Compounding strain: The impact of caregiver strain on health outcomes in older adults with new cancer diagnoses

Introduction: We sought to examine the association between pre-existing caregiving strain levels and care recipient health outcomes following a new cancer diagnosis.

Materials and methods: We used the National Health and Aging Trends Study (NHATS) linked with the National Study of Caregiving (NSOC) and Medicare claims to identify older adults receiving family caregiving within one year before an index cancer diagnosis. Caregiving strain was determined using NSOC items of self-reported emotional, physical, and financial difficulties measured before the cancer diagnosis. We used care recipient NHATS responses to determine outcomes with the Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder Scale (GAD-2), and self-reported general health pre and post-cancer diagnoses. Multivariable logistic regression models were used to examine care recipient's health outcomes following cancer diagnosis by previously existing caregiver strain levels.

Results: We identified 584 caregivers who had completed the NSOC items related to caregiving strain and were linked to 404 care recipients whose index cancer diagnoses occurred in the year following the NSOC interview. Care recipients with highly strained caregivers were more likely to report anxiety than recipients with less strained caregivers (33.5 % vs. 22.9 %, p < 0.05). In adjusted models, high strain was associated with increased odds of recipient anxiety (aOR: 2.08, 95 % CI 1.14-3.79). Depressive symptoms and general health outcomes did not differ by caregiver strain in adjusted models.

Discussion: The presence of caregiver strain may contribute to worsening care recipient anxiety following a new cancer diagnosis. Strategically placed caregiver screenings early in the cancer care planning could identify strained caregivers who may benefit from targeted support and training. and support.