Methods. We conducted secondary analysis of baseline data from three RCTs that enrolled Black Americans with breast, lung, colorectal or prostate cancers (i.e., patients) and their caregivers (N=124 dyads). We restricted our analysis to patients ages 50 and older. Symptom distress of each individual was assessed with 13 items from the Symptom Scale of the Risk for Distress Scale, which measures trouble managing physical and psychological symptoms during the past week as (0) no trouble, (1) some, and (2) a lot of trouble (patients: α = 0.780; caregivers: α = 0.779). QOL was assessed using the FACT-G, which measures physical, emotional, social and functional QOL (patient subscales: α = 0.767 - .892; caregiver subscales: α = 0.736 - .859). The actor-partner interdependence model (APIM) was used to our hypotheses that increased symptom distress among patients and caregivers would be negatively associated with their own QOL (actor effects) and the other dyad members’ QOL (partner effects). Data were analyzed using path analysis in MPlus. Model covariates included demographic, medical, and relationship factors.
Results. The most common symptoms were fatigue (66.9%), pain (62.1%), and sleep problems (61.3%) among patients and fatigue (56.5%), sleep problems (54.0%) and mental distress (53.2%) among caregivers. Symptom distress was higher (p<.001) among patients (= 7.20) than caregivers (= 3.79). We observed several actor and partner effects (p<.05). Increased symptom distress among patients was associated with poorer physical, emotional, and functional QOL (actor effects) and poorer emotional QOL among caregivers (partner effects). Increased symptom distress among caregivers was associated with their own poorer physical, emotional, and social QOL (actor effects), and poorer emotional QOL among patients (partner effects).
Conclusion. More symptom distress among Black Americans with cancer and their caregivers contributed to their own poorer QOL, particularly physical and emotional dimensions. Emotional QOL was also influenced by the other dyad member’s symptom distress. Supporting both Black middle-aged and older adults with cancer and their caregivers’ symptom management may improve their individual and dyadic outcomes. Documented racial disparities in symptom management suggest anti-racism frameworks may be useful for future research and interventions to improve outcomes in this population.