-Original-

Psychological Distress among Caregivers for Patients Who Die of Cancer: A Preliminary Study in Japan

Mariko Asai^1,2, Yoshihisa Matsumoto³, Tomofumi Miura³, Hideaki Hasuo⁴, Isseki Maeda⁵, Asao Ogawa⁶, Tatsuya Morita⁷, Yosuke Uchitomi^8,9 and Hiroya Kinoshita¹⁰

¹Graduate School of Clinical Psychology, Teikyo Heisei University, Tokyo, Japan
²Department of Medical Psychology, Nippon Medical School, Tokyo, Japan
³Department of Palliative Medicine, National Cancer Center Hospital East, Chiba, Japan
⁴Department of Psychosomatic Medicine, Kansai Medical University, Osaka, Japan
⁵Department of Palliative Care, Senri-Chuo Hospital, Osaka, Japan
⁶Psycho-Oncology Division, National Cancer Center Hospital East, Chiba, Japan
⁷Palliative and Supportive Care, Seirei Mikatahara Hospital, Shizuoka, Japan
⁸Institute for Cancer Control, National Cancer Center, Tokyo, Japan
⁹Psycho-Oncology Division, National Cancer Center Hospital, Tokyo, Japan
¹⁰Department of Palliative Care, Tokatsu Hospital, Chiba, Japan

Background: In Japan, little is known of the severity of and factors associated with psychological distress among caregivers of patients with advanced or recurrent cancer who die.
Methods: This prospective cohort study of cancer patients at the National Cancer Center Hospital East, Japan, and their caregivers followed the participants from the initial palliative care consultation (T1) to 6 months (T2) and 13 months (T3) after the patient's death. At T1, patients and caregivers were interviewed separately. After T1, telephone interviews were conducted periodically, and a mail survey was distributed at T2 and T3. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, and the Distress and Impact Thermometer (DIT) was used to screen for psychological distress. Items on end-of-life attitudes, including awareness, discussion, and willingness of cancer care and death, were developed.
Results: Thirty-one of 86 eligible pairs participated in this study. The participation rate was low (36%) and enrollment was thus halted. Data were collected up to T3 for 22 pairs (completion rate 71%). PHQ-9 scores at T2 and T3 were higher than at T1, but the difference was not significant (p = 0.07). PHQ-9 score at T3 was significantly associated with caregiver PHQ-9 and distress at T1, with patient distress and impact at T1, and with caregiver health problems at T2.
Conclusions: Caregiver depression persisted up to 13 months after the patient's death, which suggests that pre-bereavement screening with the DIT might be useful. The present paired enrollment process requires improvement.

J Nippon Med Sch 2022; 89: 428-435

Keywords
caregiver, cancer patient, psychological distress, prospective cohort study, post-bereavement

Correspondence to
Mariko Asai, PhD, Department of Medical Psychology, Nippon Medical School, 1-7-1 Kyonan-cho, Musashino, Tokyo 180-0023, Japan
mariko-asai@nms.ac.jp

Received, February 8, 2022
Accepted, March 10, 2022