The humanistic burden of advanced non-small cell lung cancer: What are the key drivers of caregiver burden?

Abstract

149 Background: Advanced Non-Small Cell Lung Cancer (aNSCLC) impacts the lives of patients and their caregivers. This analysis aimed to provide insight into the clinical, patient and caregiver factors associated with increased caregiver burden. Methods: Data from a cross-sectional study of aNSCLC patients and informal (unpaid) caregivers in France, Germany and Italy, were collected from May 2015 to June 2016, consisting of a chart review and patient and caregiver surveys. Caregiver burden was assessed using the Zarit Burden Interview (ZBI), measured on a 0-88 scale. An ordinary least square regression model was constructed to assess clinical, patient and caregiver factors associated with ZBI. Measured at time of survey completion, covariates included: country, patient age, sex, body mass index, stage of NSCLC, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), disease duration, smoking status, presence of brain metastases, histology, comorbidities, chemotherapy treatment, caregiver age and sex, and the number of formal (paid) and informal caregiver hours provided per week by additional caregivers. A significance level of 0.05 was used. Results: 331 caregivers were analysed. Mean (SD) caregiver age was 53.8 years (12.4), 239 (72.2%) were female. Caregivers provided a mean (SD) of 17.8 (23.4) hours of care per week. Mean (SD) formal / informal caregiver hours provided by other caregivers was 3.9 (13.3) / 3.9 (12.0). Many caregivers did not receive support from additional formal (75.5%) or informal (68.6%) caregivers. Mean (SD) ZBI score was 31.3 (14.8). Significant independent predictors of ZBI were patient’s ECOG-PS and number of additional informal caregiver hours provided. ZBI scores for caregivers of patients with an ECOG-PS of 3-4 were 7.68 units higher compared to those with an ECOG-PS of 0-2 (p = 0.006). Also, ZBI scores increased by 0.16 units per hour of informal caregiver provided by additional caregivers (p = 0.008). Conclusions: The key drivers of caregiver burden found in the study reinforce the need to develop supportive and personalised interventions to maintain patient performance status by delaying progression, and reduce informal caregiver hours supporting the patient.