Original Article

When Do We Need to Care About the Caregiver? Supportive

Care Needs, Anxiety, and Depression Among Informal
Caregivers of Patients With Cancer and Cancer Survivors
Halina Sklenarova, MA1; Arne Kru
€mpelmann, MD Candidate2; Markus W. Haun, MD1,3; Hans-Christoph Friederich, MD1,4;
Johannes Huber, MD, PhD5; Michael Thomas, MD, PhD6; Eva C. Winkler, MD7; Wolfgang Herzog, MD, PhD1;
and Mechthild Hartmann, MA1

BACKGROUND: Cancer not only affects patients but also their caregivers. The objective of the current study was to assess the unmet
needs of cancer caregivers and to identify possible predictors of their supportive care needs. METHODS: In a cross-sectional survey,
188 dyads of patients diagnosed with lung, urological, or gastrointestinal cancer and their primary caregivers were recruited. Caregiv-
ers were asked to complete the Supportive Care Needs Survey self-report questionnaire (for partners and caregivers); patients com-
pleted the corresponding questionnaire. Both groups provided information regarding their distress (National Comprehensive Cancer
Network Distress Thermometer), anxiety, and depression (Patient Health Questionnaire-4). Clinical characteristics were obtained from
medical records. RESULTS: The mean age of the caregivers was 57.8 years. Approximately 72.3% were female. Patients had an aver-
age age of 62.5 years, with 33.0% being male. Caregivers were more distressed (P<.01) and exhibited higher anxiety scores (P<.01)
compared with patients. Approximately 14.4% of caregivers reported no unmet need and 43.6% had at least 10 needs that were
unmet. Main caregiver concerns were regarding health care service and information needs followed by emotional and psychological
needs. To some degree, unmet needs in patients and caregivers’ anxiety predicted unmet caregiver needs. Sociodemographic and
clinical variables were not found to be significant predictors. CONCLUSIONS: A substantial percentage of caregivers have unmet
needs for support, mainly with regard to fears concerning the patient’s condition, receiving disease-related information, and emo-
tional support for themselves. Prediction of unmet needs in caregivers from other clinical and psychological variables was rather
poor. Therefore, by means of the frequency and disparity of caregivers unmet needs, they should be systematically assessed to direct
specific offers. Cancer 2015;121:1513-9. V
C 2015 American Cancer Society.

KEYWORDS: neoplasms, caregivers, spouses, family, depression, anxiety, health services needs.

INTRODUCTION
Cancer not only affects patients but also their caregivers, encompassing partners, family members, and close friends.1-3
Confronted with the diagnosis and uncertainty of the disease, caregivers’ emotional well-being is at stake and a notable
number of them are affected by significant anxiety and depression.4 Because patients with cancer stay in the hospital for
shorter periods of time5 and more and more cancer treatment takes place in outpatient settings,6 family caregivers face
increasing duties and responsibilities. These comprise direct and indirect care tasks, such as assisting with activities of daily
living, managing symptoms, providing emotional support, coordination of care,7 and assistance with seeking informa-
tion.8 The multiplicity of these challenges emphasizes the great importance of caregivers to both patients and health care
staff and raises the question of how to support the caregiver most efficiently.
To detect and describe caregivers’ current need of support, the concept of “unmet needs” was endorsed from patient-
oriented psychooncological research. Following this concept, unmet needs are defined as the “requirement for some desir-
able, necessary, or useful action to be taken or some resource to be provided, to attain optimal well-being.”9 There is grow-
ing interest in assessing caregivers’ needs by specific caregiver-tailored instruments9-11 targeting different domains of
frequently unmet needs (eg, emotional and psychological, comprehensive cancer care, and information).12 In fact,

Corresponding author: Mechthild Hartmann, MA, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Im Neuenheimer
Feld 410, D-69120, Heidelberg, Germany; Fax: (011) 49-6221-56-5988; [email protected]
1
Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany; 2Heidelberg University Medical School, Hei-
delberg, Germany; 3Soteria Bern, University Hospital of Psychiatry, Bern, Switzerland; 4LVR-Clinic, Clinics and Institute of the University Duisburg-Essen, Germany;
5
Department of Urology, Heidelberg University Hospital, Heidelberg, Germany; 6Department of Oncology, Thorax Clinic Heidelberg, Heidelberg University Hospi-
tal, Heidelberg, Germany; 7National Center for Tumor Diseases, Programme Ethics and Patient-Oriented Care, University of Heidelberg, Heidelberg, Germany

See editorial on pages 1344-46, this issue.

The current study introduces a family perspective to cancer. It reports that caregivers’ emotional well-being is also significantly affected and presents detailed in-
formation concerning their needs for support.

DOI: 10.1002/cncr.29223, Received: May 13, 2014; Revised: September 5, 2014; Accepted: October 17, 2014, Published online February 11, 2015 in Wiley
Online Library (wileyonlinelibrary.com)

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Original Article

Soothill et al13 demonstrated that cancer caregivers can mensional intensity scale (1 indicates no need/need met, 2
have considerably more unmet needs than the patients indicates low need, 3 indicates moderate need, and 4 indi-
they care for. Furthermore, it appears that there is a signif- cates high need), a cutoff value was set at 3 to detect a mod-
icant percentage of cancer caregivers experiencing a multi- erate or high need of support in each item. There is also the
tude of unmet needs.1,11 Female caregivers, nonspouses, option of calculating mean scores for 4 different domains
and caregivers reporting distress, anxiety, and/or depres- of needs (ie, health care service and information needs,
sion are considered to be at a higher risk of unmet support emotional and psychological needs, work and social secu-
needs.12 However, to the best of our knowledge there is rity needs, and communication and family needs).
no comprehensive study including a broad range of possi- Patients completed the 34-item Supportive Care
ble medical, social, and psychological predictors to iden- Needs Survey-Patient.15 Both surveys (caregiver and
tify the group of caregivers at highest risk. patient versions) demonstrated good psychometric prop-
The objective of the current study was to assess and erties in the validation of the German version (Cronbach
characterize the unmet needs of cancer caregivers in rela- alpha ranges, .76-.94 and .82-.95, respectively). In addi-
tion to the unmet needs of patients, and to identify possi- tion, caregivers were asked if they would accept psychoso-
ble predictors of high supportive care needs in caregivers. cial support offered by professionals.
To our knowledge, it is the first systematic assessment and
analysis of the supportive care needs of caregivers using Distress
established and robust instruments in a broader sample of The National Comprehensive Cancer Network Distress
patients with heterogeneous malignancies. Thermometer (DT),16 a widely used visual analog scale
from 0 (no distress) to 10 (extreme distress), identifies
MATERIALS AND METHODS patients’ and caregivers’ emotional distress experienced
Study Design and Sample within the week before the interview. The clinical signifi-
A cross-sectional survey was conducted in the National cance of distress was assessed by setting a cutoff value of 5
Center for Tumor Diseases and the affiliated Thorax Clinic points as recommended previously.16
at Heidelberg University Hospital. Ethical approval was
granted by the Ethics Commission of Heidelberg Medical Anxiety and depression
School. Subjects diagnosed with lung, urological, or gastro- In addition, patients and caregivers completed the Patient
intestinal cancer and their primary caregivers, defined as lay Health Questionnaire-4 (PHQ-4)17 as well. This is an
health care providers and nominated by the patients, were ultrabrief, self-administered tool with excellent psycho-
recruited in several inpatient and outpatient units between metric properties consisting of a 2-item depression scale
September and October 2012. At the time of the survey, (PHQ-2) and a 2-item anxiety scale (Generalized Anxiety
patients were receiving curative or palliative cancer treat- Disorder Scale-2 [GAD-2]). Subjects report the presence
ment or were in follow-up, respectively. We included adult of a depressed or anxious mood on a 4-point Likert scale
patients with known cancer and their adult primary care- with subscale scores ranging from 0 to 6. The authors rec-
giver. Exclusion criteria were insufficient German language ommend considering scores of 3 as “yellow flags” for
skills, cognitive impairment, and outstanding disclosure of the presence of a depressive or anxiety disorder.17
diagnosis/disease stage to patients. Participants had the
option to complete the survey immediately at the hospital Demographic and Clinical Variables
or later at home. Written informed consent was obtained Sociodemographic variables, including age, sex, working sta-
from all participants included in the study. tus, type of relationship, and social class, were collected from
patients and caregivers. Social class was defined according to
Measures Winkler and Stolzenberg18 using the information regarding
Needs assessment the type of school attended, graduation degree, and occupa-
Caregivers were asked to complete the German version of tional level of the participants. For married couples with dif-
the Supportive Care Needs Survey for Partners & Caregiv- fering social class levels, the higher level for both partners was
ers.14 This instrument contains 45 items and identifies used. Disease-specific variables (tumor localization, metastatic
unmet needs of cancer caregivers. On a 5-point Likert scale, status/type, disease status, and World Health Organization
participants indicate whether they have needed help with a [WHO]-Eastern Cooperative Oncology Group [ECOG]
specific concern within the last month. After recoding the performance status)19 were obtained according to the Basic
items according to scoring instructions14 to build an unidi- Documentation for Psycho-Oncology (PO-Bado) assessment

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Needs of Caregivers of Patients With Cancer/Sklenarova et al

TABLE 1. Sample Description

Caregiver (N5188) Patient (N5188)

N % N %

Age, y 57.8 (SD, 12.5)a 62.5 (SD, 10.3)a

Sex Female 136 72.3a 62 33.0a
Male 52 27.7a 126 67.0a
Type of relationship Spouse/partner 156 83.0
Other family member 30 16.0
Other 2 1.0
Working status Currently working 77 41.0a 17 9.0a
Currently not working 111 59.0a 171 91.0a
Social class (n5161) Low 20 12.4
Middle 27 16.8
High 114 70.8
Tumor localization (n5185) Lung 64 34.6
Gastrointestinal 57 30.8
Urological 64 34.6
Metastasis Yes 140 74.5
No 33 17.6
Uncertain 15 8.0
Disease status Progressive disease 53 28.7
(n5185) Stable disease 68 36.8
Partial remission 19 10.3
Complete remission 15 8.1
Uncertain 30 16.2
ECOG PSb 0-1 172 91.5
2-4 16 8.5

Abbreviations: ECOG PS, Eastern Cooperative Oncology Group performance status; SD, standard deviation; y, years.
a
Level of significant differences between patients and caregivers, P< .001.
b
ECOG PS1 indicates normal activity; 2, from partial to complete bed rest.

sheet20 from medical records and complemented by the 267 eligible pairs of patients and caregivers contacted,
attending physicians. 193 agreed to participate and completed the survey
(response rate, 72.3%). Questionnaires with <60% of the
Statistical Analyses items rated were excluded from analysis. A total of 188
Statistical analysis was performed using SPSS statistical questionnaire pairs (97.5% of completed sets) were finally
software (version 21.0; IBM Corporation, Armonk, NY). subject to analysis.
Initially, after investigation of distribution characteristics, The mean age of the caregivers was 57.8 years
descriptive statistics were calculated to describe the study (standard deviation [SD], 12.5), and 136 subjects
sample. For comparison of caregivers’ and patients’ DT (72.3%) were female (Table 1). The majority of caregivers
scores, anxiety scores, depression scores, and number of were living in a partnership with the patient (156 caregiv-
unmet needs, the Student t test for paired data was com- ers; 83.0%) and 77 caregivers (41.0%) were working
puted. Finally, linear regression analysis was performed to when interviewed.
identify possible predictors of caregiver unmet needs. Patients with cancer had an average age of 62.5
According to previous studies focusing on cancer caregiv- years (standard deviation, 10.3 years), 67.0% of whom
ers’ needs, independent variables of interest were age, sex, were male (126 patients). Patients were diagnosed with
type of relationship, social class, tumor type, WHO- lung (64 patients; 34.6%), urological (64 patients;
ECOG performance status, disease status, depression, 34.6%), or gastrointestinal (57 patients; 30.8%) tumors.
anxiety, distress, and patients’ unmet needs (overall score). The majority of patients with cancer had stable (68
Dependent variables were caregivers’ unmet needs patients; 36.8%) or progressive (53 patients; 28.7%) dis-
(grouped in the 4 need domains). The level of significance ease whereas 34 patients (18.4%) were in partial or
was set to .05 (2-sided for all statistical analyses). complete remission. Three of 4 patients had known
RESULTS metastatic disease (140 patients; 74.5%) and the major-
Sample Description ity of patients (172 patients; 91.5%) had a good
A total of 331 patients were assessed for eligibility, 64 of functional performance according to WHO-ECOG
whom (19.3%) did not meet the inclusion criteria. Of (status of 0-1).

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Original Article

TABLE 2. Caregivers’ Unmet Needs

Unmet No. With Unmet

Rank Need item Need Need

1 Addressing fears about the patient’s physical or mental deterioration 52.7% 97

2 Managing concerns about the cancer coming back 44.6% 83
3 Working through your feelings about death and dying 40.8% 75
4 Accessing information about alternative therapies 36.4% 68
5 Feeling confident that all the doctors are talking to each other to coordinate the 36.2% 67
person with cancer’s care
6 Obtaining the best medical care for the person with cancer 35.3% 65
7 Ensuring there is an ongoing case manager to coordinate services for the person with cancer 35.0% 64
8 Accessing information regarding the benefits and side effects of treatments 34.6% 64
9 Making decisions concerning your life within the context of uncertainty 32.8% 60
10 Accessing information regarding the patient’s prognosis or likely outcome 32.3% 60
24 Getting emotional support for yourself 22.0% 41
26 Balancing the needs of the patient and your own needs 20.7% 38
27 Looking after your own health, including eating and sleeping properly 20.4% 38
Caregivers with at least 5 moderate or high needs 56.4%
Caregivers with at least 10 moderate or high needs 43.6%

The percentage of caregivers reporting moderate or high need on listed items; N total: 183-187 responding to each item.

Unmet Caregiver Needs all cancer caregivers, 48.3% would accept psychosocial sup-
Of all caregivers, 14.4% had no unmet needs, 42.0% port if it was offered to them.
reported <10 unmet needs, and 43.6% reported having
>10 needs unmet. On average, caregivers rated 22.4% of Distress, Anxiety, and Depression
the presented needs as not met (10 of 45 need items). Dis- The mean caregiver score on the DT was 5.47 (SD,
persed over the 4 domains, the highest scores were found 2.37). For patients, the mean DT score was 4.75 (SD,
for health care service and information needs (mean, 1.91; 2.35). Using a cutoff point of 5, 69.1% of cancer care-
SD 6 0.85) followed by emotional and psychological givers and 54.1% of patients were screened as positive
needs (mean, 1.72; SD 6 0.72). With regard to work and for distress, respectively. The Student t test for paired
social security needs (mean, 1.52; SD 6 0.64) and com- data revealed that caregivers were significantly more dis-
munication and family needs (mean, 1.27; SD 6 0.50), tressed than patients (P<.01).
the scores were somewhat lower. For caregivers, the mean depression score (PHQ-2)
In reference to single need items (Table 2), caregivers was 1.82 (SD, 1.55) and the mean anxiety score (GAD-2)
reported most frequently the need for support in was 2.15 (SD, 1.58). Using the cutoff point of 3, 26.5%
“addressing fears about the patient’s physical or mental of caregivers screened positive for depression and 34.9%
deterioration” (item 17; 52.7%), in “managing concerns for anxiety. For patients, the mean score was 1.88 (SD,
about the cancer coming back” (item 31; 44.6%), and in 1.53) on the PHQ-2 and 1.70 (SD, 1.55) on the GAD-2.
“working through your feelings about death and dying” This corresponds to elevated levels of depression in 28.4%
(item 39; 40.8%). Apart from these support needs related of patients and anxiety in 26.3% of patients. Caregivers
to their emotional well-being, caregivers experienced exhibited significantly higher anxiety scores compared
unmet needs regarding information about alternative thera- with patients (P<.01).
pies (item 4; 36.4%) and treatment benefits and side effects
(item 6; 34.6%) as well as the patient’s prognosis (item 2; Predictors of Caregiver Needs
32.3%). Furthermore, 36.2% of caregivers had unmet Regression analysis revealed the following to be significant
needs for support in “feeling confident that all the doctors predictors of unmet needs in cancer caregivers. A higher
are talking to each other to coordinate the person with can- amount of unmet needs in patients predicted higher unmet
cer’s care” (item 11). Every fifth caregiver reported having a caregiver needs in all domains, namely health care service
moderate or high unmet need in receiving “emotional sup- and information needs (ß, .40; P<.01), emotional and psy-
port for oneself” (item 37; 22.0%). Approximately the chological needs (ß, .38; P<.01), work and social security
same amount of caregivers reported needs for support in needs (ß, .23; P<.05), and communication and family
both looking after their own health (including eating and needs (ß, .21; P<.05). In addition, a greater caregiver DT
sleeping properly; item 15 [20.4%]) and in balancing their score was associated with unmet needs in the domains of
own needs against the patient’s needs (item 34; 20.7%). Of health care service and information (ß, .23; P<.05),

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Needs of Caregivers of Patients With Cancer/Sklenarova et al

TABLE 3. Predictors of Caregiver Unmet Needs (Multiple Linear Regression Analysis)

Health Care
Service and Emotional and Work and Social Communication
Information Psychological Security Needs and Family
Needs (Scale 1) Needs (Scale 2) (Scale 3) Needs (Scale 4)
R250.22 R250.40 R250.13 R250.25

Predictor b P b P b P b P

Age (patient) 2.12 .417 2.04 .774 2.15 .343 2.28 .053
Age (caregiver) .03 .866 .02 .911 .10 .555 .21 .175
Sex (patient) 2.05 .764 .00 .980 2.12 .499 .05 .791
Sex (caregiver) .05 .760 .03 .861 2.07 .701 .03 .862
Relationship (partner vs others) .00 .984 .01 .926 .05 .765 2.14 .333
Social class (low/middle vs high) 2.02 .801 .00 .969 2.05 .549 .07 .373
Tumor localization (lung vs others) 2.03 .674 .04 .597 2.11 .176 .02 .759
ECOG PS (021 vs 224) 2.05 .592 2.03 .648 2.04 .638 2.19a .021
Disease statusb .03 .702 .04 .594 .02 .844 .00 .961
Depression (patient) .07 .560 .13 .234 .05 .714 .20 .109
Depression (caregiver) 2.02 .858 .11 .323 .07 .572 .13 .271
Anxiety (patient) 2.25 .065 2.29a .016 2.07 .642 2.41c .002
Anxiety (caregiver) .21 .087 .33c .003 2.01 .931 .36c .003
Distress (patient) 2.08 .421 2.02 .854 2.07 .481 .02 .823
Distress (caregiver) .23a .016 .22c .008 .25a .011 .03 .758
Unmet needs (patient) .40c .000 .38c .000 .23a .014 .21a .016

Abbreviation: ECOG PS, Eastern Cooperative Oncology Group performance status; b, regression coefficient.
a
P<.05.
b
Progressive disease/stable disease/uncertain versus partial/complete remission.
c
P< 01.

emotional and psychological needs (ß, .22; P<.01), and Study results revealed that caregivers’ well-being
work and social security needs (ß, .25; P<.05). Higher anx- is highly affected by a cancer diagnosis. Recently, a
iety scores in caregivers and, in contrast, lower anxiety study by Goldzweig et al21 revealed that levels of psy-
scores in patients were associated with unmet caregiver chological distress were nearly double in a group of
needs in the domains of emotional and psychological needs caregivers of older patients with cancer compared with
(ß, .33 [P<.01] and ß, 20.29 [P<.05], respectively) and a control group. In this study sample, the majority of
communication and family needs (ß, .36 [P<.01] and ß caregivers were screened as positive for distress
20.41 [P<.01], respectively). In addition, a lower WHO- (69.1%), significantly more so than patients. Com-
ECOG performance status was associated with an elevated pared with the general population,17 a remarkable
need for support for caregivers in the domain of communi- number of caregivers and patients were screened as
cation and family needs (ß, -.19; P<.05). In this sample, positive for anxiety and depression; L€ owe et al17
age, sex, type of relationship, social class, tumor type, dis- reported a prevalence of 2.0% for anxiety in the gen-
ease status, depression, and patient’s distress were not found eral German population compared with 8.1% and
to be significant predictors of unmet needs in caregivers 5.4%, respectively, in the caregivers and patients in the
(Table 3). current study. In addition, 6.1% of caregivers and
6.6% of patients were screened as positive for depres-
DISCUSSION sion (vs 2.8% in the general population).17 As
Analysis of caregivers’ support needs demonstrated that reported, caregivers had a significantly higher anxiety
cancer caregivers have unmet needs across different score than patients, which corresponds to their most
domains: These were most frequently found in the frequently mentioned needs, emphasizing that fears
domains of health care service and information needs and the possible threat of losing a loved one arise in
and emotional and psychological needs. Considering caregivers when confronted with a diagnosis of cancer.
single need items frequently not met, analysis revealed The results of the current study indicate a need for
caregiver fears and sorrows are at the very fore: caregiv- psychological support for numerous relatives caring for
ers often reported the need for support concerning patients affected by different tumor types.
their fear regarding disease progression or recurrence of Approximately one-third of all cancer caregivers
the cancer. were in need for support in accessing information

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Original Article

regarding alternative therapies as well as in feeling confi- in the same domains. This finding might appear surpris-
dent that physicians coordinate the patient’s care coher- ing at first. It may be explained with psychodynamic
ently. Involving patients and caregivers in theory,27 which states that defense mechanisms, such as
multidisciplinary tumor conferences might constitute a suppression of anxiety, are common in patients dealing
step toward meeting that goal. Caregivers are mainly with cancer but may lead through processes of transfer-
dealing with the patient’s needs rather than their own. ence to higher levels of anxiety in caregivers. In this sce-
This is in accordance with previous findings by Frieth- nario, caregivers appear to require additional support to
riksdottir et al,22 who demonstrated that the most im- cope with negative feelings.
portant needs were related to patient care and honest and This raises the question of the potential implications of
understandable information. However, caregivers in the the results of the current study for clinicians. Easy-to-assess
current study sample did not negate their own unique variables (eg, age, sex, and type of relationship) demonstrated
needs as observed before23; a noticeable percentage of no associations with the amount of caregivers’ unmet needs.
caregivers had a moderate or high need for help in receiv- In addition, caregivers’ need for support can hardly be
ing emotional support, respecting their own health, and derived from patient’s medical data, namely tumor localiza-
balancing their own needs and the patient’s needs. In tion, disease status, and WHO-ECOG performance status.
addition, it is encouraging to note that asking for accep- Consequently, it is possible that a caregiver of a cancer survi-
tance of psychosocial support programs finds approval of vor has the same need for support as a caregiver of a termi-
relatives; nearly one-half of the caregivers asked (48.3%) nally ill patient. In addition, anxiety and distress scores were
stated they intended to take part in such programs if found to be poor predictors of caregiver needs. Only a very
offered to them. This indicates that a low-threshold complex variable, namely the amount of patients’ unmet
access to psychooncological counseling should be offered supportive care needs, was found to be a consistent but mod-
to caregivers with positive and borderline screening erate predictor. This implies that in some cases, the needs of
results. patients as well as caregivers can be fulfilled by including
Multiple regression analysis revealed few variables both simultaneously, although in some other cases individual
that were associated with cancer caregivers’ unmet needs. offers for caregivers will be necessary.
However, only the amount of patients’ supportive care The ability to predict caregivers’ unmet needs by soci-
needs consistently predicted caregiver needs across all odemographic or medical variables is rather limited. Never-
domains. This finding is in accordance with previous theless, many of the caregivers exhibited the need for
studies23,24 and confirms that higher unmet needs of support when requested explicitly. Compared with previ-
patients tend to go along with a higher need for support ous studies, a remarkably high percentage of caregivers
among caregivers. This emphasizes the relevance of (43.6%) had 10 unmet supportive care needs. This indi-
recently reported psychosocial interventions for both cates that it might not be a minority of cancer caregivers
patients with cancer and caregivers.25 In fact, dyadic inter- who are affected by multiple needs, as reported elsewhere.11
ventions are reported to be at least as efficacious as A better integration of caregivers in routine comprehensive
patient-only and caregiver-only interventions.26 cancer care is necessary to fulfill their roles adequately.
Caregiver distress was found to be associated with a
higher need for support in the domains of health care serv- Strengths and Limitations
ice and information, emotional and psychological needs, The current study assessed the unmet needs of caregivers
and work and social security needs. However, the strength supporting patients with heterogeneous malignancies, spe-
of this association was poor. This observation might result cifically lung, urologic, and gastrointestinal tumors. Com-
from the finding that distress was not able to predict the pared with other studies surveying only caregivers of
caregiver’s unmet needs of the last month because it disease-free cancer survivors,11,28 the current study sample
referred only to a short period of time (last 7 days only). included caregivers of patients with different disease status
The caregivers’ high need for support concerning fear of (progressive disease, stable disease, and partial and com-
disease progression and fear of disease recurrence is a main plete remission) because caregiver needs occur over the
finding. Consequently, anxiety in caregivers is associated whole cancer trajectory.29 In addition, the results of the
with increased caregiver unmet needs, but only within the current study demonstrated a good response rate (72.3%).
domains of emotional and psychological needs and com- However, female caregivers were overrepresented in the
munication and family needs. In contrast, less anxiety in current study sample. This sex imbalance is likely to be
patients was correlated with higher caregiver unmet needs caused by distributions of tumor types in the study sample

1518 Cancer May 1, 2015

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Needs of Caregivers of Patients With Cancer/Sklenarova et al

(men are more frequently affected by lung and urological 10. Girgis AS, Lambert S, Lecathelinais C. The supportive care needs
survey for partners and caregivers of cancer survivors: development
tumors)30 and limits the generalization of study results and psychometric evaluation. Psychooncology. 2011;20:387-393.
onto all caregivers. 11. Hodgkinson K, Butow P, Hobbs KM, Hunt GE, Lo SK, Wain G.
Assessing unmet supportive care needs in partners of cancer survi-
vors: the development and evaluation of the Cancer Survivors’ Part-
Conclusions ners Unmet Needs measure (CaSPUN). Psychooncology. 2007;16:
The results of the current study indicated that a significant 805-813.
number of caregivers had a high need of support. Health 12. Lambert SD, Harrison JD, Smith E, et al. The unmet needs of part-
ners and caregivers of adults diagnosed with cancer: a systematic
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