Neuro-oncology family caregivers are at risk for systemic inflammation

Abstract

Background Prolonged periods of family caregiving can induce stress levels that may negatively influence caregiver health. However, the physiologic effect of psychological distress in oncology family caregivers has received little attention. Therefore we aimed to determine longitudinal profiles of inflammatory cytokines (IL-6 and IL-1ra) in neuro-oncology caregivers and identify associations between psychological distress and cytokine levels. Methods Depressive symptoms, anxiety, caregiver burden and blood were collected from 108 adult caregivers at adult patients' diagnosis, 4-, 8-, and 12-months. Trajectory analyses of log transformed cytokine levels were performed. Multiple logistic regression analyses evaluated the impact of psychological distress on cytokine levels. Results For both cytokines, two distinct populations were identified, neither of which changed over time. High IL-1ra was associated with male caregivers with anxiety (OR=1.7; 95%CI 1.06-2.83) and obese caregivers (BMI=40) who felt burdened due to disrupted schedules (OR=1.3; 95%CI 1.02-1.77). Conversely, caregivers with a healthy weight (BMI=25) who felt burdened due to disrupted schedules were less likely to have high IL-1ra (OR=0.71; 95%CI 0.54-0.92). Caregivers ≤30 years old with lower self-esteem from caregiving were 1.16 times (95%CI 1.04-1.30) more likely to have high IL-6. Conclusions Analysis demonstrated groups of family caregivers with high and low levels of systemic inflammation and these levels did not change longitudinally over the care trajectory. Poor physical health in family caregivers may have a negative impact on the burden placed on the healthcare system in general and on the well-being of neuro-oncology patients in particular.

Analysis of caregiver burden in palliative care: An integrated review

“…For instance, Rohleder et al analyzed salivary biomarkers of caregivers of patients with cancer, finding marked changes in neurohormonal and inflammatory processes within the first year of caregiving. Likewise, Sherwood et al found higher levels of proinflammatory cytokines in male caregivers. Not surprisingly, caregivers perceiving higher levels of caregiver burden have a higher possibility of being diagnosed with stroke and an increased mortality rate .…”

Caregiving alters immunity and stress hormones: a review of recent research

“…However, such consequences are not limited to older caregivers, but may be more apparent in those reporting high burden, or during specific stressful periods. For example, increased inflammatory cytokines have been shown to be specific to males with anxiety, high BMI, disrupted schedules, ages 30-39 years with high burden [12] and those with high grief in the presence of blame and anger [13] or in the 6-months post-diagnosis of a child with cancer in caregiving mothers [14], a particularly stressful period. In support of this idea about stressful time periods, not all markers of inflammation were raised among long-term caregivers [15] and in caregivers with low caregiving burden allostatic load (incorporating inflammatory markers) was lower than non-caregivers [16]; potentially indicating lower distress at less stressful periods.…”

“…Sherwood et al (2016) study focuses on younger caregivers of cancer patients and shows an important link with caregiving stress and inflammation as well as showing that caregiving effects are not homogeneous but that effects may relate to specific behavioural and emotional responses such as anxiety, or life disruption. Walsh et al (2018) are the first to demonstrate that chronic stress influences the development of glucocorticoid resistance by downregulating the sensitivity of glucocorticoid receptors, which corresponded with changes in psychological distress.…”

Anxiety and Depression Associated With Burden in Caregivers of Patients With Brain Metastases

“…Caregivers of patients with brain metastases not only acquire new care demands while facing the increasing intensity of existing demands, but also deal with physical and cognitive deterioration of their loved ones (Gerstenecker et al, 2014;Vaughan, 2012). Unfortunately, despite decades of research showing the negative emotional and physical responses of caregivers in the context of chronic illnesses (e.g., cancer, dementia), little caregiving research has been done in the field of neuro-oncology (Sherwood & Baer, 2011;Sherwood et al, 2016).…”