1. Fuerst, Mark L.

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The use of a videoconference intervention can significantly reduce the levels of anxiety and distress among "distance" caregivers of patients with cancer, according to a new study.

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Caregivers in general have high rates of anxiety and stress, which has been found to have a negative impact not only on their own health but their ability to provide high-quality care to the patient. Distance caregivers are informal, unpaid caregivers (family or friends) who live more than 1-hour travel time from the patient.


"This distress and anxiety are often caused by uncertainty regarding the patient's condition or a lack of first-hand information from clinical visits," said Sara L. Douglas, PhD, RN, lead author of the study, as well as the Gertrude Perkins Oliva Professor in Oncology Nursing and Assistant Dean for Research at the Case Western Reserve University School of Nursing.


Approximately 20 percent of caregivers live more than 1 hour away from patients with cancer, and nearly one-third of distance caregivers are the sole caregiver for their loved ones. Douglas presented the results of the study at a press briefing before the 2020 ASCO Annual Meeting (Abstract 12123).


To address the challenges of distance caregivers, Douglas and colleagues developed a three-part intervention comprised of four monthly videoconference coaching sessions with a nurse practitioner or social worker, focused on providing information and support (Arm 1); videoconference participation in patient-oncologist visits (Arm 2); and access to a website with resources designed specifically for distance caregivers (controls). The videoconference helped strategize self-care and examine what resources were available for stress reduction and ways to be more involved in more advanced care planning, she noted.


"Distance caregivers experience a tremendous amount of anxiety and distress-often greater than people with cancer themselves," said Douglas. "With COVID-19, the challenges that distance caregivers face are now the same challenges facing many local caregivers who can't attend their loved ones' appointments. Our video conferencing intervention shows that it's possible to meaningfully reduce anxiety and distress for distance caregivers through fairly simple technology."


About the Study

The randomized controlled trial was conducted at a large urban comprehensive cancer center, though distance caregivers in the study lived in a variety of settings. Participants were randomized to receive one of three interventions. The researchers assessed changes in levels of distress and anxiety before and after the interventions using a questionnaire completed before randomization and at the end of the 4-month intervention.


A total of 441 patient-caregiver groups were enrolled. The average age of distance caregivers was 47 years; 71 percent were female and about two-thirds of caregivers were children of the patient. The average age of patients was 65 years; 60 percent were female, and 30 percent and 18 percent had gastrointestinal and hematologic cancers, respectively. Of patients with solid tumors, 59 percent had stage IV disease.


Of the distance caregivers who received the full intervention (Arm 1), 19.2 percent experienced significantly reduced anxiety and 24.8 percent reported reduced distress. In Arm 2, 17.3 percent had improvements in anxiety scores and 19.8 percent had improvements in distress scores.


"We found the greatest percentage improvement in stress and anxiety score if the distance caregiver received the full intervention, with the effect moderate to large. In Arm 2, the effect was moderate," said Douglas.


Financial costs did come up during the videoconferences. "In general, the distance caregiver spent $400 per month in expenses. Distance caregivers expressed the desire to travel more to see loved ones, but financial issues can be an impediment," said Douglas.


The use of videoconferencing added 2-4 minutes to the office visit and had a high degree of getting all participants involved. "Anecdotally, oncologists reported fewer phone calls and emails at the end of the day if the distance caregiver participated. Distance caregivers liked being able to ask questions in real time, and patients reported feeling more supported by having the distance caregiver present," said Douglas.


She recommends that oncologists ask their patients if they have a distance caregiver, and encourage the distance caregiver to join the office visit. "This benefits not only the distance caregiver, but the patient as well, and does not add a significant amount of time to the office visit," said Douglas. "We recognize that not all health care systems have the resources to provide individualized coaching sessions to distance caregivers, but videoconferences in the office can improve stress and anxiety in this group of distance caregivers."


Douglas noted that "in this time of COVID-19 and distancing, this intervention has the potential to benefit not only true distance caregivers, but other caregivers who may not be able to be with their loved ones with cancer for office visits and treatments due to institutional or health restrictions."


Cardinale B. Smith, MD, PhD, Chief Quality Officer of Cancer Services at the Mount Sinai Health System in New York, told Oncology Times, "caregivers play an important role in cancer care delivery and the literature demonstrates that they often have increased anxiety, depression, and poorer health outcomes when caring for a loved one with serious illness. This intervention is important in that it provides clear and concrete activities (videoconference and coaching) that caregivers can participate in to decrease anxiety and stress."


Next Steps

The researchers plan to test this intervention in other caregiver populations, for example, patients with Alzheimer's disease. They also plan to work with health care providers to offer videoconference technology to cancer patients with a distance caregiver.


ASCO President Howard A. "Skip" Burris III, MD, Chief Medical Officer and President of Sarah Cannon Research Institute, commented: "As COVID-19 forces separation from loved ones and increases anxiety for people with cancer and their caregivers, providing emotional support virtually is more important than ever. This study shows how effective videoconferencing interventions can be in improving the emotional well-being of remote caregivers, who in turn provide critical support for patients."


Mark L. Fuerst is a contributing writer.