Older Patient and Caregiver Prognostic Estimates Suggest Need for Prognostic Interventions

A study published in Cancer found that caregiver distress, patient communication self-efficacy, patient polypharmacy, and the sex of the oncologist are all associated with older patient and caregiver disagreement about prognostic estimates.

“Caregivers (generally family members or friends) play an integral role in the care of older adults, and many participate in prognostic discussions and assist patients with treatment decision making,” the authors wrote. “Therefore, there is a need to comprehend prognostic understanding among caregivers.”

In this study, researchers obtained baseline data from a cluster-randomized geriatric assessment trial that recruited patients aged 70 years or older who had incurable cancer from community oncology practices. Patient and caregiver dyads were asked to estimate the patient’s prognosis, with options including 0 to 6 months, 7 to 12 months, 1 to 2 years, 2 to 5 years, and over 5 years.

Of a total of 354 dyads, consisting of 89% of screened patients, 26% and 22% of patients and caregivers, respectively, reported a longer estimate.

When compared with dyads that were in agreement, patients were found to be more likely to report a longer estimate when they screened positive for polypharmacy (β = 0.81; P = .001), and caregivers reported greater distress (β = 0.12; P = .03). Moreover, when compared with dyads that were in agreement, caregivers were more likely to report a longer estimate when patients screened positive for polypharmacy (β = 0.82; P = .005) and had lower perceived self-efficacy in interacting with physicians (β = -0.10; P = .008).

“One possible explanation is that patients who are on many medications see many physicians, undergo more tests, strongly believe in the necessity of their medications and cancer treatments, and may perceive the medications as being able to cure them and make them feel better,” the authors explained. “These beliefs may also occur in their caregivers, which may explain the reason polypharmacy was the only variable to demonstrate an association with both patients and caregivers reporting longer estimates. These beliefs may be influenced by the relationship with their physician.”

In conjunction with previously published studies, the researchers indicated that these findings demonstrate a need for interventions to improve prognostic understanding between patients, caregivers, and health care professionals. One such intervention includes the implementation of palliative care, which investigators noted has been found to improve caregiver communication as well as prognostic understanding through the development of coping skills.

Of note, this study only included patients who had incurable disease, as determined by the oncologist at enrollment, and were considering or receiving treatment. Thus, these findings are not generalizable to those who were not considered for treatment due to underlying frailty or other reasons. Additionally, these results are mainly applicable to older, non-Hispanic white patients living in the US and those who are relatively well educated. Therefore, studies focused on other population groups are needed.

“Future longitudinal studies are needed to examine the effects of prognostic disagreement on patient and caregiver outcomes,” the authors added.

Reference:

Loh KP, Soto-Perez-de-Celis E, Duberstein PR, et al. Patient and Caregiver Agreement on Prognosis Estimates for Older Adults With Advanced Cancer. Cancer. doi: 10.1002/cncr.33259