Biological and Psychosocial Mechanisms of Cancer Caregivers' Elevated Health Risk

项目总结/摘要 癌症不仅影响患者，也影响他们的家庭成员。众所周知，家庭护理人员 已经损害了健康，因为患者的癌症对其照顾者的不利影响是巨大的。 研究表明，病人的痛苦与照顾者的健康状况较差有关，反之亦然， 这表明癌症照顾者的健康是一个人际关系的，二元的问题。未知的是何时以及如何 二进，交叉效应发生。癌症照顾者及其患者的压力调节 相互依存，护理者与患者的关系本身也是如此。这种二元压力调节发生在 二元体的成员相互平静对方的压力反应，抑制负面影响和生理 唤醒（协同调节）或相互增加这些结果（凝血）。我们认为更大的压力 协同调节可防止不利的健康结果，而更大的压力凝血则会加剧这些结果。 这个项目将研究癌症照顾者和他们的病人之间的二元压力调节，并测试 协同调节和凝血作为健康结果的预测因子。共调节/凝血将通过以下方式定量： 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 反应性和调节，以响应与健康和 亲密的关系然后，我们将前瞻性地研究在何种程度上的共同管制的指标， 这种离散的压力源与日常结果（情绪、昼夜皮质醇和睡眠）和中期健康结果有关 （抑郁症状，静息心率变异性，和医疗保健访问），以及性别在多大程度上缓和这种 方面的影响.共120例结直肠癌（CRC）患者（60例男性和60例女性）及其异性恋 护理人员（120对）将参与。 了解潜在的生物和心理机制对于识别癌症照顾者至关重要 和他们的病人谁是最危险的健康状况不佳，由于他们的相互压力调节模式。结果 该项目的成果将很容易转化为有关有效和相互的新干预措施的发展。 日常生活中的压力管理和对健康促进的双重影响。这些干预措施的目的是 帮助彼此更好地调节和管理压力，并优化协同调节的有益效果。 癌症对健康的影响这些量身定制和有针对性的干预措施将帮助护理人员识别 在亲属疾病轨迹的背景下，他们应该何时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，特别是与以下方面有关的过早发病率和死亡率： 心血管、神经内分泌和免疫系统失调，以及心理困扰， 这一方案还包括为患有癌症和其他慢性病的人提供医疗服务，从而改善公众健康。

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.