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Caregivers of patients with cancer: perceived stress, quality of life and immune function
  1. Yoonjoo Kim1,
  2. Misook L Chung2,3 and
  3. Hyangkyu Lee3
  1. 1Department of Nursing, Graduate School, Yonsei University, Seoul, Republic of Korea
  2. 2College of Nursing, University of Kentucky, Lexington, Kentucky, USA
  3. 3Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
  1. Correspondence to Professor Hyangkyu Lee, Yonsei University College of Nursing, Seoul, Republic of Korea; HKYULEE{at}


Objectives To examine the mediating effect of quality of life (QoL) on the relationship between perceived stress and immune function in Korean family caregivers of patients with cancer.

Methods In this cross-sectional study, 89 family caregivers of patients with cancer completed perceived stress and QoL questionnaires. Immune function was assessed using two proinflammatory biomarkers, IL-6 and tumour necrosis factor-alpha (TNF-α). Multiple parallel mediator regression was conducted using four mediators (burden, lifestyle disruption, positive adaptation and financial concern) representing the subscales of QoL related to caregiving.

Results Psychological (indirect effect (ab)=−0.52, 95% CI −1.25 to −0.01) and physical (ab=−0.44, 95% CI −1.07 to −0.05) stress had a significant indirect effect on IL-6 levels attributed to lifestyle disruption associated with caregiving. Psychological (ab=−0.97, 95% CI −2.37 to −0.11) and physical (ab=−1.10, 95% CI −2.87 to −0.08) stress also had a significant indirect effect on TNF-α as a result of financial concerns owing to caregiving. Other indirect effects of psychological/physical stress on inflammation were not significant.

Conclusion This study demonstrated that the effects of perceived psychological and physical stress on IL-6 and TNF-α levels were mediated by the caregiver’s QoL, especially lifestyle disruption and financial concerns. Stress management and improvement of caregivers’ QoL related to lifestyle disruption and financial issues should be considered to reduce the negative effects of caregiving on immune function.

  • cancer
  • quality of life

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors Conception and design of study: YK, MLC and HL. Literature searching and data collection: YK. Analysis and/or interpretation of data: YK and MLC. Drafting the manuscript: YK and MLC. Revising the manuscript critically for important intellectual content: YK, MLC and HL. Approval of the version of the manuscript to be published: YK, MLC and HL.

  • Funding This research was supported by the Student-Faculty Research Grant of Yonsei University College of Nursing (6-2016-0171).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.