Lung cancer patients have a poor survival prognosis and high levels of morbidity associated with their disease and treatment. Lung cancer can have an adverse effect on multiple QOL domains including functional status and psychological well-being. The latter has received less attention, which is surprising because patients are at high risk for psychological distress given the debilitating nature of the illness, a possible history of substance abuse in addition to tobacco dependence, the likelihood of experiencing guilt or self-blame because of their disease cause, and a possible past history of psychological distress. Spouses of chronically ill patients frequently experience equal, if not higher, levels of distress than patients. High levels of both patient and spouse psychological distress may promote conflict within the couple's relationship. Relationships of couples facing lung cancer may be at increased risk for distress as compared to couples facing non-tobacco-related cancers. Conflict may be exacerbated in couples in which the patient, spouse, or both continue to smoke following diagnosis. As lung cancer progresses, the level of caregiving demands may increase. The spouse's ability to meet these demands and offer support may be challenged in distressed relationships. No studies have assessed spouse response to lung cancer diagnosis and treatment, how spouse response affects that of the patient, or how the couple's relationship affect's the patient's adjustment, the spouse's adjustment and caregiver burden. This study will employ a longitudinal design to assess the psychological and relationship functioning of lung cancer patients and spouses.
The specific aims are to: (1) determine the prevalence of distressed patients, spouses and spousal relationships in lung cancer over time; (2) determine whether the prevalence of distressed spousal relationships is higher in relationships where the patient, spouse, or both smoke following diagnosis; (3) characterize the associations among predictors of psychological functioning in both patients and spouses (coping, social support, tobacco use, and attribution), patient psychological functioning, spouse psychological functioning, relationship functioning, and caregiver burden from diagnosis to six months following diagnosis; and (4) determine baseline predictors of caregiver burden at three and six months following diagnosis.
