Differences in patient and caregiver assessments of the patient’s physical, mental, and social function, especially in instrumental activities of daily living (IADLs), may lead to increased caregiver burden, according to a study in The Oncologist.

Frailty and cognitive impairments occur at a higher rate in older patients with cancer, and there is an increased burden on caregivers to not only assist with IADLs but also to assess patient conditions and provide health care information.

Researchers identified 100 patients with cancer who were aged 65 years and older and their caregivers, and had them independently complete an assessment measuring patient function, comorbidity, mental health, social activity, social support, and nutrition. Caregiver burden was assessed using the Caregiver Strain Index (CSI).

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Caregivers assessed patients as having decreased function more than patients themselves, rating patients has having more IADLs dependency (P =.008), lower Medical Outcomes Study [MOS]-Physical Function (P <.0001), lower Karnofsky performance status (P =.02), having more social support (P =.03), and poorer mental health (P =.0002).

Only a discrepancy in patient and caregiver assessment of IADL was significantly associated with an increased caregiver burden (P =.03). Sixty percent of patients reported requiring assistance with IADL.

The authors conclude saying “further research investigating caregiver burden and caregiver-patient assessment, with the addition of an objective marker of patient health and function, would be helpful to better understand whether caregiver burden is the cause or consequence of differences in caregiver-patient perception of patient health.”


1. Hsu T, Lascalzo M, Ramani R, et al. Are disagreements in caregiver and patient assessment of patient health associated with increased caregiver burden in caregivers of older adults with cancer? [published online August 14, 2017]. Oncologist. doi: 10.1634/theoncologist.2017-0085