がん情報サイト | がん情報各論：[患者さん向け]Informal Caregivers in Cancer (PDQ®)

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This PDQ cancer information summary has current information about challenges and helpful interventions for caregivers of cancer patients. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.

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Roles of Informal Caregivers

This summary is about the roles, needs, and burdens of informal caregivers who are caring for a person with cancer.

Caregivers are either formal or informal.

An informal caregiver is usually a relative or friend who may or may not live in the same house as the person they are caring for. A formal caregiver, such as a nurse, is paid and has training to care for a patient. Informal and formal caregivers help people with cancer during and after treatment in many ways.

Caregivers often provide care for cancer patients.

Being a caregiver means helping with the daily needs of another person. They may do the following:

Caregiving can also be long-distance, such making appointments and planning care and services by phone or email.

Needs of Informal Caregivers

Caregiver’s needs change over time.

The needs of caregivers change as the cancer patient goes from screening to diagnosis, to treatment, and to either long-term survivorship or the end of life. Worry and the need for information are two demands that most caregivers have during the patient’s cancer journey.

Caregivers may have questions about treatment and side effects, how to find helpful resources, and ways to practice self-care.

One of the demands caregivers have is the need for information. They may ask the health care provider about the following:

Caregivers also have emotional, social, and financial demands.

Caregivers may need support for themselves, including help with the following:

Caregivers may have some unmet needs when the patient becomes a cancer survivor.

When the cancer patient becomes a cancer survivor the needs of a caregiver decrease, but there may be concerns that continue. Some caregivers of cancer survivors worry about the following:

The end of life of a cancer patient increases caregiver distress.

Caregivers of patients who are nearing the end of life often have lower than expected mental and physical quality of life. Caregiver distress and the number of unmet needs increase as the patient’s end of life gets close.

Hospice care can provide much needed support to caregivers as well as cancer patients. Caregivers are often relieved by the higher quality of end-of-life care in hospice and the honoring of the patients’ goals.

Burdens of Being an Informal Caregiver

Caregivers may find it hard to cope with the emotional and physical aspects of caring for someone with cancer.

It is easy to become overwhelmed as a caregiver. Caregivers may worry after hearing the cancer diagnosis or that cancer has come back. It can be hard to give support and stay positive if there is uncertainty about the patient’s future or the patient is suffering. Keeping up with the practical aspects of patient care, such as household chores and medical appointments, while also working, can be hard for the caregiver to balance. The patient also worries about these things, but the top concern of the patient and caregiver may not be the same, which may cause added stress.

Caregivers may feel burdened when caring for cancer patients.

Caregiver burden is the stress or strain felt by the person who cares for the family member or friend who needs help during a treatment or an illness. A burden is felt when the demands of caregiving are greater than the resources available to them. These demands can lead to negative effects of caregiving such as:

Caregiver burden may be increased by certain factors, such as gender and age.

The following factors may increase caregiver burden:

Female gender. Women are more likely to have caregiver burden.
Age. Caregiver burden can occur at any age but increases for the younger and older caregivers.
- Older caregivers. Older caregivers are at risk for caregiver burden when they have the following conditions:
  - Health problems of their own that they neglect.
  - Fixed incomes.
  - Small social support networks.
  - Less time to exercise.
  - Trouble remembering to take their own medicines.
  - Fatigue from lack of sleep.
  - It is common that caregiving by older people may lead to depression, poor health, and even death.
- Middle-aged caregivers. Middle-aged caregivers may often have to miss all or part of their workday. Some may even need to take a leave of absence.
- Younger caregivers. Younger caregivers often juggle work and their own family duties. They may also have to give up part of their social lives.
Race and ethnicity. People of different races and cultures approach caregiving in their own way.
- Asian American caregivers. Asian American caregivers often provide more caregiving hours than White, African American, and Hispanic caregivers. They also use less support services, tend to have fewer financial resources, lower levels of education, and higher levels of depression than other groups of caregivers.
  
  Asian American individuals may not talk about death or dying because they believe it is bad luck. This can make it hard for healthcare providers to discuss prognosis and hospice care with them. Keeping a cancer diagnosis secret from the patient and not talking about it can add to a caregiver’s sense of burden and duty.
- Hispanic and African American caregivers. Hispanic and African American caregivers often have strong family ties, which may prevent them from seeking help outside of their family. As a result, they may not use local health resources, including counseling and support groups, home care, long-term care, and hospice services. They usually have higher levels of caregiver strain, a lower household income, and are more likely to reduce their work hours compared with White caregivers.
Socioeconomic status. Socioeconomic status is the social standing of someone that is measured by a person’s education, income, and job. People with a lower socioeconomic status may have less access to resources and financial help. Lower incomes and limited financial options may cause patients to make treatment-related choices that are not the same as their doctor prescribed.
Employment. Caregivers may need to make changes in the hours they work at their job, make changes in their duties, or take paid or unpaid time off. Work progress may suffer when a caregiver is not focused and can lead to anxiety and depression. Women who have a job are more likely to feel burdened.
Role strain. Other roles a caregiver may have include spouse, parent, child, friend, employee, or student. Role strain happens when the rights, duties, and behaviors of one role conflict with a different role. When caregivers perform more than one role, they may become stressed. However, many roles do not always lead to stress. For example, when a caregiver goes to work, they may benefit from the support of their employer and coworkers, and from the time away from caregiving.
Site of care. Caregivers may have more burden when the cancer patient leaves the hospital and comes home. The caregiver now must help manage the patient’s symptoms and may be unsure about the prognosis or if the cancer can spread. Visits by home health nurses can help reduce this burden. Sudden changes in site of care, such as going back to the hospital, also increase caregiver burden.
Patient characteristics. Caregivers may have more burden when the patient has poor physical and mental health, such as anxiety and depression. If the patient has a poor quality of life, this may also increase caregiver burden.

Ways to Reduce Informal Caregiver Burden and Increase Personal Growth

There are many ways to help decrease caregiver burden.

The following therapies or skills may prevent or reduce caregiver burden:

Cognitive behavioral therapy. A type of therapy that helps change the way a caregiver thinks and feels about certain things.
Complementary and/or alternative therapies. Many options, such as guided imagery, massage therapy, or healing touch, are available to help caregivers manage stress and anxiety.
Family/couples therapy. Counseling that helps families work through problems in a way that makes the family stronger.
Interpersonal therapy. One-on-one counseling that focuses on your relationships with other people to reduce caregiver burden.
Problem solving/skill building. Helping the caregiver develop skills that include the following:
- Ability to assess and manage the patient’s symptoms.
- Identify solutions to caregiving problems.
- Enhance the caregiver’s ability to cope with cancer caregiving roles and duties.
Psychoeducational. Providing caregivers with information about the following to help them better cope with their new role:
- Diagnosis.
- Prognosis.
- Coping.
- Self-care/home care.
- Impact on partners and family.
- Hospital care.
- Follow-up and recovery.
Palliative care. Using palliative care to improve the patient’s quality of life. When the patient’s quality of life is improved, the caregiver often feels less burdened.
Supportive therapy. A type of therapy that addresses the emotional needs of caregivers.

While the caregiver can try most of these therapies or skills at any time during the cancer patient’s journey, it is most helpful to have them when the cancer patient is given palliative care or at the end of life to help reduce the burden of the caregiver.

Caregivers may find benefits from caregiving.

Being caregiver to a person with cancer can lead to personal growth. Reducing caregiver burden increases the positive effects of caregiving that often lead to personal growth in the following areas:

To Learn More About Caregiving

For more information from the National Cancer Institute about caregiving, see the following:

About This PDQ Summary

About PDQ

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Purpose of This Summary

Reviewers and Updates

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

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The best way to cite this PDQ summary is:

PDQ® Supportive and Palliative Care Editorial Board. PDQ Informal Caregivers in Cancer. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/coping/family-friends/family-caregivers-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389372]

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