Caregiving burden of informal caregivers of older adults with advanced cancer: The effects of rurality and education

Huiwen Xu, Sindhuja Kadambi, Supriya G. Mohile, Shuhan Yang, Lee A. Kehoe, Megan Wells, Eva Culakova, Charles Kamen, Spencer Obrecht, Mostafa Mohamed, Nikesha J. Gilmore, Allison Magnuson, Valerie Aarne Grossman, Judith O. Hopkins, Jodi Geer, Jeffrey Berenberg, Karen Mustian, Anapaula Cupertino, Nimish Mohile, Kah Poh Loh

Research output: Contribution to journalArticlepeer-review


Objectives: Rural-urban disparities in the experiences of caregivers of older adults with advanced cancer may exist. This study examined factors associated with caregiver mastery and burden and explored whether rural-urban disparities in caregiver outcomes differed by education. Materials and methods: Longitudinal data (baseline, 4–6 weeks, and 3 months) on caregivers of older adults (≥ 70) with advanced cancer were obtained from a multicenter geriatric assessment (GA) trial ( NCT02107443). Rurality was determined based on 2010 Rural-Urban Commuting Area codes. Caregivers' education was categorized as ≥ some college vs ≤ high school. Caregiver outcomes included Ryff Environmental Mastery (scored 7–35) and Caregiver Reaction Assessment (including self-esteem, disrupted schedules, financial problems, lack of social support, and health problems; each scored 1–5). Separate linear mixed models with interaction term of education and rurality were performed. Results: Of 414 caregivers, 64 (15.5%) were from rural areas and 263 (63.5%) completed ≥ some college. Rurality was significantly associated with more disrupted schedules (β = 0.21), financial problems (β = 0.17), and lack of social support (β = 0.11). A significant interaction between education and rurality was found, with rurality associated with lower mastery (β = −1.27) and more disrupted schedule (β = 0.25), financial problems (β = 0.33), and lack of social support (β = 0.32) among caregivers with education ≤ high school. Conclusion: Our study identifies subgroups of caregivers who are vulnerable to caregiving burden, specifically those from rural areas and with lower education. Multifaceted interventions are needed to improve caregivers' competency and reduce caregiving burden.

Original languageEnglish (US)
Pages (from-to)1015-1021
Number of pages7
JournalJournal of Geriatric Oncology
Issue number7
StatePublished - Sep 2021
Externally publishedYes


  • Caregiving burden
  • Education
  • Environmental mastery
  • Geriatric assessments
  • Rural-urban disparities

ASJC Scopus subject areas

  • Oncology
  • Geriatrics and Gerontology


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