Background Older adults with cancer are vulnerable to functional decline, placing greater onus on caregivers. Few studies have prospectively examined burden in caregivers of older cancer patients. We sought to determine factors associated with high caregiver burden. Methods 100 caregivers of patients age ≥65 with cancer, recruited at a single-institution, completed questionnaires gauging their perception of the patient’s physical, emotional, and social health. The association between these items, cancer-related factors, sociodemographic factors, and caregiver burden [measured by the Caregiver Strain Index (CSI)] was determined through multivariate analysis. Results Patients were a median age of 70 (range 65–91), 70% had advanced disease, and 98% were receiving treatment. Caregivers were mostly female (73%), spouses (68%), and lived with the patient (79%). Median hours of care provided was 10 hours/week. Mean CSI score was 3.1±3.2. Most caregivers (75%) reported some burden, with 15% reporting high caregiver burden (CSI ≥7). In multivariate analysis, employed caregivers (OR 4.5; 95% CI 1.1–18.4, p=0.04) and those who cared for patients requiring more help with instrumental activities of daily living (OARS-IADL score <12 of 14) (OR 12.4; 95% CI 2.4–62.5, p<0.001) were more likely to experience high caregiver burden (CSI ≥7). Conclusions Caregiver burden is common in those who care for older cancer patients. High burden is more likely in employed caregivers and those who care for patients who require increased functional assistance. Further studies are needed to determine unique challenges experienced by caregivers of older adults with cancer and potential interventions to alleviate burden in these caregivers.

Aging is a heterogeneous process. Most newly diagnosed cancers occur in older adults, and it is important to understand a patient's underlying health status when making treatment decisions. A geriatric assessment provides a detailed evaluation of medical, psychosocial, and functional problems in older patients with cancer. Specifically, it can identify areas of vulnerability, predict survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice; however, the uptake is hampered by limitations in both time and resources, as well as by a lack of expert interpretation. In this review, we describe the utility of geriatric assessment by using an illustrative case and provide a practical approach to geriatric assessment in oncology. CASE J.K. is a 73-year-old man who presented to his primary care physician complaining of bright red blood per rectum. He has a medical history of coronary artery disease, hypertension, hyperlipidemia, and cerebrovascular disease. He is on aspirin, lisinopril, metoprolol, and atorvastatin. A subsequent colonoscopy revealed a 3-cm mass in his descending colon. Biopsy of the mass showed invasive adenocarcinoma. He underwent computed tomography scans of the chest, abdomen, and pelvis, which showed no evidence of metastases. A laparoscopic colectomy was performed, and his cancer was staged as T2N2 (stage III) and microsatellite stable. He is referred to you to discuss adjuvant chemotherapy.

Long-term BC survivors show improvement in many domains of QOL over time, and they appear to have similar QOL in most respects to age-matched noncancer controls, although small deficits in cognition and finances were identified.

Chemotherapy-related cognitive impairment (CRCI) can occur during or after chemotherapy and represents a concern for many patients with cancer. Among older patients with cancer, in whom there is little clinical trial evidence examining side effects like CRCI, many unanswered questions remain regarding risk for and resulting adverse outcomes from CRCI. Given the rising incidence of cancer with age, CRCI is of particular concern for older patients with cancer who receive treatment. Therefore, research related to CRCI in older patients with cancers is a high priority. In this manuscript, we discuss current gaps in research highlighting the lack of clinical studies of CRCI in older adults, the complex mechanisms of CRCI, and the challenges in measuring cognitive impairment in older patients with cancer. Although we focus on CRCI, we also discuss cognitive impairment related to cancer itself and other treatment modalities. We highlight several research priorities to improve the study of CRCI in older patients with cancer.