Family members confronting serious illness have been found to experience as much distress as, if not more distress than, the patient with cancer. This distress arises from the caregiver role itself as well as witnessing the patient's suffering. A meta-analysis of psychological distress among cancer patients and family caregivers found that both members of the dyad experienced similar levels of distress.
Related personality characteristics such as optimism and pessimism affect the psychological impact of caregiving. A family caregiver burdened by loss, stressful life events, or strife in the relationship with the patient may enter the new caregiving role already overwhelmed. Although meeting the psychological needs of the caregiver may fall outside the scope of the oncology team, these needs are significant insofar as they affect the quality of caregiving as well as the likelihood of premature and unnecessary hospital admissions.
A caregiver's quality of life has been found to be influenced by the cancer patient's stage of illness and goals of care.[Level of evidence: I] One prospective population-based cohort study found that caregiver strain increased mortality risk by 63% within 5 years.[Level of evidence: II]
The spiritual aspect of caregiver quality of life has been inadequately studied. A few studies have shown patients and caregivers to have parallel spiritual tasks when dealing with cancer, such as finding meaning and hope in the disease process while also posing existential questions about the meaning of life.
Spiritual well-being may provide a stress-buffering effect for caregivers. Higher levels of spirituality are associated with lower psychological distress and improved well-being for caregivers. In addition, maintaining faith and finding meaning have been shown to mitigate the adverse effects of caregiving stress on mental health. Spirituality can fortify caregivers against hopelessness, help caregivers derive meaning from the cancer experience, and provide an existential perspective on hope and suffering. Any member of the oncology team can explore the spiritual or religious values that inform a person's response to caregiving, but generally speaking, the social worker and chaplain are most adept in this area. (Refer to the PDQ summary on Spirituality in Cancer Care for more information about spirituality and religion in cancer care.)
Positive Aspects of Caregiving
Caregivers assume their tasks for reasons that include a sense of familial obligation and loyalty and altruism in the face of their loved one's suffering; more practical reasons include lack of paid help and lack of insurance coverage for services. Other positive rewards of caregiving include the following:
- Discovery of personal strength through adversity.
- Improved sense of self-worth.
- Deepening of the relationship with the cancer patient.
- A sense of personal growth.
Studies have shown that caring for a patient with cancer has rewards such as satisfaction, closeness with the cancer patient, and a sense of fulfilling an obligation. Positive and negative aspects of caregiving are associated with psychological well-being and the caregiver's willingness to continue providing care.