old
English or Spanish
Dx colon or rectal cancer Stage I through V
Past 3 months
Have a family-like individual assisting with their care
> 21 years old
Non-Hispanic White, Black, or Hispanic
English or Spanish
Providing support to the cancer patient
PATIENTS CAREGIVERS
N pt = 84 N cg = 86N dyads = 81
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Variable Measured Via Processed Via Calculation
Depressive Symptoms
Center for EpidemiologicalStudies-Depression
Self-report Sum score after reverse codingCronbach αs= .82-.90
IL-6 Blood Sample R&D Systems Quantikine ELISA kit
Natural log transformed
CRP Blood Sample High-sensitivity Luminex 200 xMap
Natural log transformed
CortisolSlope1-6
Salivettes from waking, afternoon, & evening (2 days)
Chemiluminescenceimmunoassay
Natural log transformedCortisol’ = (cortisol slope)(time) + error
1 Sephton et al., 2000; 2Smyth et al., 1997; 3 Turner-Cobb et al., 2000; 4 Kraemer et al., 2005; 5 Nicholson, 2008; 6 Sephton et al., 2000
Measures
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Descriptives: Covariates
Patient Caregiver Paired t / χ2
Age – 54.20 (9.88) 50.70 (14.43) 2.08*
BMI – 26.28 (6.12) 28.30 (6.93) -1.68†
Gender Female 57% 73% 4.87*
Treatment Status
Receiving Treatment 36%
– –Prior to Treatment 12%
Unknown 52%
Cancer Stage
Early (I – II) 23%
– –Late (III-IV) 66%
Unknown 11%
† p < .10 * p < .05
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Descriptives: Depressive Symptoms and Stress Biomarkers
Patient Caregiver Comparison
CES-D 13.24 (8.03) 15.31 (11.02) Both samples > prior studies1-3
IL-6pg/mL
3.14 (2.56) 1.83 (1.71) Both samples ≈ prior studies3-6
CRPmg/L
6.49 (11.56) 3.60 (4.71)Patients < prior studies4
Caregivers > prior studies3,6-7
Cortisol Slopeμg/dL/hour
-0.09 (0.06) -0.12 (0.07) Both samples ≈ prior studies8-10
1 Cohen et al., 2012, 2 Kurtz et al., 2004, 3 Rohleder et al., 2009, 4 Dymicka-Piekarska et al., 2007, 5 Kaminska et al., 2005, 6
von Känel et al., 2006; 7 Gimeno et al., 2009, 8 Sephton et al., 2013, 9 Turner-Cobb et al., 2000; 10 Kraemer et al., 2006
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Paper 1: Bivariate Results
Own Depressive Symptoms
Partner Depressive Symptoms
Patient IL-6 .08 .05
Patient CRP .02 .18
Patient Cortisol Slope .04 .12
Caregiver IL-6 .16 .20
Caregiver CRP .09 .06
Caregiver Cortisol Slope -.10 .09
• Patient and caregiver depressive symptoms r = .06
No significant associations between patients’ and caregivers’ depressive symptoms with own or partner stress biomarkers
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Pt Stress Biomarker
Cg Stress Biomarker
e1
e2
Paper 1: Dyadic ResultsPatient age, gender, BMI,
treatment, stage
Caregiver age, gender, BMI
Patient Depressive Symptoms
Caregiver Depressive Symptoms
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Paper 1 conclusions
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Timing of data collection during acute diagnosis/ treatment phase
Elevated depressive symptoms in both samples warrant (individualized) intervention
Current sample caregivers
Patient Depressive Symptoms
Caregiver Depressive Symptoms
Figure from: Tuinstra et al., 2004
Current sample patients
Report Clinically Significant Depressive Symptoms (CESD>16)
Patients 28%
Caregivers 38%
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Howren et al., 2009
Patients: .08Caregivers: .12
Patients: .04Caregivers: .07
Patient Stress Biomarkers
Caregiver Stress Biomarkers
Patient Depressive Symptoms
Caregiver Depressive Symptoms
Analysis IL-6 Effect Size CRP Effect Size
BMI Adjusted 0.08** 0.11***
BMI Unadjusted 0.50*** 0.32***
Self-report 0.08** 0.12***
Clinical interview 0.52*** 0.26***
Community sample 0.09** 0.11***
Clinical sample 0.71*** 0.40***
** p < .01 *** p < .001
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Schrepf et al., 2013 Rohleder et al., 2009
Morning
Afternoon
Nocturnal
SalivaryCortisol(nmol/L)
IL-6(pg/mL)
Pre-Surgery 6 month f/u 12 month f/u
Caregivers
Controls
IL-6(pg/mL)
CRP(mg/L)
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Alternative psychosocial correlates/ predictors
Moderating factors
Caregiving Stress
Depressive Symptoms
Physiological Response
Caregiver Disease
Patient’s Disease
Depressive Symptoms
Physiological Response
Patient Stress
Shared Social Environment
SES
Culture
RelationshipFactors
Anxiety
Anxiety
Post-Traumatic Stress
Post-Traumatic Stress
Coping
Coping
Social Support
Social Support
Future Directions
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Cancer Patients’ and their Caregivers’ Stress Biomarkers are Positively Related at the Early Phase of SurvivorshipPAPER 2
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Figure from: Miller et al., 2008
• Inflammation
• Interleukin-6
• C-Reactive Protein
• HPA axis
• Diurnal cortisol variation
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StressPhysiological
ResponseDisease
Depressive Symptoms
Figure from: Grivennikov et al., 2010
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Beach et al., 2005 ; Hagedoorn et al., 2008; Hodges et al., 2005; Kim et al., 2014; Shaffer et al., 2015
StressPhysiological
Response
Physiological Response
DiseaseStress
Cancer
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Participants
> 21 years old
English or Spanish
Dx colon or rectal cancer Stage I through V
Past 3 months
Family-like individual assisting with care
> 21 years old
Non-Hispanic White, Black, or Hispanic
English or Spanish
Providing support to the cancer patient
PATIENTS CAREGIVERS
N pt = 84 N cg = 86N dyads = 81
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Variable Measured Via Processed Via Calculation
IL-6 Blood Sample R&D Systems Quantikine ELISA kit
Natural log transformed
CRP Blood Sample High-sensitivity Luminex 200 xMap
Natural log transformed
CortisolSlope1-6
Salivettes from waking, afternoon, & evening (2 days)
Chemiluminescenceimmunoassay
Natural log transformedCortisol’ = (cortisol slope)(time) + error
1 Sephton et al., 2000; 2Smyth et al., 1997; 3 Turner-Cobb et al., 2000; 4 Kraemer et al., 2005; 5 Nicholson, 2008; 6 Sephton et al., 2000
Measures
Covariates: Patients – age, BMI, gender, treatment status, cancer stage, own & partner depressive sx
Caregivers – age, BMI, gender, own & partner depressive sx
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Descriptives: Stress Biomarkers
Patient Caregiver Paired t Comparison
IL-6pg/mL
3.14 (2.56) 1.83 (1.71) 4.21*** Both samples ≈ prior studies1-4
CRPmg/L
6.49 (11.56) 3.60 (4.71) 1.83† Patients < prior studies2
Caregivers > prior studies1,4-3
Cortisol Slopeμg/dL/hour
-0.09 (0.06) -0.12 (0.07) 1.37 Both samples ≈ prior studies6-8
1 Rohleder et al., 2009, 2 Dymicka-Piekarska et al., 2007, 3 Kaminska et al., 2005, 4 von Känel et al., 2006; 5 Gimeno et al., 2009, 6 Sephton et al., 2013, 7 Turner-Cobb et al., 2000; 8 Kraemer et al., 2006
† p < .10 *** p < .001
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Paper 2: Bivariate Results
Pt IL-6 Pt CRP Pt Cort Slope Cg IL-6 Cg CRP
Patient CRP .70** 1
Patient Cortisol Slope .32* .35* 1
Caregiver IL-6 .27† .32* .01 1
Caregiver CRP .19 .31* .05 .80*** 1
Caregiver Cortisol Slope .25† .19 .31** .23† .20
† p < .10 * p < .05 ** p < .01 *** p < .001
Small-to-moderate correlation in stress biomarkers
between patients and their caregivers
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Pt Stress Biomarker
Cg Stress Biomarker
e1
e2
IL-6:
CRP:
Cort:
Paper 2: Multivariate ResultsPatient age, gender, BMI,
treatment, stage
Caregiver age, gender, BMI
Patient Depressive Symptoms
Caregiver Depressive Symptoms
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Paper 2 conclusions
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Shared risk factors & cross-over effects
Dyadic health-promotion interventions
Future use of dyadic framework warranted
Pt Stress Biomarkers
Cg Stress Biomarkers
StressPhysiological
Response
Physiological Response
DiseaseStress
Cancer
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Cross-sectional
Figures from: Berg & Upchurch, 2007; Currier & Nemeroff, 2014
Patient Stress
Caregiver Stress
Patient Physiology
Caregiver Physiology
Patient Disease
Caregiver Disease
Diagnosis
Longitudinal
Future Directions
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StressPhysiological
Response
Physiological Response
DiseaseStress
Cancer
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Youngmee Kim, Ph.D.
Stephanie Giraldo, M.P.H.
Armando Mendez , Ph.D.
Maria L. Llabre, Ph.D.
Michael Antoni, Ph.D.
Neil Schneiderman, Ph.D.
& many wonderful research assistants of the FAMILY Lab
Shaffer: NCI NRSA F31 CA189431-01A1Kim: ACS 121909-RSG-12-042-01-CPPB
Thank you!