Older cancer patients and their carers often differ in their assessment of physical ability, with caregivers generally rating the patient’s physical function as poorer, according to a study.
The study, published in The Oncologist journal, also found that differences in assessment of physical abilities between patients and carers were associated with greater burden on those doing the caring.
“Caregivers play an essential role in supporting older adults with cancer”
As a result, the researchers said clinicians should consider assessing carer burden in those who report that the patient is more dependent than the patient actually does themselves.
They noted that, for as long as possible, older cancer patients were generally cared for in their own homes by family or friends, with spouses being the most common caregivers.
Senior study author Dr Arti Hurria, from the City of Hope National Medical Center in California, highlighted the important role played by carers, “particularly for older adults with cancer”.
“We wanted to further understand the factors that are associated with caregiver burden,” she said.
“In daily practice, we sometimes see a disconnect between what the patient perceives in comparison to what the caregiver thinks”
Based on their experience of treating older cancer patients, she said a factor her team thought might be important was differing assessments of health and physical abilities between patients and carers.
“In daily practice, we sometimes see a disconnect between what the patient perceives their general health and abilities to be in comparison to what the caregiver thinks,” she said. “We wanted to see whether this disconnect impacted caregiver burden.”
The researchers questioned 100 older cancer patients, together with their caregivers, about the patient’s general health and physical function, and then compared the answers given.
They also assessed the level of burden experienced by the caregivers – defined as a subjective feeling of stress caused by being overwhelmed by the demands of caring. They did this using a standard questionnaire on topics such as sleep disturbance, physical effort and patient behaviour.
The 100 cancer patients, aged from 65 to 91, were suffering from a variety of different types of cancer, with the most common being lymphoma, breast cancer and gastrointestinal cancers.
Older cancer patients disagree with their carers on capability
The ages of the caregivers ranged from 28 to 85, of which 73% were female and 68% were the spouse of the patient.
The researchers found that carers consistently rated patients as having poorer physical function and mental health, and requiring more social support than the patients themselves did.
However, only the disparity in the assessment of physical function was associated with greater caregiver burden.
Lead study author Tina Hsu said: “I think there are two possible explanations. 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.
“Alternatively, it is possible that caregivers who are more stressed out perceive their loved one to require more help than they actually do need,” she said. “Most likely, the truth of how much help the patient actually needs lies somewhere between what patients and caregivers report.”
But, either way, she highlighted that “caregivers play an essential role in supporting older adults with cancer”.