This application is in response to FOA “Intervening with cancer caregivers to improve patient health
outcomes and optimize heath care utilization” (PAR-16-317) in which we specifically address employed
caregivers (CG) and their spousal or partnered cancer patient. Sixty-six million Americans cared for a disabled
or ill person in 2015 while CGs of cancer patients represented about 17% of all CGs. Cancer CGs are more
distressed than CGs of other medical disorders. Minimal availability of supportive interventions for CGs who
care for those with cancer during treatment and afterwards represents an important service disparity.
Furthermore, employed cancer CGs must manage multiple responsibilities (the so-called “sandwich
generation”) while still caring for their loved-one. Continued employment of the CG may be required for CGs to
provide a source of income and/or health insurance for the family. Interventions specifically addressing stress
management for cancer CGs have not incorporated unique needs of employed CGs, tracked CG's healthcare
utilization as well as emotional and physiological wellbeing. We will test the influence(s) of an evidence-based
psychosocial stress management intervention enhanced for employed CGs preselected for greater distress
compared to treatment as usual (TAU) on their depression (the CG primary outcome), CG healthcare
utilization, and biomarkers of chronic stress. We will allow CGs to select as desired to reduce CG burden from
three effective modalities (one-on-one, video chat, or web-based) similar in content as their stress
management intervention. This approach allows greater flexibility for the CG to participate in the intervention
and thus improve adherence. We will test the extent to which the CG's participation in the intervention
compared to TAU also influences the patient's symptom management, distress, and patient healthcare
utilization. Emotional distress will be measured using reliable self-reports of psychological depression, anxiety,
and stress for both the CG and the patient. Healthcare utilization will use both self-report alongside an
available electronic system, COMPASS. COMPASS includes pharmacy use, laboratory results, physician
encounters, hospitalizations, and other information also in the electronic medical record. This study will fill an
important gap in our understanding of an intervention enhanced for working CGs on improved health outcomes
both for themselves as well as for their patient compared to TAU.
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