Presentation (CTI)

OBJECTIVES: Health technology assessment (HTA) can include caregiver health-related quality of life (HRQoL), yet caregiver effects remain rarely incorporated in cancer appraisals. This research assessed whether current evidence supports inclusion of caregiver HRQoL in cancer HTA, identified key barriers, and provides recommendations for future evidence generation.
METHODS: We reviewed evidence from a prior systematic review and supplementary targeted searches to identify studies reporting HRQoL among caregivers of people with cancer. We also reviewed National Institute for Health and Care Excellence (NICE) final draft guidance to examine how caregiver HRQoL has been considered in cancer appraisals. We identified evidence gaps, transferability issues, and modelling challenges and synthesised these into research recommendations.
RESULTS: Eleven studies reported HRQoL outcomes for cancer caregivers; eight used EQ-5D. Studies were conducted in the USA (n=3), Korea (n=2), China (n=2), and one from each of: Sweden, Greece, Jordan, and international. The sample sizes ranged from 26 to 3,406. Several studies reported poorer caregiver HRQoL than general population comparators, but confounding adjustment was inconsistent, and no study established a causal effect of cancer caregiving on HRQoL. HTA bodies were not convinced that caregiver burden in cancer is more profound than in other serious illnesses. We did not find robust evidence of how cancer treatments affect the HRQoL of cancer caregivers. Key barriers include heterogeneous cancer populations, limited country-specific and longitudinal data, uncertain transferability from non-cancer conditions, and modelling risks for life-extending therapies.
CONCLUSIONS: Cancer caregiving is associated with HRQoL burden, but current evidence is insufficient for routine inclusion in oncology HTA. Future research should generate cancer-specific, decision-grade evidence through caregiver qualitative work, longitudinal or trial-aligned HRQoL studies, comparative analyses of unpaid care intensity, and early engagement with HTA decision-makers on acceptable evidence and modelling approaches.