Individuals with cancer commonly rely on their informal caregivers (e.g., spouse/partner, family member, close friend) to help them manage the demands of the disease and its treatment. Caregiving, including helping with patient care, performing household chores, and providing emotional and practical support, can be particularly demanding for employed caregivers, who must juggle their work responsibilities while providing care. Although a burgeoning literature describes the toll that balancing these oft-competing demands can exact, few resources exist to support employed cancer caregivers. To address this gap, we conducted a narrative review of the impacts of cancer on employed caregivers. We found that employed caregivers experience significant financial impacts in terms of lost time and income. They also experience a variety of work-related (e.g., reduced productivity, absenteeism) and mental health (e.g., stress, burden) impacts. Going forward, prospective studies are needed to characterize changes in caregiver support needs and preferences at different time points along the cancer care continuum (e.g., at diagnosis, during treatment, end-of-life) so that appropriate workplace accommodations can be provided. More population-based studies are also needed to develop models for identifying caregivers who are at increased risk for poor employment or mental health outcomes so that more targeted support programs can be developed. Ultimately, a multipronged effort on behalf of employers, healthcare, and community-based organizations may be needed to support and empower this vulnerable subgroup.

The COVID-19 pandemic’s global scope and resulting social distancing measures have caused unprecedented economic, lifestyle, and social impacts to personal and relationship well-being. While lockdowns have prompted individuals to increase reliance on intimate partners for support, stressful external contexts can also interfere with partners’ capacity to request and provide support, resulting in relationship dissatisfaction and even dissolution. Guided by a risk and resilience framework, this study examined the impact of perceived stress, social contextual factors, and dyadic coping on self-reported relationship satisfaction changes during the initial United States COVID-19 lockdown period. Participants were adults in romantic relationships who completed an online survey between April 13 and June 8, 2020. Overall, survey respondents ( N = 1106) reported higher perceived stress levels than established population norms, and small but significant decrements in relationship satisfaction. Multivariable models revealed that higher perceived stress levels were associated with lower relationship satisfaction levels. Additionally, dyadic coping was found to moderate the impact of perceived stress on relationship satisfaction (B = .05, 95% CI = .02– .07), suggesting that engaging in dyadic coping buffered individuals from adverse effects of perceived stress on their relationships. Findings emphasize heightened stress experienced by individuals during the pandemic, potential detrimental effects of stress on couple relationships, and suggest dyadic coping may help buffer couples from adverse effects of the pandemic on their relationships. As such, dyadic coping may be an important target for future interventions designed to assist couples during the ongoing pandemic and future pandemics/natural disasters.

This population-based study investigated gender differences in the use of coping strategies and their relationship to anxiety symptoms during the initial COVID-19 lockdown period in the United States. A national online survey was administered between 13 April 2020 and 8 June 2020. The study sample comprised 1673 respondents (66% women). Overall, 46% reported high levels of anxiety, and women experienced significantly (p < 0.001) higher levels of anxiety than men. Women were significantly (p < 0.05) more likely to use acceptance, self-distraction, positive reframing, and emotional support than men. Significant interactions between gender and coping strategies were also identified. Of note, women who reported high levels (+1SD) of acceptance and positive reframing had significantly lower levels of anxiety when they engaged in low levels (−1SD) of acceptance (t = −4.56, p < 0.001) and positive reframing (t = −3.95, p < 0.001). In contrast, men who engaged in high levels of active coping had significantly higher levels of anxiety when they had low levels of active coping (t = 3.38, p = 0.001). Overall, these findings extend our understanding of the nature of gender differences in stress responsivity during periods of high psychological distress and can inform the development of mental health interventions to respond to the COVID-19 pandemic and future infectious disease outbreaks.

35 Background: Medical comorbidities pose challenges to the delivery of quality cancer care. Underserved cancer patients have the highest burden of chronic comorbidities, with increased risk for worse outcomes. Their health outcomes and care transitions might be improved by enhancing collaboration between oncologists and primary care providers (PCPs). Methods: This is a cross-sectional study of oncologists and PCPs in a large public safety-net hospital system in Houston, TX. Providers completed electronic surveys assessing demographics, attitudes, and satisfaction regarding the shared care of cancer patients with chronic comorbidities. Results: Eighteen oncologists (39% minority, 72% female) and 25 PCPs (23% minority, 77% female) completed the surveys. Independent samples t-tests revealed both oncologists and PCPs reported moderate levels of interprofessional collaboration, felt that existing processes to facilitate coordination of care were inadequate, and expressed moderate levels of dissatisfaction with the management of cancer patients with comorbidities within HHS (all p-values = n.s.). However, their attitudes toward care coordination differed significantly depending on the nature and timing of the care being provided. With regard to side effect management during cancer-directed therapy, 81% of PCPs preferred to co-manage side effects with oncologists, but 100% of oncologists preferred to be responsible for this activity (χ2= 23.08, p <.001). With regard to management of late-effects of cancer treatment, 40% of oncologists were either interested in co-managing late effects with PCPs or having PCPs be solely responsible for this activity. Conversely, 86% of PCPs preferred to co-manage late effects with oncologists (χ2= 26.74, p <.001). For cancer surveillance, oncologists and PCPs expressed interest in sharing responsibility depending on the patient’s risk for recurrence (χ2= 1.62, p =.30). Conclusions: Oncologists and PCPs were similarly dissatisfied with comorbidity management in cancer patients, but differed in their attitudes towards care coordination. Oncologists were more resistant to sharing responsibilities of toxicities during and after treatment. They were more accepting of PCPs assuming follow-up care for lower-risk patients. Further investigation is needed to determine specific areas of care coordination, barriers to provider collaboration, and knowledge and processes for effective shared care.