Quality of Life of Caregivers of Older Patients with Advanced Cancer

Kehoe, Lee; Xu, Huiwen; Duberstein, Paul R.; Loh, Kah Poh; Culakova, Eva; Canin, Beverly; Hurria, Arti; Dale, William; Wells, Megan; Gilmore, Nikesha; Kleckner, Amber S.; Lund, Jennifer L.; Kamen, Charles; Flannery, Marie; Hoerger, Mike; Hopkins, Judith O.; Liu, Jane Jijun; Geer, Jodi; Epstein, Ron; Mohile, Supriya G.

doi:10.1111/jgs.15862

Cited by 68 publications

(79 citation statements)

References 52 publications

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“…The relationship between caregiver health and discordance should therefore be further investigated. This is important because many caregivers of older adults have poor physical health and comorbidities .…”

Section: Discussionmentioning

confidence: 99%

Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists

et al. 2019

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Background Ensuring older patients with advanced cancer and their oncologists have similar beliefs about curability is important. We investigated discordance in beliefs about curability in patient‐oncologist and caregiver‐oncologist dyads. Materials and Methods We used baseline data from a cluster randomized trial assessing whether geriatric assessment improves communication and quality of life in older patients with advanced cancer and their caregivers. Patients were aged ≥70 years with incurable cancer from community oncology practices. Patients, caregivers, and oncologists were asked: “What do you believe are the chances the cancer will go away and never come back with treatment?” Options were 100%, >50%, 50/50, <50%, and 0% (5‐point scale). Discordance in beliefs about curability was defined as any difference in scale scores (≥3 points were severe). We used multivariate logistic regressions to describe correlates of discordance. Results Discordance was present in 60% (15% severe) of the 336 patient‐oncologist dyads and 52% (16% severe) of the 245 caregiver‐oncologist dyads. Discordance was less common in patient‐oncologist dyads when oncologists practiced longer (adjusted odds ratio [AOR] 0.90, 95% confidence interval [CI] 0.84–0.97) and more common in non‐Hispanic white patients (AOR 5.77, CI 1.90–17.50) and when patients had lung (AOR 1.95, CI 1.29–2.94) or gastrointestinal (AOR 1.55, CI 1.09–2.21) compared with breast cancer. Severe discordance was more common when patients were non‐Hispanic white, had lower income, and had impaired social support. Caregiver‐oncologist discordance was more common when caregivers were non‐Hispanic white (AOR 3.32, CI 1.01–10.94) and reported lower physical health (AOR 0.88, CI 0.78–1.00). Severe discordance was more common when caregivers had lower income and lower anxiety level. Conclusion Discordance in beliefs about curability is common, occasionally severe, and correlated with patient, caregiver, and oncologist characteristics. Implications for Practice Ensuring older patients with advanced cancer and their caregivers have similar beliefs about curability as the oncologist is important. This study investigated discordance in beliefs about curability in patient‐oncologist (PO) and caregiver‐oncologist (CO) dyads. It found that discordance was present in 60% (15% severe) of PO dyads and 52% (16% severe) of CO dyads, raising serious questions about the process by which patients consent to treatment. This study supports the need for interventions targeted at the oncologist, patient, caregiver, and societal levels to improve the delivery of prognostic information and patients’/caregivers’ understanding and acceptance of prognosis.

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Section: Discussionmentioning

confidence: 99%

Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists

et al. 2019

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“…However, little is known about how increasing aging‐related impairments in this vulnerable population impact caregiver health and quality of life (QOL). The study by Kehoe et al in this issue sought to evaluate the relationships between geriatric assessment (GA) impairments in older adults with cancer and their caregivers' QOL, physical health, and emotional health …”

Section: Challenges and Barriers To Successful Caregiver Interventionmentioning

confidence: 99%

“…The study by Kehoe et al in this issue sought to evaluate the relationships between geriatric assessment (GA) impairments in older adults with cancer and their caregivers' QOL, physical health, and emotional health. 4 Kehoe et al conducted a cross-sectional study using baseline data from older adults with advanced cancer and their caregivers from 31 community oncology practice clusters enrolled in the Improving Communication in Older Cancer Patients and Their Caregivers (COACH) study. 4 The COACH study is a cluster-randomized trial evaluating if GAguided recommendations improve communication between patients, caregivers, and oncologists.…”

mentioning

confidence: 99%

“…4 Kehoe et al conducted a cross-sectional study using baseline data from older adults with advanced cancer and their caregivers from 31 community oncology practice clusters enrolled in the Improving Communication in Older Cancer Patients and Their Caregivers (COACH) study. 4 The COACH study is a cluster-randomized trial evaluating if GAguided recommendations improve communication between patients, caregivers, and oncologists. 5 Eligible patients were aged 70 years or older, had an advanced solid tumor or lymphoma, were considering or receiving cancer treatment, and had one or more GA domain impairment at enrollment.…”

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confidence: 99%

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Who Will Care for the Caregivers? Increased Needs When Caring for Frail Older Adults With Cancer

Huang

Smith

Wong

2019

J American Geriatrics Society

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“…Several articles in this issue examine these outcomes in older adults with cancer, including characterization of functional resilience among older women who received chemotherapy . Two articles demonstrate the importance of attention to the quality of life of caregivers of older adults with cancer …”

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confidence: 99%