Family caregivers of those with cancer: quality of life outcomes from a sequential multiple assignment randomized trial

Kanjana Thana, Alla Sikorskii, Rebecca Lehto, Pratim Guhaniyogi, Sarah Brewer, David Victorson, Thaddeus Pace, Terry Badger, Gwen Wyatt

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: To conduct a secondary analysis focused on health-related quality of life (HRQOL) among caregivers engaged in a 12-week complementary therapy sequential multiple assignment randomized trial (SMART) of reflexology and/or meditative practices (MP), to manage cancer patients’ symptoms. Methods: In this SMART, patient-caregiver dyads were initially randomized to 4 weeks of caregiver-delivered reflexology for the patient (N = 150), MP with the patient (N = 150), or control (N = 47). After 4 weeks, dyads with patients not improving on fatigue (non-responders, n = 69 to reflexology and n = 57 to MP) were re-randomized to continue the same therapy or add the other therapy for an additional 4 weeks. Week-12 caregiver HRQOL was measured using the Patient Reported Outcomes Measurement Information System (PROMIS) Profile-29 and the Caregiver Reaction Assessment Tool (CRAT) for caregiver burden; scores were analyzed using general linear models. Results: In the comparison of 4 adaptive intervention sequences: reflexology for 8 weeks, reflexology for 4 weeks followed by MP for 4 weeks if no response to reflexology, MP for 8 weeks, and MP for 4 weeks followed by reflexology for 4 weeks if no response to MP, there were no differences in PROMIS-29 scores. However, CRAT domains of impact on schedule, family support, and finances worsened when adding reflexology after the first 4 weeks of MP. The CRAT domain of health worsened by adding either intervention compared to continuing the same one. Conclusions: Clinicians should be aware that caregiver engagement in more than one complementary therapy may increase caregiver burden in some domains but not affect other HRQOL domains. Trial registration:

Original languageEnglish (US)
Pages (from-to)5891-5902
Number of pages12
JournalSupportive Care in Cancer
Issue number7
StatePublished - Jul 2022
Externally publishedYes


  • Caregiver burden
  • Health-related quality of life
  • Intervention
  • Meditative practices
  • Non-responders
  • Reflexology
  • Symptoms

ASJC Scopus subject areas

  • Oncology


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