Academic Background

Caregivers of patients with Primary Malignant Brain Tumors (PMBT) face significant psychological distress. PMBT is not only an incurable cancer but also accompanied by degenerative neurological conditions, leading caregivers to cope with the gradual loss of the patient’s physical functions and irreversible changes in personality and cognition. These challenges result in a psychological burden that far exceeds that of caregivers for other types of cancer. Studies have shown that anxiety symptoms among PMBT caregivers remain elevated for months after the patient’s diagnosis, and anxiety is more prevalent than depressive symptoms. However, psychological interventions tailored to this specific population are limited, and existing intervention studies often suffer from methodological flaws, failing to significantly improve caregivers’ anxiety symptoms.

To address this gap, the research team developed a psychological intervention program called “NeuroCare,” aimed at providing targeted psychological support to PMBT caregivers through telehealth. The study evaluated the effectiveness of NeuroCare in alleviating caregivers’ anxiety symptoms through a Randomized Controlled Trial (RCT) and explored its impact on depressive symptoms, quality of life, caregiver burden, self-efficacy, coping skills, and Post-Traumatic Stress Disorder (PTSD) symptoms.

Study Source

The study was conducted by a research team from Massachusetts General Hospital, Harvard Medical School, and the University of Massachusetts Memorial Medical Center. The primary authors include Deborah A. Forst, Alyx F. Podgurski, Sumita M. Strander, and others. The study was published on September 16, 2024, in the Journal of Clinical Oncology, with the DOI: https://doi.org/10.1200/jco.24.00065.

Study Process

Participants and Recruitment

Between October 2019 and June 2022, the study recruited 120 caregivers of PMBT patients who exhibited significant anxiety symptoms (Generalized Anxiety Disorder-7, GAD-7 score ≥5) within six months of the patient’s diagnosis. Participants were identified through Electronic Health Records (EHR) and contacted by the research team via phone or during outpatient visits. Caregivers could also self-refer or be referred by the care team. Eligible caregivers were randomly assigned to either the NeuroCare intervention group or the usual care control group in a 1:1 ratio after completing baseline surveys.

Intervention

The NeuroCare intervention consisted of six telehealth sessions, each lasting 60 minutes, conducted by behavioral health specialists (e.g., psychologists, social workers). The intervention was based on Cognitive-Behavioral Therapy (CBT) and incorporated mindfulness, cognitive restructuring, and other techniques. The goal was to help caregivers identify and manage emotions, improve coping skills, and enhance self-efficacy. Follow-up surveys were conducted at 11 weeks and 16 weeks post-intervention.

Study Measures

The primary outcome was anxiety symptoms at 11 weeks (Hospital Anxiety and Depression Scale-Anxiety subscale, HADS-A). Secondary outcomes included depressive symptoms (HADS-Depression subscale, HADS-D), quality of life (Caregiver Oncology Quality of Life Survey), caregiver burden (Caregiver Reaction Assessment), self-efficacy (Lewis Cancer Self-Efficacy Scale), coping skills (Measure of Current Status), and PTSD symptoms (PTSD Checklist for DSM-5).

Data Analysis

Analysis of Covariance (ANCOVA) and Linear Mixed-Effects Regression Models were used to assess the intervention’s impact on study outcomes. The primary analysis focused on anxiety symptoms at 11 weeks, while secondary analyses explored changes in other psychological measures.

Main Results

At 11 weeks, the NeuroCare intervention group reported significantly lower anxiety symptoms compared to the usual care group (adjusted mean difference: -1.82, p=0.008). Additionally, the NeuroCare group showed significantly reduced depressive symptoms (adjusted mean difference: -1.69, p=0.004), improved self-efficacy (adjusted mean difference: 17.63, p<0.001), and enhanced coping skills (adjusted mean difference: 6.59, p<0.001). However, there were no significant differences between the groups in quality of life, caregiver burden, or PTSD symptoms. Longitudinal analysis revealed that the improvements in depressive symptoms, self-efficacy, and coping skills were sustained after the intervention period.

Conclusion

NeuroCare, as a psychological intervention specifically designed for PMBT caregivers, significantly improved anxiety and depressive symptoms, self-efficacy, and coping skills. The findings highlight the importance of tailored psychological interventions in alleviating caregiver burden. Although NeuroCare did not show significant effects on quality of life, caregiver burden, or PTSD symptoms, its improvements in anxiety and depressive symptoms provide valuable insights for future intervention research.

Study Highlights

1. Targeted Intervention: NeuroCare is the first psychological intervention specifically designed for PMBT caregivers, addressing a critical gap in existing research.
2. Significant Effects: The study demonstrated NeuroCare’s effectiveness in reducing anxiety and depressive symptoms and enhancing self-efficacy and coping skills.
3. Telehealth Delivery: By utilizing telehealth, NeuroCare offers convenient psychological support, making it highly scalable.
4. Long-Term Benefits: Longitudinal analysis showed that the intervention’s effects were sustained post-intervention, indicating long-term psychological support.

Study Implications

This study not only provides an effective psychological intervention for PMBT caregivers but also offers important insights for psychological support research for caregivers of other cancers. Future studies could further explore the mechanisms of NeuroCare and expand its application to help more caregiver populations facing similar challenges.