Introduction

Family caregivers continue to play a vital and ever-expanding role in meeting the practical, physical, and psychosocial needs of patients with cancer, including pain management. The past several years have seen a shift toward early hospital discharge, increasingly complex home-based treatment protocols, and rising expectations that caregivers participate actively in treatment-related decision making, the accomplishment of treatment goals – including symptom management – and home care. Yet policy, research, and clinical services for caregivers have not kept pace with these new developments.

As cancer treatment has changed, people with cancer have benefited greatly from early detection, aggressive multimodal treatment protocols, outpatient care, and longer survival times. These advances have been possible because in the United States, family caregivers form the foundation of the health care system, with an estimated 44.4 million caregivers providing informal care to ill relatives, with an expected economic value of about $350 billion in 2006.

Of the adults currently providing care to relatives in the United States, 60% are female, the average age is 45 years, and most are providing care for women aged 50 years and older. The amount of time devoted to caregiving is substantial, with most caregivers providing at least 40 hours of care each week and spending an average of 4.3 years as a caregiver. In a 1999 national survey of older adults in the last year of life, nearly three quarters reported receiving help from informal family caregivers.