Interventions to Improve Outcomes for Caregivers of Patients with Advanced Cancer: a Meta-Analysis.

Abstract

Family caregivers of patients with advanced cancer often have poor quality of life (QOL) and mental health. We examined the effectiveness of interventions offering support for caregivers of patients with advanced cancer on caregiver QOL and mental health outcomes. We searched Ovid MEDLINE, EMBASE, Cochrane CENTRAL, and CINAHL databases from inception through 6/2021. Eligible studies reported on randomized controlled trials for adult caregivers of adult patients with advanced cancer. Meta-analysis was conducted for primary outcomes of QOL, physical well-being, mental well-being, anxiety, and depression, from baseline to follow-up of 1-3 months; secondary endpoints were these outcomes at 4-6 months and additional caregiver burden, self-efficacy, family functioning and bereavement outcomes. Random effects models were used to generate summary standardized mean differences (SMD). Of 12,193 references identified, 56 articles reporting on 49 trials involving 8,554 caregivers were eligible for analysis; 16 (33%) targeted caregivers, 19 (39%) patient-caregiver dyads, and 14 (29%) patients and their families. At 1-3 month follow-up, interventions had a significant effect on overall quality of life (SMD 0.24 (0.10 to 0.39), I2=52.0%), mental well-being (SMD 0.14 (0.02 to 0.25), I2=0.0%), anxiety (SMD 0.27 (0.06 to 0.49), I2=74.0%), and depression (SMD 0.34 (0.16 to 0.52), I2=64.4), compared to standard care. In narrative synthesis, interventions demonstrated improvements in caregiver self-efficacy and grief. Interventions targeting caregivers, dyads, or patients and families led to improvements in caregiver QOL and mental health. These data support the routine provision of interventions to improve well-being in caregivers of patients with advanced cancer.