The impact of coping strategies of cancer caregivers on psychophysiological outcomes: an integrative review

Figures & data

Table 1 Study characteristics and main results of included studies for associations between caregiving and psychophysiological stress responses (N=4)

Study references	Study design	Results
Weitzner et al,^Citation47 2000	Review – caregiving among older cancer patients	Caregiving was associated with lowered immune system functioning, increase in blood pressure, and altered lipid profiles.
Lucini et al,^Citation48 2008	Observational study with 58 cancer caregivers (vs. 60 controls)	Caregivers showed an autonomic imbalance, suggestive of sympathetic predominance at rest and of a reduction of vagal cardiac regulation.
Teixeira and Pereira,^Citation49 2014	Cross-sectional study with 78 cancer caregivers (vs. 78 controls)	Cancer caregivers showed higher cardiovascular (heart rate) and electrodermal reactivity (skin conductance) while visualizing standardized pictures with different emotional valences.
Luecken and Lemery,^Citation55 2004	Review – early caregiving and pathways to dysregulated physiological stress responses	Different genetic, psychosocial, and cognitive-affective pathways to dysregulated physiological stress responses among caregivers were found.

Table 2 Study characteristics and main results of included studies for associations between coping strategies and psychophysiological correlates (N=5)

Study references	Study design	Results
Patrick and Hayden,^Citation60 1999	Cross-sectional study with 596 women with an adult child with a chronic disability	Coping strategies were associated with well-being.
Elliott and Shewchuk,^Citation61 2003	Cross-sectional study with 60 caregivers of patients with several physical disabilities	Problem-focused coping was associated with depression, mental health, social functioning, and vitality.
Fuemmeler et al,^Citation62 2005	Cross-sectional study with 47 parents of childhood cancer survivors (vs. 31 parents of children with type 1 diabetes mellitus)	Lower levels of emotion-focused coping were associated with increased frequency of both posttraumatic stress symptoms and general psychological distress.
Hoekstra-Weebers et al,^Citation63 2000	Longitudinal study with parents of pediatric cancer patients	Coping was associated with levels of distress and was a buffer for depression.
Schumacher et al,^Citation64 1993	Longitudinal study with 75 caregivers of persons receiving chemotherapy	Coping strategies were associated with both strain and depression. Further analysis showed that coping mediated the relationship between strain and depression.

Table 3 Models for understanding the experience of cancer caregivers

	The caregiver stress model (Pearlin et al^Citation40)	The theory of stress and coping (Lazarus and Folkman^Citation68)
Background and the context	SES, caregiving history, family and network composition, program availability	Personal and situational factors
The stressors	Primary stressors: 1) Objective indicators – cognitive status, problematic behaviors, IADL, dependences 2) Subjective indicators – overload, relational deprivation	Acute or chronic stressors and their appraisal (primary and secondary)
The mediators	Coping, social support	Coping (emotional-focused, problem-solving, meaning-focused)
The outcomes	Depression, anxiety, irascibility, cognitive disturbance, physical health, yielding of role	Health and well-being

Abbreviations: IADL, instrumental activities of daily living; SES, socioeconomic status.

Figure 1 A proposed model of the impact of coping strategies of cancer caregivers on psychophysiological indicators of burden.

Abbreviations: HPA, hypothalamic–pituitary–axis; SAM, sympathetic adrenomedullary.

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