Caregiver professional employment and its impact on glioblastoma patient survival: Results from two prospective studies.

Abstract

2050 Background: Caregiver burden is a crucial factor to consider in the diagnosis and care of patients with glioblastoma (GBM). Despite growing interest in caregiver issues, data on caregiver burden and, in particular, professional and working burden are limited, as well as the potential effect of caregiver burden on patients’ survival. Methods: We collected caregiver data from two prospective observational studies (ISES 1 and ISES 2) investigating the impact of socioeconomic variables (SES) in GBM patients. In particular, we collected data on the presence and type of caregiver, the caregiver's professional situation, and any professional modifications after the GBM diagnosis at time of adjuvant treatment start and after six months (in patients enrolled in ISES 2 study). Results: Overall, 511 GBM isocitrate dehydrogenases wild-type (IDH-wt) patients were included. The median follow-up period was 55.2 months (95% CI, 44.3–86.3), and the median overall survival was 15.7 months (95% CI, 14.8–17.2). A caregiver was present for 472 patients (92.4%), consisting mainly of partners or daughters and sons. At the start of adjuvant treatment, 158 caregivers (30.9%) reduced their working hours, and 55 caregivers (10.8%) stopped working. For 232 patients, a longitudinal assessment of caregiver condition was collected, and 71 caregivers (30.6%) reduced their working hours, while 33 patients (14.2%) stopped their work activities. Patients whose caregivers were in stable employment had a longer life expectancy than those whose caregivers were not (multivariate - HR 0.76, 95% CI 0.60–0.94, p = 0.03), regardless of other known prognostic factors, as confirmed by a multivariate analysis (Table 1). Conclusions: Our study revealed that GBM diagnosis often leads to a negative impact on caregiver work activities. A stable caregiver employment translates independently to a long-life expectancy of patients with GBM, regardless of other recognized prognostic factors. Policies supporting the professional and social activities of caregivers could improve not only the quality of care for GBM patients but also their clinical outcomes. Clinical trial information: 0321-3733778. VARIABLES Univariate analysesHazard Ratio (95%CI) p value Multivariate analysesHazard Ratio (95%CI) p value MGMTUnmethylated vs methylated 2.23 (1.79 – 2.77)p < 0.001 0.43 (0.34-0.55)p < 0.001 SURGERYBiopsyPartial resectionComplete resection Ref0.51 (0.38-0.69)0.50 (0.37-0.69)p <0.001 Ref0.62 (0.43-0.88)0.61 (0.42-0.89)p = 0.008 TREATMENTRT (40Gy)/CT ->CT vsRT (60Gy)/CT ->CT 1.31 (1.04-1.73)p = 0.02 1.04 (0.77-1.49)p = 0.8 ECOG0 vs 1 or more 0.67 (0.54-0.82)p <0.001 0.72 (0.56-0.91)p = 0.007 STEROIDSYes vs No 1.94 (1.57-2.40)p < 0.001 1.75 (1.31-2.13)p < 0.001 AGE (As continuous for year) 1.02 (1.01-1.03)p < 0.001 1.01 (1.0009-1.03)p = 0.04 CAREGIVER (professional condition)Employed vs other 0.73 (0.59-0.90)p = 0.005 0.76 (0.60-0.94)p = 0.03