Psychological Distress among Family Caregivers of Cancer Patients Khartoum State 2020

Research Article

Ann Depress Anxiety. 2021; 8(2): 1110.

Psychological Distress among Family Caregivers of Cancer Patients Khartoum State 2020

Osama E¹*, Kamil S², Hiba E¹ and Tahani M¹

¹Department of Community Medicine, National University, Sudan

²Department of Community Medicine, University of Khartoum, Sudan

Corresponding author: Elkhidir Osama, Department of Community Medicine, National University, Sudan

Received: November 09, 2021; Accepted: December 01, 2021; Published: December 08, 2021


Introduction: The incidence of cancer in Sudan, like other world, shows an increasing pattern; consequently, a greater number of people are expected to take the role of principal caregivers in the near future. Hence, it is high time to achieve inclusive knowledge about the outcome of caregiver burden related to the caregiver’s well-being.

Materials and Methods: This study is a cross-sectional, observational study aiming to assess psychological distress among the principal family caregivers of cancer patients at oncology public specialized outpatients’ clinics in Khartoum State. Multiple validated and structured questionnaires and a checklist were implemented to collect relevant data related to both cancer patient and family caregiver. Systematic random sample was applied to recruit 143 of cancer patients’ caregivers.

Results: Majority of cancer patients were females 56.6% and 32.2% were in the age group (51-65) years. Breast cancer and leukemia were the most frequent types of cancer among participants, with 11.9% each. Regarding family caregiver most of them were females 54.5% with average age was (37.7) years. About half of them were the cancer patient’s child descendants. Concerning psychological distress among family caregivers, depression and anxiety were reported by (53.8%) and (72.7%), respectively. Psychological distress is more prevalent among caregivers with subsequent characteristics: females, younger and middle age, and lower economic status.

Conclusion: Findings point to high proportions of elevated psychological distress, among family caregivers of cancer patients. Further, longitudinal studies with qualitative dimensions are recommended. Multidisciplinary arrangements are necessary to meet caregivers’ needs.

Keywords: Anxiety; Caregiver burden; Depression; Family caregiver


CES-D: Centre for Epidemiological Studies - Depression Scale; POMS: Profile of Mood States; SD: Standard Deviation; SPSS: Statistical Package for the Social Sciences; WHO: World Health Organization


Nowadays cancer is widely considered as a global public health problem and one of the primary sources of death and suffering. It affects individuals at different ages in different countries around the world, irrespective of a country’s economic level or population demography. In spite of noticeable advances in the health sector and medical technology during the last thirty years, incidence rates of cancer have shown escalating trends [1-3].

In the year 2015, international statistics established the significance of cancer as a second leading cause of death, just behind cardiovascular diseases which top the list. The World Health Organization (WHO) forecasts that cancer will cause additional burdens in the near future [4].

The estimation of the incidence of the disease is projected to surge from ten million in 2000 to 27 million in 2030, above and beyond additional 17 million deaths and 75 million individuals living with malignant neoplasms, most of which are in low-income countries [5,6].

In accordance with existing statistics, cancer in Sudan shows an increasing trend during the last twenty years. Even though, no study reveals the exact reason for this trend, cancer may be associated with recurrent exposure to public and local carcinogens and to transformation in a way of living realised in Sudan. Population growth and aging also act as supplementary important risk factors [7-9].

More and more, cancer care is delivered in a home-based setting by means of the patient’s family members taking up caregiving roles, supporting patients with daily activities and medical measures at home. Paradoxically, progress in cancer treatment has extended the life expectancy of cancer patients, with an expected additional load on family members [10,11].

This clears up the fact that cancer diagnosis has significant impact, not only on the patients, but also on their family members and close ones. Individuals who go through the management of malignant disorders are profoundly confronted with considerable social, psychological, and financially draining experiences which affect those patients, alongside their families, relatives and friends [12]. The principal family caregiver is accountable for about 60-80% of the total home care received by the patient [13].

The word “caregiver” is a new terminology that covers a wide variety of practices and circumstances. Caregiving may possibly be informal; comprising caring for a family member or loved one within a home-based setting, or formal caregiving which is provided by medical professionals within an institutional setting [14].

Family caregivers so often face a wide array of stressors, comprising transformation in day-to-day activity, family role variations, own health settings, economic and work-related pressure. Those stressors help to explain the high prevalence of clinically elevated psychological distress among cancer patients’ family caregivers. Family members have been considered as co-sufferers in the fight against malignant disorders [15,16].

Healthcare experts and related institutes can greatly assist in alleviating the caregiver burden. Joint actions can be adopted to recognise, order caregiver burden and accordingly build appropriate interventions to this prevailing problem [17].

The aim of this study was to assess psychological distress in terms of “level of depression and anxiety” among the principal family caregivers of cancer patients.

Materials and Methods

Study design

A quantitative, descriptive cross sectional was applied. The study was conducted at oncology public specialized outpatients’ clinics in Khartoum State. In fact, about 80% of patients diagnosed with cancer in Sudan received scheduled management at Khartoum Oncology Hospital [7,18].

Study Participants

The study sample consisted of 143 caregivers whose patients had been diagnosed with cancer at least 3 months earlier than the time of data collection. The selection of patients was done through systematic random sampling by means of using cancer national registry. Then principal caregiver was identified as such by the cancer patient “care recipient”, (the person who is responsible for majority of their unpaid, informal care).

Data collection and measures

A face-to-face interview was administered the same day consent was attained. The following instruments were employed in the interviews: Socio-demographic Questionnaire, Centre for Epidemiological Studies Depression Scale (CES-D)-10 items and Reduced Profile of Mood States (POMS)-Anxiety Subscale. In addition, patients’ medical files were reviewed to record patients’ medical information.

General information regarding family caregivers and cancer patients was gathered using a structured modified questionnaire. The questionnaire was divided into two sections, the first of which contained demographic, social, and economic data about the family caregiver. The second section featured information on cancer patients’ demographics and medical conditions. Clinical data on disease type, stage, and management method were extracted from patients’ medical records.

The CES-D-10 is considered as a satisfactory psychological measure in both healthy and mentally ill individuals. Overall scale scores vary between 0 and 30 [19-21].

The POMS questionnaire is a standard authenticated psychometric test used in research [22]. In this study, POMS anxiety subscale was implemented to minimise participant and researcher loads. (POMS) subscale scores range between 0 and 12 [23].

Data management and analysis

Statistical Package for the Social Sciences (SPSS)® version 20 was used for data entry and statistical analysis. Percentages, frequencies, means, and standard deviations were used to characterise demographic and medical information of cancer patients and principal caregivers’ socio-demographic characteristics, level of anxiety and depression. A 2-sided P value < .05 was considered statistically significant.


Cancer patients’ characteristics

In this study, females made up a slight majority of cancer patient 56.6%. The female to male ratio was 1.3:1, almost similar figures were observed similar studies regarding gender distribution of cancer in Sudan. Similarly, age distribution in the study samples reflected actual same age distribution among Sudanese cancer patients. Middle age categories were the most affected groups [7,24,25] (Table 1).