Background Older adults with cancer are vulnerable to functional decline, placing greater onus on caregivers. Few studies have prospectively examined burden in caregivers of older cancer patients. We sought to determine factors associated with high caregiver burden. Methods 100 caregivers of patients age ≥65 with cancer, recruited at a single-institution, completed questionnaires gauging their perception of the patient’s physical, emotional, and social health. The association between these items, cancer-related factors, sociodemographic factors, and caregiver burden [measured by the Caregiver Strain Index (CSI)] was determined through multivariate analysis. Results Patients were a median age of 70 (range 65–91), 70% had advanced disease, and 98% were receiving treatment. Caregivers were mostly female (73%), spouses (68%), and lived with the patient (79%). Median hours of care provided was 10 hours/week. Mean CSI score was 3.1±3.2. Most caregivers (75%) reported some burden, with 15% reporting high caregiver burden (CSI ≥7). In multivariate analysis, employed caregivers (OR 4.5; 95% CI 1.1–18.4, p=0.04) and those who cared for patients requiring more help with instrumental activities of daily living (OARS-IADL score <12 of 14) (OR 12.4; 95% CI 2.4–62.5, p<0.001) were more likely to experience high caregiver burden (CSI ≥7). Conclusions Caregiver burden is common in those who care for older cancer patients. High burden is more likely in employed caregivers and those who care for patients who require increased functional assistance. Further studies are needed to determine unique challenges experienced by caregivers of older adults with cancer and potential interventions to alleviate burden in these caregivers.

QUESTION ASKED: Does a computer-based approach for collecting geriatric assessment information provide a practical and efficient means of obtaining reliable and reproducible data from older adults with cancer?SUMMARY ANSWER: Computer-based geriatric assessment provides a feasible, reliable, and valid approach in older adults with cancer. WHAT WE DID:Older patients ($ 65 years) with cancer were randomly assigned to one of four treatment arms to compare the feasibility, reliability, and validity of two computer-based platforms for geriatric assessment with traditional paper-and-pencil data capture.WHAT WE FOUND: Completion times were similar for computer-based and paper-and-pencil assessments (Fig), and data gathered via computer-based assessment showed high test-retest reliability as well as internal consistency. BIAS, CONFOUNDING FACTOR(S), REAL-LIFE IMPLICATIONS:Many of the patients in our study were white, non-Hispanic, and college-educated older adults. This patient population may be more comfortable using computer technologies than other demographic groups; thus our results may not be generalizable to other segments of the patient population. Older patients with cancer are at increased risk for treatment toxicity. Geriatric assessment captures a range of physiological and psychological metrics that predict toxicity and survival, and thus have high utility in guiding interventions. In the current study, we found that computer-based geriatric assessment provides an efficient method for acquiring reliable and valid data. Adoption of computer-based geriatric assessment into oncology practice thus can provide a cost-and time-efficient approach for acquiring high-value data to be used in formulating treatment decisions for older adults with cancer. Completion Time (minutes) Abstract PurposeThe goal of this study was to evaluate the feasibility, reliability, and validity of a computerbased geriatric assessment via two methods of electronic data capture (SupportScreen and REDCap) compared with paper-and-pencil data capture among older adults with cancer. MethodsEligible patients were $ 65 years old, had a cancer diagnosis, and were fluent in English.Patients were randomly assigned to one of four arms, in which they completed the geriatric assessment twice: (1) REDCap and paper and pencil in sessions 1 and 2; (2) REDCap in both sessions; (3) SupportScreen and paper and pencil in sessions 1 and 2; and (4) SupportScreen in both sessions. The feasibility, reliability, and validity of the computer-based geriatric assessment compared with paper and pencil were evaluated. ResultsThe median age of participants (N = 100) was 71 years (range, 65 to 91 years) and the diagnosis was solid tumor (82%) or hematologic malignancy (18% ). There were no significant differences in completion times between SupportScreen and paper and pencil (P = .50). The computer-based geriatric assessment was feasible. Few participants (8%) needed help with completing the geriatric assessment (REDCap, n = 7 and SupportScreen, n = 1), 89% reported th...

Many families and close friends are experiencing bereavement due to cancer. A review of recent studies of bereavement outcomes, mainly elevated psychological distress, suggests that bereaved family members, compared with nonbereaved, have poorer quality of life. They display high levels of complicated grief, anxiety, and depression and use bereavement services, but also report finding meaning in the loss, during the first 6 months after death. Similar demographic (e.g., female sex and younger age) and psychological (e.g., premorbid mental health conditions and lack of preparedness for the death) predictors are related to the bereavement outcomes across different familial groups. However, the severity of psychological distress and bereavement needs expressed vary by familial groups. Unrelieved pain and anxiety of the patient before the death and family members being unprepared for the impending death appear to be related to several postdeath psychological and physical morbidities of the surviving family members. Although the number of articles addressing bereavement-related issues associated with cancer has been growing in recent years, more rigorous studies that use longitudinal prospective designs, which bridge cancer survivorship with bereavement research, are needed.

This review focuses on the aspects of biopsychosocial screening that have specific and significant implications for supportive care related to cancer care and research. There is a robust literature relating to the unmet supportive care needs of cancer patients and their families and the clinical interventions needed to effectively manage many of their problems. The Zeitgeist movement, which promotes the idea that the resources of this planet are the inherent right of all peoples, is also uniquely aligned to see supportive care services in oncology bringing significant value (cost and quality) to a health care system that is experiencing great uncertainty. Overall, there is a broadening of perspective within the supportive care community that there needs to be greater levels of interdisciplinary integration. More significantly, there is a growing realization that for cancer care to be truly patient and family centered and even minimally efficient, disease-directed care and supportive care need to be integrated from the time of diagnosis. The coordination of these services should not be based on the stage of the disease but rather tailored to the needs of the patient, family, and social context. Biopsychosocial screening programs have the potential to be the connective tissue of these patient- and family-centered systems.

The oncology nurse plays a key role in supporting patient preventive care and screening uptake through assessment, counseling, education, advocacy, and intervention. As oncology nurses become expert in the culturally competent care of LGBT persons, they can contribute to the improvement of quality of care and overall well-being of this health care disparity population.

A sizeable proportion of cancer patients experience significant problems with their sleep before any treatment has occurred. This clinical issue cannot be ignored as treatment is likely to worsen existing sleep problems. Oncology providers should routinely screen for sleep-related problems. Identifying and treating patients for sleep problems during a vulnerable period early in their cancer trajectory should be an essential component of clinical care.

This Special Issue was proposed and supported by the Board of the American Psychosocial Oncology Society (APOS). Our esteemed Guest Editors were nominated by APOS to bring these papers together and reflect the special circumstances their members face, and indeed that are faced by psycho-oncology professionals globally, namely ensuring that psychosocial care is fully accepted and integrated, equally and without bias, as part of comprehensive cancer care.-.Maggie Watson, Editor-in-Chief This year, we have witnessed so much suffering as we have confronted the intersecting public health crises of the COVID-19 pandemic and systemic racism. Marginalized populations: Black, Latino, indigenous populations, older adults, individuals affected by poverty, disabilities, and mental illness, have experienced disproportionate burden from the pandemic. These populations have increased rates of infection, worse health outcomes, and encounter additional barriers to maintaining financial wellbeing and accessing care. We have experienced the impact of a health care system that is ill-prepared and ill-designed to meet the minimal health needs of underserved populations. As psycho-oncologists, we have seen our patients struggle with the decision to delay their cancer care and experience increased isolation and fear. As care delivery has rapidly transformed from in-person to virtual models, we are failing to reach the patients who likely need our interventions the most. Adults with low socioeconomic status, particularly older adults from marginalized populations, lack access to technology, are socially isolated, and must balance many competing needs.

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