Biological and Psychosocial Mechanisms of Cancer Caregivers' Elevated Health Risk

项目摘要/摘要 癌症不仅影响那些患有这种疾病的人，也影响他们的家庭成员。众所周知，家庭照顾者 已经损害了健康，因为患者癌症对其照顾者的有害影响是巨大的。 研究已经记录了患者的痛苦与照顾者较差的健康有关，反之亦然， 这表明癌症照顾者的健康是一个人际关系、两难问题。未知的是何时以及如何 发生并元、交叉效应。癌症护理人员和他们的患者之间的压力调节 照顾者和病人之间的关系本身就是相互依赖的。这种二元应激调节在以下情况下发生 二分体成员相互镇定对方的应激反应，抑制负面情绪和生理 唤醒(共同调节)或相互增加这些结果(凝血)。我们认为更大的压力 共同调节可以防止不利的健康后果，而更大的压力凝结会加剧这些后果。 这个项目将检验癌症照顾者和他们的病人之间的二元压力调节，并测试 共同调节和凝血作为健康结果的预测因子。协同调节/凝血作用将通过以下方式量化 心血管(心率变异性：HRV)、神经内分泌(唾液皮质醇)和自我报告的情感性 反应性和调节，以应对标准化的压力情况，这既与健康有关，也与 亲密的关系。然后我们将前瞻性地审查共同监管的指标在多大程度上 这种离散的压力源与日常结果(情绪、白天皮质醇和睡眠)和临时健康结果有关。 (抑郁症状、静息心率变异和就诊)，以及性别在多大程度上缓和这些 效果。共120例结直肠癌(CRC)患者(男60例，女60例)及其异性恋 照顾者(120对)将参与其中。 了解潜在的生物学和心理机制对于识别癌症照顾者至关重要 以及他们的患者，由于他们的相互压力调节模式，他们的健康状况不佳的风险最大。发现 将很容易地转化为开发有关有效和相互的新干预措施 日常生活压力的管理和对健康促进的二元性影响。这些干预措施的目的是 相互帮助更好地调节和管理压力，并优化共同调节的有益效果 与癌症相关的压力对更好的健康。这些量身定做的有针对性的干预措施将帮助照顾者识别 在亲属患病轨迹的背景下，他们应该在什么时候以及如何进行压力自我管理 得了癌症。它们还将致力于减少过早发病率和死亡率，特别是与 心血管、神经内分泌和免疫系统失调，以及心理困扰 与癌症和其他慢性病接触的人，从而改善公共健康。

Project Summary/Abstract Cancer affects not only those with the disease, but also their family members. Family caregivers are known to have compromised health, as the detrimental impact of patients' cancer on their caregivers is substantial. Studies have documented the patient's distress relates to the caregiver's poorer health and vice versa, suggesting that cancer caregivers' health is an interpersonal, dyadic problem. Unknown are when and how the dyadic, cross-over effects occur. Stress regulation among cancer caregivers and their patients is interdependent, as is the caregiver-patient relationship itself. This dyadic stress regulation occurs when members of a dyad mutually calm each other's stress reactions and dampen negative affect and physiological arousal (coregulation) or mutually increasing those outcomes (coagitation). We propose that greater stress coregulation protects against adverse health outcomes, whereas greater stress coagitation exacerbates them. This project will examine dyadic stress regulation between cancer caregivers and their patients, and test coregulation and coagitation as predictors of health outcomes. Coregulation/coagitation will be quantified by cardiovascular (heart rate variability: HRV), neuroendocrine (salivary cortisol), and self-reported affective reactivity and regulation, in response to a standardized stress situation that is relevant both to health and to close relationships. We will then examine prospectively the extent to which the indicators of coregulation for this discrete stressor relate to daily outcomes (mood, diurnal cortisol, and sleep) and interim health outcomes (depressive symptoms, resting HRV, and healthcare visits), and the degree to which gender moderates such effects. A total of 120 colorectal cancer (CRC) patients (60 male and 60 female) and their heterosexual caregiver (120 dyads) will participate. Understanding underlying biological and psycholgoical mechanisms is critical for identifying cancer caregivers and their patients who are at most risk for poor health due to their mutual stress regulation patterns. Findings of this project will be readily translated to development of novel interventions pertaining to effective and mutual management of stress in daily life and dyadic influences on health promotion. Those interventions will aim helping one another to better modulate and manage stress and optimizing beneficial effects of coregulation of cancer-related stress on better health. These tailored-and-targeted interventions will help caregivers identify when and how they should engage in stress self-management in the context of illness trajectory of their relative with cancer. They will also aim at reducing premature morbidity and mortality, particularly related to dysregulated cardiovascular, neuroendocrine, and immunologic systems, and psychological distress, among persons touched by cancer and other chronic illness, thereby improving public health.