Signs of Depression Associated with Physical Health Decline among Cancer Caregivers

Female caregiver helping older man with groceries

"At MSK, there are lots of resources available for caregiver support," says Dr. Shaffer.

Cancer affects more than just people who have it: Family and friends face their own unique set of challenges when a loved one is diagnosed. Kelly Shaffer, a clinical psychologist and research fellow at MSK, found that caregivers who said they had more signs of depression than other caregivers tended to report worsening physical health over the following six years. Of the factors studied, depressive symptoms were the only predictor of a decline in caregiver physical health, and the findings rang true across ethnic and socioeconomic backgrounds.

We spoke with Dr. Shaffer to learn more about the study’s results, which were reported in the journal Cancer.

What did you already know about caregivers going into this study?

We already knew that family members are integral to a person’s cancer treatment and recovery. We also knew that, unfortunately, caregiving increases family members’ own risk for worsening health. My colleagues and I wanted to better understand what factors may influence caregivers’ physical health decline, how to identify who’s at greatest risk, and how we might intervene to prevent that decline.

What did you find?

As part of an American Cancer Society survey, caregivers across the nation answered questions at two-, five-, and eight-year time points after their loved one’s cancer diagnosis. We looked at how caregivers’ depressive symptoms at two years post-diagnosis related to the change in their reported physical health over the course of those three assessment points. We found caregivers who had higher depressive symptoms two years after a loved one’s diagnosis had a more pronounced physical health decline over the following six years. This was the only factor we studied that predicted caregivers’ more pronounced physical health decline.

Why do you think that was the case?

This study wasn’t looking for a mechanism — a reason why something happens — but was instead looking at factors that might predict an outcome. That said, other literature suggests that this could be related to behavioral factors. For example, studies have shown that people with depression have a harder time exercising and eating well, they are more likely to smoke, and they have a hard time sleeping. Also, we know that depression is physiologically related to higher stress hormones, which can affect health over time. So there are a few mechanisms that could be at work linking depression to worsening health among caregivers.

How can we help improve the conversation around caregiver health?

Kelly Shaffer, a clinical psychologist and research fellow at MSK

Kelly Shaffer, a clinical psychologist and research fellow

It’s definitely a growing area of science, which is exciting and important. There are pushes from the National Cancer Institute and the National Institute of Nursing Research to fund research in this area.

Here at MSK, there are lots of resources available for caregiver support from the Department of Social Work, Integrative Medicine, and Psychiatry and Behavioral Services. I help all types of caregivers in a one-on-one setting in our Caregivers Clinic led by psychologist Allison Applebaum. We also have caregiver support groups and a lot of written materials. The Patient and Caregiver Education Department has a comprehensive guide to caregiving. We’ve also been developing a caregiver resources webpage that should be launching in July as part of the MyMSK online patient portal.

On an individual level, how can someone help a caregiver?

A specific offer to help can really go a long way. Instead of saying, “Let me know if you need anything,” you could offer to provide transportation for the patient, or to pick up his or her prescriptions at the pharmacy. Anything specific that you feel comfortable and able to assist with, make that known.

It’s important to regularly reach out to caregivers to see how they’re doing. We sometimes forget about friends and family of people with cancer, who are going through the cancer experience in their own way too.

What advice would you give a caregiver?

Helping your loved one is an important role, but it can also be so challenging. Taking care of yourself is essential for you to be there for your loved one. Seek out and allow support through both informal networks like family and friends and also through formal, professional services like those offered here at MSK. Caregiving is a challenging experience. We want to support you as you support your loved one.