Un Abrazo Intervention May Help Address Distress, Anxiety, and Depression in Cancer Co-Survivors

Dr. Catherine Marshall’s latest publication makes the case for adding interventions like Un Abrazo Para La Familia™ to the standard of care. Data show it may improve access to mental health care and help support vulnerable and underserved populations.

Family caregivers, or cancer co-survivors, are unpaid volunteers who spend time and energy caring for and fearing for a loved one undergoing cancer treatment (a cancer survivor). There are approximately 2.8 million people providing this type of informal care in the United States. A caregiver may work closely with cancer care clinical teams, administer drugs, report any concerns on behalf of the patient, manage health insurance claims, and keep other family members informed of the patient’s condition. Many who have taken up this role have reported lacking resources or support. Reports show that rates of depression for cancer patients and their loved ones is approximately twice as high as for people who live in the same communities. Caregiving is often characterized as a public health crisis.

Dr. Catherine Marshall and a team of researchers at the University of Arizona have developed a psychoeducational intervention that may be effective for the prevention, detection, and intervention of psychiatric problems in survivors and co-survivors of cancer. Their latest publication makes the case for adding interventions like Un Abrazo Para La Familia™ to the standard of care. Data show it may improve access to mental health care and help support vulnerable and underserved populations.

Dr. Marshall developed Un Abrazo Para La Familia™ after her own experience as a cancer co-survivor. She developed the intervention following the recommendations of the National Institutes of Health, which established that support for family caregivers should address cultural needs, acknowledge health concerns that can arise during the caregiving experience, and recognize that caregiving issues can impact family, friends, and the community at large. Un Abrazo was especially designed to help low income Latinx cancer survivors and their caregivers. If cancer survivors and co-survivors lack access to higher education and English proficiency, they are more likely to misunderstand their prognosis, or the potential outcome of their cancer diagnosis. The resulting confusion can cause emotional problems during a challenging time. It could even hinder decision-making about cancer care.


As a program partner with the Alliance to Advance Patient-Centered Cancer Care, Dr. Marshall was able to work with Alliance Principal Investigator Dr. Heidi Hamman to locate vulnerable and underserved families dealing with a diagnosis of cancer in Southern Arizona. What participants received is three one-hour sessions that were especially formulated to prepare them to face every aspect of cancer care, including how to navigate cancer clinical systems, communicating effectively, and building socio-emotional support. These types of skill building exercises can be an important tool to reduce racial and ethnic health disparities.

In this most recent study, the majority of participants were Latinx and preferred Spanish as their spoken language. They resided in two counties in Southern Arizona: Pima and Yuma County. 17.8% and 20.1% of the population in these counties, respectively, live below the poverty line. The rates are higher than the national average of 13.1%. Participants from both counties reported clinically significant levels of distress, anxiety, and depression when first recruited. A higher proportion of participants showed significant levels of distress compared to samples of white, middle-income cancer survivors, highlighting the unmet need for mental health support.


Results from distress screenings administered before and after the intervention show that Un Abrazo may be an effective tool in helping cancer co-survivors cope with the demands of dealing with a diagnosis of cancer. The paper found between a twenty and thirty-one percent decrease in levels of distress and anxiety/depression after the intervention. Co-survivors were also found to have a high increase in cancer knowledge and self-efficacy. Self-efficacy is defined as a person’s perceived ability to succeed in a given circumstance, in this case, facing up to a diagnosis of cancer.

The gains in knowledge and self-efficacy for cancer survivors were more modest. Further, results also indicated that completion of Abrazo did not translate into a decrease in distress scores for this group of participants. According to the study authors, it’s possible that participating in Abrazo may have validated feelings of distress for cancer survivors, encouraging them to share their negative feelings more openly. Overall, the results do confirm the need to train and assist co-survivors to provide comprehensive support to their loved ones through their cancer journeys.

Un Abrazo Para La Familia™ may be an effective intervention to prevent, detect, and manage psychiatric problems in survivors and co-survivors who are weathering the stress of the cancer experience. Including these types of interventions as part of the standard of care may help cancer centers around the country provide cancer care that addresses patients’ physical ailments as well as their mental wellbeing. It would also help better support the needs of vulnerable and underserved populations. This latest publication is the first by the authors to investigate distress, anxiety, and depression outcomes after Abrazo participation. Further studies are needed to help identify survivors and co-survivors in need of further mental health treatment.

For more information: Implementation of Un Abrazo Para La Familia™ in Southern Arizona With Extension to Survivors and Assessment of Effects on Distress

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