Men who reported the highest levels of stress in relation to their wives’ cancer were at the highest risk for physical symptoms and weaker immune responses, the study showed.
The researchers sought to determine the health effects of a recurrence of breast cancer on patients’ male caregivers, but found that how stressed the men were about the cancer had a bigger influence on their health than did the current status of their wives’ disease.
The findings imply that clinicians caring for breast cancer patients could help their patients by considering the caregivers’ health as well, the researchers say.
This care could include screening caregivers for stress symptoms and encouraging them to participate in stress management, relaxation or other self-care activities, said Sharla Wells-Di Gregorio, lead author of the study and assistant professor of psychiatry and psychology at Ohio State University.
“If you care for the caregiver, your patient gets better care, too,” said Kristen Carpenter, a postdoctoral researcher in psychology at Ohio State and a study co-author.
The research is published in a recent issue of the journal Brain, Behavior and Immunity.
Thirty-two men participated in the study, including 16 whose wives had experienced a
breast cancer recurrence an average of eight months before the study began and approximately five years after the initial cancer diagnosis. These men were matched with 16 men whose wives’ cancers were similar, but who remained disease-free about six years after the initial diagnosis.
The participants completed several questionnaires measuring levels of psychological stress related to their wives’ cancers, physical symptoms related to stress, and the degree to which fatigue interfered with their daily functioning. Researchers tested their immune function by analyzing white-blood-cell activation in response to three different types of antigens, or substances that prompt the body to produce an immune response.
The men’s median age was 58 years and they had been married, on average, for 26 years. Almost all of the participants were white.
In general, the men whose wives had experienced a recurrence of cancer reported higher levels of stress, greater interference from fatigue and more physical symptoms, such as headaches and abdominal pain, than did men whose wives had remained disease-free.
The subjective stress assessment used in the study, called the Impact of Events Scale, measures intrusive experiences and thoughts, as well as attempts to avoid people and places that serve as painful reminders. The scale produces a score between 0 and 75; in this case, the higher the score, the more stressed the men were in relation to their wives’ cancer.
Overall, the men in the study produced an average score of 17.59. Men whose wives’ cancer had recurred scored 26.25 as a group, and men whose wives were disease-free scored 8.94. According to the scale, scores above nine suggest a likely effect from the events, and scores between 26 and 43 indicate an event has had a powerful effect on a person’s stress level. Scores over 33 suggest clinically significant distress.
“The scores reported here are quite high, substantially higher than we see in our cancer patient samples outside the first year,” Carpenter said. “Guilt, depression, fear of loss – all of those things are stressful. And this is not an acute stressor that lasts a few weeks. It’s a chronic stress that lasts for years.”
The participants also reported, on average, a total of approximately seven stress-related physical symptoms. Men with wives with recurrent cancer reported nine symptoms, on average, and those whose wives were disease-free reported fewer than five symptoms, on average. These symptoms varied, but included headaches, gastrointestinal problems, coughing and nausea.
“If you care for the caregiver, your patient gets better care, too.”
When the analysis took into consideration the impact of men’s perceived stress in relation to their wives’ cancer, higher stress was associated with compromised immune function: Specifically, men with the highest scores on the stress scale also showed the lowest immune responses to two of the three antigens. Previous research has suggested that people with an impaired immune response are more susceptible to infection and might not respond well to vaccines.
“Caregivers are called hidden patients because when they go in for appointments with their spouses, very few people ask how the caregiver is doing,” said Wells-Di Gregorio, who works in Ohio State’s Center for Palliative Care. “These men are experiencing significant distress and physical complaints, but often do not seek medical care for themselves due to their focus on their wives’ illness.”
In these men undergoing chronic stress, the researchers said that it remains unclear whether the immune dysregulation causes more physical symptoms, or stress causes the symptoms and the impaired immune response.
Wells-Di Gregorio noted that the stress effect might have been even more pronounced than what they observed because disease-free spouses were more reluctant to participate in the study.
“We found that many were not willing to participate because they said they didn’t want to think about cancer again,” she said.
This research was supported by the Ann and Herbert Siegel American Cancer Society Postdoctoral Fellowship, the Longaberger Company-American Cancer Society Grant for Breast Cancer Research, the U.S. Army Medical Research Acquisition Activity Grants, the National Institute of Mental Health and the National Cancer Institute.
Co-authors included Caroline Dorfman and Hae-Chung Yang of Ohio State’s Department of Psychology; Laura Simonelli of the Christiana Care Health System; and William Carson III of Ohio State’s Department of Surgery and Comprehensive Cancer Center.
Written by Emily Caldwell, (614) 292-8310; [email protected]