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Older patients with cancer may burden caregivers by overestimating physical abilities

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August 14, 2017

Older patients with cancer often reported having better physical function, mental health and social support than their caregivers’ assessments, according to study results published in The Oncologist.

This discrepancy in physical abilities, in turn, led to greater caregiver burden, results showed.

Because cancer care is increasingly delivered in the outpatient setting, caregivers often are required to assist with daily activities and cancer-related tasks, such as taking medication and transportation to appointments. However, factors such as advanced cancer stage, health status and symptom burden can increase caregiver burden, leading to stress and demands that can overwhelm the caregiver.

“Caregivers often play a vital role in providing information to health care providers about patient health, such as that obtained from a geriatric assessment,” Tina Hsu, MD, FRCPC, assistant professor of medicine at University of Ottawa, told HemOnc Today. “This is particularly true in older adults with cancer, who are more likely to be frail or have cognitive impairments. It is unclear how accurate this information is although health care providers routinely use it to make treatment recommendations. Furthermore, if differences did exist, we were interested to know if this caused conflict and thus was associated with higher caregiver burden.”

Researchers asked 100 patients aged 65 years or older (median age, 70 years; 53% men) and their caregivers (median age, 66 years; 73% women) to independently assess patient function, comorbidity, nutrition, social activity, social support and mental health.

Seventy percent of patients had advanced disease and most were receiving treatment (chemotherapy, 62%; targeted therapy alone, 34%). In most cases, the caregiver was the patient’s spouse (68%) and lived with the patient (79%).

Sixty percent of patients reported requiring help with instrumental activities of daily living, but most reported having good social support and mental health. Patients reported a median of two comorbid conditions and a median Karnofsky Performance Status of 90.

However, caregivers more frequently rated the patients as having poorer physical function (P < .0001), requiring more help with instrumental activities of daily living (P = .008) and having a lower Karnofsky Performance Status (P = .02). Caregivers also reported patients having more social support (P = .03) and poorer mental health (P = .0002) than patients reported.

There are two possible explanations for this disparity, Hsu said.

“One is that older adults with cancer either don’t appreciate how much help they require, or more likely, they are able preserve their sense of independence and dignity through a perception that they feel they can do more than they really can,” she said. “Alternatively, it is possible that caregivers who are more stressed out perceive their loved one to require more help than they actually do need.”

Assessments of patient’s comorbid conditions, falls, weight change and social activity appeared comparable between patients and caregivers.

Researchers then evaluated caregiver burden using the Caregiver Strain Index, which has scores from 0 to 13, where a score of 7 or higher indicates high burden.

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Seventy-five percent of caregivers experienced some degree of burden (mean score, 3.1), and 15% had high burden.

Caregivers who reported that the patient required more help with instrumental activities of daily living than the patient reported had higher caregiver burden (4.71 vs. 1.89; P < .001).

“Unlike other studies, we found that patients and caregivers differed in their evaluation of the patient’s physical health,” Hsu said. “This might be because patients in our study were fairly mobile, and this might have made it more challenging for caregivers to estimate subtle differences in the patient’s physical health. As caregiver burden has been strongly associated with how much physical care patients require, it makes sense that differences in between what caregivers and patients report in terms of patient physical health are associated with caregiver burden.”

Researchers plan to further explore factors associated with caregiver burden, especially among those who care for frailer patients. They also plan to evaluate resources that can help caregivers in their role.

 “The importance of caregiver research cannot be emphasized enough,” Arti Hurria, MD, director of the cancer and aging research program at City of Hope and a HemOnc Today Editorial Board Member, told HemOnc Today. “The caregivers are the backbone of our health care system. We will continue research that helps us understand the burdens which they face and how best to support them.” – by Alexandra Todak

For more information:
Tina Hsu, MD, FRCPC, c
an be reached at tina.hsu@medportal.ca.
Arti Hurria, MD,
can be reached at ahurria@coh.org.

Disclosures: Hurria reports she has received research funding from Celgene, GlaxoSmithKline and Novartis, and is a consultant/adviser for Boehringer Ingelheim, Carevive, GTx and Sanofi. Hsu reports no relevant financial disclosures. Two other researchers report honoraria from Eli Lilly and Novartis, one of whom also holds intellectual property in SupportScreen.