Family Caregiver Burden Among Advanced Cancer Patients: Findings from the CONNECT Trial (RP421)

 Objectives: •Compare the experiences of burden for family caregivers in general to that of caregivers for patients with advanced cancer. • Evaluate patient-related factors that contribute to burden among caregivers for advanced cancer patients. • Assess how the relationship between patient-related factors and caregiver burden is affected by time spent caregiving.  Importance: Family caregivers for patients with advanced cancer spend significant time caregiving and experience burden that has been associated with poor outcomes. Patient-related factors associated with caregiver burden in this population are not well understood.  Objective(s): (1) Identify patient-related factors associated with caregiver burden and (2) examine how this relationship is modified by time spent caregiving.  Method(s): This cross-sectional study draws from baseline data collected as part of a cluster randomized trial of an oncology nurse-led primary palliative care intervention (CONNECT). Patients with advanced cancer and their family caregivers were enrolled from 17 oncology practices in Western Pennsylvania. Caregiver burden was measured using the Zarit Burden Interview (ZBI-12; range 0-48, higher scores indicating more burden). Patient-related factors included functional status (ECOG), depression and anxiety symptoms (HADS), and quality of life (FACIT-Pal). Oncologists assessed functional status, while patients reported mood symptoms and QOL. Using multivariable regression with interaction terms, we analyzed (1) independent associations between patient-related factors and caregiver burden and (2) the effect modification of hours spent caregiving on these relationships.  Results: Among 430 patient-caregiver dyads, the mean patient age was 69.8 ± 10.2 and the mean caregiver age was 61.4 ± 13. Over 70% of caregivers were women, spending an average 43.9 ± 52.7 hrs per week caregiving. Caregivers' mean ZBI-12 scores were 10.4 ±7.3, indicating low burden. Worse patient functional status (p<0.001), poorer patient QOL (p<0.001), and higher levels of patient anxiety (p<0.001) and depression (p<0.001) were significantly associated with higher caregiver burden; the number of caregiving hours per week did not affect these relationships.  Conclusion(s): Among patients with advanced cancer, patient-related factors are associated with higher caregiver burden regardless of hours spent caregiving.  Impact: Targeting interventions to support caregivers for patients with worse functional status, QOL, and mental health, may alleviate caregiver burden.