MON-862 - Unmet Daily Living Needs in Older Veterans with Endocrine Cancers: A Veteran-Caregiver Perspective Analysis

Background:

Endocrine-related cancers commonly affect older adults with multimorbidity and risk for functional decline. Unmet activities of daily living (ADL) needs have been associated with hospitalization, institutionalization, and mortality. Little is known about the ADL needs of Veterans with endocrine-related cancers.

Methods:

We combined 2021 HERO CARE survey and Veteran administrative data to identify Veterans with endocrine-related cancers and their cardiometabolic comorbidities as captured by Hierarchical Condition Category (HCC) codes. Unmet needs were operationalized with a 24-item summated unmet needs score based on self-reported basic, instrumental, and advanced ADL information from the survey responses. Linear regression, with heteroscedasticity-robust standard error correction, evaluated associations between unmet need scores and Veteran-caregiver sociodemographic factors, financial insecurity, and caregiver education and employment, adjusting for Veterans' total ADL need (including met and unmet).

Results:

We analyzed 457 Veteran-caregiver dyads across cancer groups: pancreatic (HCC 9; n = 80); metastatic disease involving the thyroid, pituitary, adrenal, and pancreas (HCC 11, n = 123); and primary thyroid, pituitary, adrenal, and pancreatic neuroendocrine tumors (HCC 12, n = 254). Veterans were mostly older (age 81.30 ± 8.53 years), male (97.4%), and non-Hispanic white (73.5%), with cardiometabolic comorbidities (76.8%).

On average, Veterans and caregivers reported Veterans having 12.28 ± 0.39 versus 10.76 ± 0.37 total functional needs, and 3.06 ± 0.25 versus 4.23 ± 0.29 unmet needs, respectively. A one-unit increase in Veteran’s self-reported total functional need was associated with a 0.29 increase in their self-reported unmet needs [B(se) = 0.29(0.03), p< 0.001], and an increase of 0.44 in their caregiver-reported unmet needs [B(se) = 0.44(0.04), p< 0.001]. Veteran’s financial insecurity was associated with a 2.94 increase in self-reported unmet needs score [B(se) = 2.94(1.08), p = 0.0066]. Caregivers having a graduate degree were associated with a 2.49 increase in their report of the Veteran’s unmet needs [B(se) = 2.49(0.94), p = 0.0086], versus those without a high school diploma.

Conclusion:

Unmet ADL needs were substantial among older Veterans with endocrine-related cancers and increased with greater functional burden and with financial insecurity. Higher caregiver-reported unmet needs among caregivers with graduate degrees may reflect differences in expectations, role strain, and/or reporting rather than objective care needs. Older Veterans with endocrine-related cancers may benefit from increased assessment of functional needs and connection when relevant to supportive resources, which may need to be tailored for adequate effectiveness when ADL needs are high and/or financial insecurity is present.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*