Older adults with cancer and their caregivers — current landscape and future directions for clinical care

Kadambi, Sindhuja; Loh, Kah Poh; Dunne, Richard F.; Magnuson, Allison; Maggiore, Ronald J.; Zittel, Jason; Flannery, Marie; Inglis, Julia Ellen; Gilmore, Nikesha; Mohamed, Mostafa R.; Ramsdale, Erika; Mohile, Supriya G.

doi:10.1038/s41571-020-0421-z

Cited by 60 publications

(51 citation statements)

References 156 publications

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“…Among caregivers of older adults, greater mastery has been shown to correlate with lower caregiver burden and less anxiety and depressive symptoms [18]. Caregiver involvement is often more substantial in the care of older adults [24,36], and caregivers generally receive very little training [37,38]. Therefore, understanding how mastery is associated with caregiver outcomes among those caring for vulnerable older adults with cancer is important.…”

Section: Discussionmentioning

confidence: 99%

Caregiver–Oncologist Prognostic Concordance, Caregiver Mastery, and Caregiver Psychological Health and Quality of Life

et al. 2021

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Background Caregivers of adults with cancer often report a different understanding of the patient's prognosis than the oncologist. We examine the associations of caregiver–oncologist prognostic concordance with caregiver depressive symptoms, distress, and quality of life (QoL). We also explore whether these relationships differed by caregiver environment mastery, an individual's sense of control, and effectiveness in managing life situations. Materials and Methods We used data from a national geriatric assessment cluster‐randomized trial (URCC 13070) that recruited patients aged 70 years and older with incurable cancer considering any line of cancer treatment at community oncology practices, their caregivers, and their oncologists. At enrollment, caregivers and oncologists estimated the patient's prognosis (0–6 months, 7–12 months, 1–2 years, 2–5 years, and >5 years; identical responses were concordant). Caregivers completed the Ryff's environmental mastery at enrollment. At 4–6 weeks, caregivers completed the Patient Health Questionnaire‐2 (depressive symptoms), distress thermometer, and 12‐Item Short‐Form Health Survey (quality of life [QoL]). We used generalized estimating equations in models adjusted for covariates. We then assessed the moderation effect of caregiver mastery. Results Of 411 caregiver–oncologist dyads (mean age = 66.5 years), 369 provided responses and 28% were concordant. Prognostic concordance was associated with greater caregiver depressive symptoms (β = 0.30; p = .04) but not distress or QoL. A significant moderation effect for caregiver depressive symptoms was found between concordance and mastery (p = .01). Specifically, among caregivers with low mastery (below median), concordance was associated with greater depressive symptoms (β = 0.68; p = .003). Conclusions Caregiver–oncologist prognostic concordance was associated with caregiver depressive symptoms. We found a novel moderating effect of caregiver mastery on the relationship between concordance and caregiver depressive symptoms. Implications for Practice Caregiver–oncologist prognostic concordance is associated with greater caregiver depressive symptoms, particularly in those with low caregiver mastery. When discussing prognosis with caregivers, physicians should be aware that prognostic understanding may affect caregiver psychological health and should assess their depressive symptoms. In addition, while promoting accurate prognostic understanding, physicians should also identify strengths and build resilience among caregivers.

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Section: Discussionmentioning

confidence: 99%

Caregiver–Oncologist Prognostic Concordance, Caregiver Mastery, and Caregiver Psychological Health and Quality of Life

et al. 2021

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“…For example, it is estimated that eliminating socioeconomic disparities could prevent 34 percent of cancer deaths among all U.S. adults between the ages of 25 to 74 (9). Older adults tend to have lower levels of health literacy and greater difficulty navigating the health care system than younger adults (10). Health risk behaviors are known to cluster and are more likely seen in individuals with lower educational attainment, putting them at greater risk of cancer (11).…”

Section: Cancer Health Disparitiesmentioning

confidence: 99%

Assessing the Coverage of US Cancer Center Primary Catchment Areas

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McNair

Yurick

et al. 2022

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Cancer centers are expected to engage communities and reduce the burden of cancer in their catchment areas. However, the extent to which cancer centers adequately reach the entire U.S. population is unknown. Methods:We surveyed all members of the Association of American Cancer Institutes (N=102 cancer centers) to document and map each cancer center's primary catchment area.Catchment area descriptions were aggregated to the county level. Catchment area coverage scores were calculated for each county and choropleths generated representing coverage across the U.S. Similar analyses were utilized to overlay U.S. population density, cancer incidence, and cancer mortality compared to each county's cancer center catchment area coverage.Results: Roughly 85% of U.S. counties were included in at least one cancer center's primary catchment area. However, 15% of U.S. counties, or roughly 25 million Americans, do not reside in a catchment area. When catchment area coverage was integrated with population density, cancer incidence, and cancer mortality metrics, geographical trends in both over-and-under coverage were apparent. Conclusion:Geographic gaps in cancer center catchment area coverage exist and may be propagating cancer disparities. Efforts to ensure coverage to all Americans should be a priority of cancer center leadership.Impact: This is the first known geographic analysis and interpretation of the primary catchment areas of all U.S.-based cancer centers and identifies key geographic gaps important to target for disparities reduction.

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“…Several areas of interventions used with other populations may have potential relevance for the older adult survivor cohort and could be considered for future program design and implementation. Lay Navigation [ 80 ], nurse coordination models [ 74 ], home telehealth [ 74 , 76 ], use of survivorship care plans [ 81 , 82 ], and active involvement of caregivers/partners in care planning [ 83 , 84 ] could be explored given the interventions were designed with the unique needs of older survivors in mind.…”

Section: Suggestions Regarding Future Research and Care Across Articlesmentioning

confidence: 99%

Challenges of Survivorship for Older Adults Diagnosed with Cancer

et al. 2022

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Purpose of Review The purpose of this brief review is to highlight significant recent developments in survivorship research and care of older adults following cancer treatment. The aim is to provide insight into care and support needs of older adults during cancer survivorship as well as directions for future research. Recent Findings The numbers of older adult cancer survivors are increasing globally. Increased attention to the interaction between age-related and cancer-related concerns before, during, and after cancer treatment is needed to optimize outcomes and quality of life among older adult survivors. Issues of concern to older survivors, and ones associated with quality of life, include physical and cognitive functioning and emotional well-being. Maintaining activities of daily living, given limitations imposed by cancer treatment and other comorbidities, is of primary importance to older survivors. Evidence concerning the influence of income and rurality, experiences in care coordination and accessing services, and effectiveness of interventions remains scant for older adults during survivorship. Summary There is a clear need for further research relating to tailored intervention and health care provider knowledge and education. Emerging issues, such as the use of medical assistance in dying, must be considered in this population.

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Older adults with cancer and their caregivers — current landscape and future directions for clinical care

Cited by 60 publications

References 156 publications

Caregiver–Oncologist Prognostic Concordance, Caregiver Mastery, and Caregiver Psychological Health and Quality of Life

Caregiver–Oncologist Prognostic Concordance, Caregiver Mastery, and Caregiver Psychological Health and Quality of Life

Assessing the Coverage of US Cancer Center Primary Catchment Areas

Challenges of Survivorship for Older Adults Diagnosed with Cancer

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