Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr;26(4):310-317.
doi: 10.1002/onco.13699. Epub 2021 Feb 13.

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

Kah Poh Loh  1 , Mostafa R Mohamed  1 , Sindhuja Kadambi  1 , Eva Culakova  2 , Huiwen Xu  2 , Allison Magnuson  1 , Marie Flannery  3 , Paul R Duberstein  4 , Ronald M Epstein  1   5   6 , Colin McHugh  1 , Ryan D Nipp  7 , Kelly M Trevino  8 , Chandrika Sanapala  1 , Bianca A Hall  1 , Beverly Canin  9 , Arlene A Gayle  10 , Alison Conlin  11 , James Bearden 3rd  12 , Supriya G Mohile  1
Affiliations

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

Kah Poh Loh et al. Oncologist. 2021 Apr.

Abstract

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.

Keywords: Caregivers; Depressive symptoms; Environmental mastery; Older patients; Prognostic concordance.

PubMed Disclaimer

Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1
Figure 1
Flow diagram depicting the number of caregivers included in the secondary analysis.
Figure 2
Figure 2
Distribution of caregiver and oncologist estimates of patient length of life.
Figure 3
Figure 3
Moderation effect of mastery on the association between caregiver–oncologist concordance and caregiver depressive symptoms.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Jayani R, Hurria A. Caregivers of older adults with cancer. Semin Oncol Nurs 2012;28:221–225. - PMC - PubMed
    1. Kadambi S, Soto‐Perez‐de‐Celis E, Garg T et al. Social support for older adults with cancer: Young international society of geriatric oncology review paper. J Geriatr Oncol 2020;11:217–224. - PMC - PubMed
    1. Ornstein KA, Liu B, Schwartz RM et al. Cancer in the context of aging: Health characteristics, function and caregiving needs prior to a new cancer diagnosis in a national sample of older adults. J Geriatr Oncol 2020;11:75–81. - PMC - PubMed
    1. Glajchen M. The emerging role and needs of family caregivers in cancer care. J Support Oncol 2004;2:145–155. - PubMed
    1. Dionne‐Odom JN, Ejem D, Wells R et al. How family caregivers of persons with advanced cancer assist with upstream healthcare decision‐making: A qualitative study. PLoS One 2019;14:e0212967. - PMC - PubMed

Publication types

LinkOut - more resources