Caregiving stress and burden associated with cardiometabolic risk in family caregivers of individuals with cancer

Figures & data

Figure 1. Conceptual model of stress and health/illness. *Adapted for the Analysis of Cardiometabolic Health in Cancer Caregivers.

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*Adapted from the theoretical model of stress and health/illness (Vitaliano et al., 2003). The gray arrows indicate the basic pathways that interrelate exposure to stress and vulnerability, psychological distress, health habits, and physiological responses in the theoretical model. The black arrows indicate the pathways explored in this analysis from the cross-sectional data including exposures to stress and vulnerability, psychological distress, and health habits on physiological responses. a. Sociodemographic = age, sex, race/ethnicity, marital status, education, employment status, relationship to the patient. b. Caregiving stress = patient’s cancer stage, hours spent for caregiving daily, perceived caregiving burden.

Table 1. Characteristics of the sample and study variables (N = 83).

Variables	Category	Mean (SD) n (%)
Exposure to stress and vulnerability
Sociodemographic factors
Age (years), range		49.8 (14.4), 21–79
Sex	Male	22 (27.2)
	Female	59 (72.8)
Race/ethnicity	Non-Hispanic/White	18 (22.2)
	Non-Hispanic/non-White	10 (12.3)
	Hispanic	53 (65.5)
Marital status	Married	58 (71.6)
	Not married^a	23 (28.4)
Education	High school graduate or less	28 (34.6)
	Associate degree/some college	18 (22.2)
	Undergraduate degree	21 (25.9)
	Graduate or professional degree	14 (17.3)
Employment status^b	Working	48 (61.5)
	Not working	30 (38.5)
Household income	Less than $5,000	7 (10.3)
	$5,000–9.999	3 (4.4)
	$10,000–19.999	12 (17.7)
	$20,000–39.999	17 (25.0)
	$40,000–74,999	16 (23.5)
	$75000 more	13 (19.1)
Relationship to the patient	Spouse/partner	30 (37.0)
	Parent	9 (11.1)
	Other^c	42 (51.9)
Caregiver morbidity
The number of morbidities^d		2.78 (3.19), 0–13
Caregiving stress
Patients of cancer stage	Stage I	10 (13.9)
	Stage II/III	38 (52.8)
	Stage IV	24 (33.3)
Hours spent caregiving daily	<8 hours/day	39 (53.4)
	8–16 hours/day	12 (16.4)
	>16 hours/day	22 (30.2)
Caregiver burden^e	Impact on schedule	2.88 (1.00), 1.0–5.0
	Lack of family support	2.09 (0.87), 1.0–4.8
	Impact on finance	2.88 (1.12), 1.0–5.0
	Caregiver esteem	4.28 (0.70), 1.6–5.0
Psychological distress
Mood disturbance^f		35.76 (21.43), 6.06–101.42
Health habits
Physical activity^g	Low	22 (29.3)
	Moderate	23 (30.7)
	High	30 (40.0)
Smoking^h	No	72 (88.9)
	Yes	9 (11.1)
Alcohol consumption	No drinking	37 (45.7)
	Moderate drinking	23 (28.4)
	Heavy drinking	21 (25.9)
Fruit and vegetable consumption	Not meet ACS recommendations	49 (64.5)
	Meets ACS recommendations	27 (35.5)

Note. Numbers may not sum to total due to missing data.

ACS: American Cancer Society.

^aNot married = single (never married), separated, divorced, widowed; ^bemployment status = working (employed, homemaker, student); not working (retired, disability, unemployed); ^cOther = friend, sibling, child; ^dthe number of morbidities was measured using the medical morbidities index for caregivers of chronic illnesses (MMICCI); ^Ecaregiver burden was measured using the Caregiver Assessment Reaction (CRA); ^fmood disturbance was measured using the 30-item Profile of Mood States Short Form (POMS-SF); ^gphysical activity was measured using the International Physical Activity Questionnaire (IPAQ); ^hsmoking was measured using a single item, “Do you smoke?”; limited variability, not considered in the model.

Table 2. Comparison among caregivers of colorectal cancer and reference range values on cardiometabolic disease risk factors.

Variables	Colorectal cancer caregivers		Reference range values^a
	Mean (SD)	Range	Mean (SD)	Range
Traditional lipids
Total cholesterol, mg/dL	197.0 (40.2)	111–318	193.8 (36.5)	140–256
LDL-C, mg/dL	117.6 (35.7)	42–214	110.5 (30.7)	63–163
HDL-C, mg/dL	54.8 (12.9)	34–99	61.1 (14.4)	41–88
Triglycerides, mg/dL	116.9 (79.1)	19–479	119.3 (89.8)	140–256
Nontraditional lipoprotein particle profile
Large TRL-P, nmol/L	4.2 (5.7)	0–35.8	2.9 (6.5)	0–12.8
LDL-P, nmol/L	1488.1 (465.0)	498–3517	1454.0 (393.0)	891–2150
Small LDL-P, nmol/L	536.0 (453.5)	0–2708	469.0 (431.0)	13–1318
HDL-P, μmol/L	21.7 (2.6)	14.7–28.7	24.0 (3.0)	19.2–29.3
Small HDL-P, μmol/L	13.8 (3.1)	7.6–22.6	13.8 (3.4)	8.1–19.6
Large HDL-P, μmol/L	1.7 (1.5)	0–9.2	2.5 (1.9)	0.2–6.3
TRL-Z, nm	49.8 (10.6)	33.7–87.1	44.0 (8.4)	33.8–60.9
LDL-Z, nm	21.4 (0.6)	19.2–22.3	21.0 (0.5)	20.1–21.7
HDL-Z, nm	9.1 (0.5)	8.2–10.0	9.0 (0.4)	8.3–9.8

Note. HDL-C: high-density lipoprotein cholesterol; HDL-P: high-density lipoprotein particles; HDL-Z: high-density lipoprotein size; LDL-C: low-density lipoprotein cholesterol: LDL-P: low-density lipoprotein particles; LDL-Z: low-density lipoprotein size; TRL-P: triglyceride rich lipoprotein particles; TRL-Z: triglyceride rich lipoprotein size.

^aManufacturer-provided reference range values are from a representative sampling (n = 698) of the general population, comprised of apparently healthy men (n = 284) and women (n = 414) aged 18–84 years (mean 39 years) (Kinzer et al., 2019).

Table 3. Multiple regressions analysis on traditional lipids and nontraditional lipoprotein particle biomarkers.

Characteristics	Traditional lipids			Nontraditional lipoprotein particle profile
	Total cholesterol^a	LDL-C^a	Triglycerides^a	Large TRL-P^a,c	LDL-P^a	Small HDL-P^a,c	Large HDL-P^b,c	TRL-Z^a	LDL-Z^b	HDL-Z^b
	B (SE)	B (SE)	B (SE)	B (SE)	B (SE)	B (SE)	B (SE)	B (SE)	B (SE)	B (SE)
Race/ethnicity (ref: Hispanic)
Non-Hispanic/White  Non-Hispanic/non-White	—	–	−17.185 (24.852) −51.850 (22.433)*	–	–	–	–	–	–	–
Marital status (ref: unmarried)
Married	–	–	52.417 (19.412)**	0.900 (0.271)**	–	–	–	–	–	–
Education (ref: graduate or professional degree)
High school graduate or less  Associate degree/some college  Undergraduate degree	–	−1.410 (11.881) −28.661 (12.403)^*−17.943 (11.860)	–	–	−0.009 (0.108) −0.263 (0.113)^*−0.160 (0.108)	–	–	–	–	–
Employment status (ref: not working)
Working	26.576 (9.525)**	24.273 (8.199)**	–	–	0.163 (0.075)*	–	–	–	–	–
Hours spent caregiving (ref: > 16 hours/day)
< 8 hours/day  8-16 hours/day	–	–	–	0.303 (0.309) −0.810 (0.391)*	–	–	–	–	0.082 (0.176) 0.468 (0.212)*	–
Caregiver burden
Impact on schedule	–	–	–	–	–	−0.161 (0.074)*	–	–	–	–
Lack of family support	–	–	5.494 (1.879)**	0.078 (0.032)**	–	–	−0.034 (0.015)*	–	–	−0.026 (0.012)*
Mood disturbance	–	–	–	–	–	0.043 (0.017)*	–	–	–	–
Adj R^2	0.129	0.140	0.504	0.386	0.138	0.107	0.237	0.202	0.282	0.265
F	F (8, 64) =2.336, p = 0.029	F (7, 65) =2.669, p = 0.017	F (12, 54) =6.598, p < 0.001	F (9, 57) =5.608, p < 0.001	F (9, 63) =2.277, p = 0.028	F (5, 69) =2.779, p = 0.024	F (11,55)=2.865, p = 0.005	F (9,57) =2.851, p = 0.008	F (8, 55) =4.086, p < 0.001	F (10, 56) =3.376, p = 0.002

Note. CRA: caregiving reaction assessment; HDL-C: high-density lipoprotein cholesterol; HDL-P: high-density lipoprotein particles; HDL-Z: high-density lipoprotein size; LDL-P: low-density lipoprotein particles; LDL-Z: low-density lipoprotein size; ref: reference; SE: standard error; TRL-P: triglyceride rich lipoprotein particles. Age, sex, and the number of morbidities controlled in all models (–) indicates variables not in the final models. ^aHigher levels are associated with increased risk for cardiometabolic disease; ^blower levels are associated with increased risk for cardiometabolic disease; ^csquare root transformed variables; *p<.05; **p<.01; ***p<.001.

Kinzer, A. B., Shamburek, R. D., Lightbourne, M., Muniyappa, R., & Brown, R. J. (2019). Advanced lipoprotein analysis shows atherogenic lipid profile that improves after metreleptin in patients with lipodystrophy. Journal of the Endocrine Society, 3(8), 1503–1517. https://doi.org/10.1210/js.2019-00103

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