Caregiving burden and sleep quality amongst family caregivers of Chinese male patients with advanced cancer: A cross-sectional study

Highlights

• Caregivers of Chinese male advanced cancer patients often experience severe caregiving burden.

• The majority of these caregivers suffer from sleep problems.

• Their caregiving burden is strongly associated with poor sleep quality.

• Implementation of interventions for alleviating caregiving burden is warranted.

Abstract

Purpose

To examine the level of caregiving burden and sleep quality as well as their interrelationship amongst family caregivers of Chinese male patients with advanced cancer.

Method

A cross-sectional study was conducted in Hong Kong. The Caregiver Reaction Assessment (CRA) and the Pittsburgh Sleep Quality Index (PSQI) were used to measure caregiving burden and sleep quality of the family caregivers.

Results

A total of 96 family caregivers were recruited. Disrupted schedule (3.8; SD = 0.8) was rated as the most affected consequence of caregiving burden. Around 78.1% of the caregivers suffered from sleep problems. Hierarchical multiple regression revealed that health problems due to caregiving burden was independently associated with poor sleep quality after controlling for socio-demographic characteristics of both patients and caregivers (regression coefficient, B = 2.09, P = 0.012).

Conclusions

Caregiving burden amongst family caregivers of male patients with advanced cancer was remarkably high and associated with poor sleep quality. Strategies aiming to alleviate caregiving burden of caregivers may help break this vicious cycle to enhance the sleep quality of caregivers. Results also underscore the need to assess and develop intervention to relieve caregiving burden for family caregivers of cancer patients.

Introduction

Cancer is among the leading causes of death worldwide. In 2017, over 33,000 new cancer cases were diagnosed in Hong Kong. The incidence and mortality of cancer were higher in men than in women, with a male-to-female ratio of 1.04 to 1 and 1.4 to 1, respectively (Hong Kong Cancer Registry, 2017). The burden of cancer is expected to increase in the coming decades considering the prevailing trends in incidence and the aging population. Family caregivers play an important role in supporting patients during their illness trajectory, especially at advanced stages (Costa-Requena et al., 2015). Advanced cancer is defined as a disease that is incurable and life threatening owing to the metastasis or recurrence of the primary cancer (American Cancer Society, 2016).

Caring for a family member with an advanced-stage disease is stressful and exhausting (Aranda and Hayman-White, 2001). Caregiving burden refers to the strain and load caused by performing the caregiving tasks (Given, 2019). Notably, family caregivers of patients with advanced cancer assume wide-ranging tasks and responsibilities. They need to care for family members by assisting them in activities of daily living, such as meal preparation and financial management; they also need to ensure patients’ adherence to their medication regime and provide medical care, as well as emotional and social support (Glajchen, 2004; Muliira et al., 2019). The level of burden on the caregivers of patients with advanced cancer has been shown to be greater than that experienced by those caring for elders or patients with dementia (Bevans and Sternberg, 2012; Kim and Schulz, 2008).

Poor sleep quality is one of the most common complaints amongst family caregivers of patients with cancer (Carter and Acton, 2006; Kotronoulas et al., 2013). Family caregivers often have difficulty managing and controlling negative feelings or distress, and these negative feelings mostly emerge at night, resulting in disturbed sleep (Aranda and Hayman-White, 2001; Berger et al., 2005; Bevans and Sternberg, 2012). A systematic review has revealed that at least 72% of caregivers reported moderate to severe sleep disturbance with a substantial reduction in total sleep time (Maltby et al., 2017). Poor sleep quality can result in numerous physical and psychological problems, which may cause a rapid decline in the quality of life, ability to function, and satisfaction in living (Beck et al., 2004; Borg and Hallberg, 2006). Evidence also suggests the association between sleep quality and caregiving burden among caregivers of patients with advanced cancer (Lee et al., 2015b).

Family caregiving is essential, common, and unique in Chinese culture owing to traditional caregiving ideology and the Confucian idea (Ikels, 2004; Tang and Chen, 2002) that family is key to individual performance and flourishing. Individuals belonging to Chinese families are obliged to take care of one another (Ikels, 2004), particularly of ill family members as a type of repayment to family (Tang and Chen, 2002). The dominance of males over females is also deeply rooted in Confucianism (Ikels, 2004). Research has shown that caregivers of male patients with cancer have statistically higher levels of depression and anxiety than those who care for female patients (Karabekiroğlu et al., 2018), suggesting that caring for male patients may impose greater burden on their spouses and family members than caring for female patients. A few studies have examined the caregiving experiences among family caregivers for patients with advanced cancer (Lee et al., 2015b; Mok et al., 2003); however, the level of caregiving burden and sleep quality amongst family caregivers of Hong Kong Chinese male patients with advanced cancer remain poorly known. Accordingly, this study aimed to (1) examine the caregiving burden and sleep quality amongst family caregivers of Chinese male patients with advanced cancer, and (2) examine the relationship between caregiving burden and sleep quality amongst family caregivers of Chinese male patients with advanced cancer.