Dyadic Analysis of Unmet Social Needs Among Breast and Gynecologic Patients and Their Informal Caregivers

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PROJECT SUMMARY/ABSTRACT Psychological distress is prevalent in cancer patients and their informal caregivers (the intimate partners, other family members, and friends who provide patients with crucial unpaid care and support). Distress has been linked to poorer adherence to treatment and elevated mortality in patients, as well as negative outcomes for caregivers. Whether patients or caregivers, women tend to report greater distress than men. Research on patient-caregiver dyads has shown patients' and caregivers' physical and mental health is often intertwined, but most prior dyadic work has analyzed predominantly middle-class spousal pairs. Given the persistent effects of poverty and the longstanding health disparities by socioeconomic status in the United States, it is crucial to understand the social context of financially vulnerable cancer patients and caregivers. Individual social needs—including food, housing, or transportation—are associated with distress as well as physical health outcomes in a range of contexts and populations. A growing body of research has analyzed single social needs—most commonly food insecurity—among cancer patients in particular, but little is known about multiple social needs in patients, how needs change over time, and whether the social needs of informal caregivers affect patient outcomes. This study focuses on female patients with breast and gynecologic cancer—which together account for over 400,000 newly diagnosed cancers among women annually—and their informal caregivers. Our aims are: Aim 1. Document unmet social needs in patient-caregiver dyads (N = 300 dyads). Analyze how needs affect patient and caregiver biopsychosocial outcomes including depressive symptoms (primary outcome), physical and mental health quality of life, emergency department (E.D.) visits, and treatment adherence (secondary outcomes). Aim 2. Analyze the experiences of patients and caregivers with unmet social needs and explore their interest in and preferences for mental health and social needs intervention. Use semi-structured dyadic interviews with 30 patient-caregiver pairs (N = 60 total participants) in which one member reports at least one unmet need at baseline to explore participants' use of community resources, whether they coordinate with the other member of the dyad to resolve unmet social needs, and their preferences for screening and intervention. Aim 3. Explore the relationship between neighborhood-level factors (census tract Area Deprivation Index and 2-1-1 helpline requests by ZIP code), social needs, and depressive symptoms within dyads. This study will provide first-of-its-kind information about the biopsychosocial effects of unmet social needs among female patients with cancer and their caregivers. A central question is whether and how caregivers' social needs affect the patient. The answer will help us create a targeted screening and intervention system to address the mental health and social needs of patients, and, if warranted, caregivers. Our ultimate goal is to improve outcomes for women with cancer and their caregivers.