Gerontology & Geriatric Research

The Caregiving Chronicles: Balancing Acts and Emotional Challenges in Cancer Care

Vatika Sibal^* Department of Sociology, St. Andrew’s College, University of Mumbai, Bandra (West), Mumbai, India
^*Correspondence: Vatika Sibal, Department of Sociology, St. Andrew’s College, University of Mumbai, Bandra (West), Mumbai, India, Email:

Received: 03-Jan-2025, Manuscript No. JGGR-24-34688; Editor assigned: 06-Jan-2025, Pre QC No. JGGR-24-34688 (PQ); Reviewed: 09-Jan-2025, QC No. JGGR-24-34688; Revised: 17-Jan-2025, Manuscript No. JGGR-24-34688 (R); Published: 24-Jan-2025, DOI: 10.35248/2167-7182.2025.14.773

Introduction

United Nations study declares that the elderly population all over the world will increase significantly. Collectively, the number of people over the age of sixty across the globe will increase by nearly 370 million from 2015 to 2030 that is more than 60 percent. Additionally, the U.N. Department of Economic and Social Affairs, Population Division, claims that the ageing population of this century would exceed from the previous century and elderly population of sixty and above would be more than that of children five and below. Elderly assessment and treatment are a joint affair of family, specialists in oncology and geriatrics. It is an integrated effort of symptom management, physical functioning and cure [1].

Caregivers have a crucial role in providing care for the elderly, whether or not they are prepared for the challenges that come with it. They provide a range of services to meet the diverse needs of the elderly, including helping with medication, arranging transportation for medical treatment, assisting with daily activities, and providing emotional support. Families may face additional stressors, such as changes in responsibilities and employment, disruptions in schedules, and frequent visits to medical clinics. Each individual responds to these stressors in their own unique way, and spouses may be particularly vulnerable due to their own frailty [2].

This could negatively affect caregivers' psychological, social, or physical health. There could be a disruption in social and economic life too. Psychological support and assistance are required at this time for patient and their spouse. If help is given that reduces the stress of frequent clinic visits, or long queues, or knowledge of available community resources, contact with health professionals would be appreciated at this time [3]. Cancers in elderly persons are sometimes under diagnosed because the resulting symptoms may be attributed to ageing, chronic diseases, or social and psychological problems. Therefore, cancers in elderly persons tend to be diagnosed at a more advanced stage as other symptoms may be more prominent. Decreased functioning is common among elderly cancer patients. Besides some show sign of having challenged daily activities and need support. Some elderly use external devices for their activities of daily living. The elderly population requires assistance not only with their physical well-being but also with their socio-psychological needs. Family members, along with the guidance of a geriatrician, can provide support and evaluate the overall physical, mental, and social capabilities of elderly cancer patients. Additionally, it is important to address the presence of other health conditions and geriatric syndromes such as immobility, instability, cognitive decline, weakened immune system, sensory impairments, insomnia, and social isolation. Various aspects need to be considered when managing and making decisions for an elderly individual with cancer, including the functioning of different body systems and appropriate therapeutic interventions. The provision of supportive care to the elderly patient is important to enhance the quality of life. It often entails recognising and managing pain effectively, relief from constipation, nutritional and hydration support, prevention and treatment of nausea and vomiting, and the treatment of fatigue and insomnia [4].

In addition, there should be psychological support for the patient and family, discussions concerning decisions on end-oflife care, and the eventual provision of palliative care. One needs to coordinate the family with oncologists, geriatricians, and physiotherapists to generate treatment plans for elderly cancer patients [5].

The elderly population requires assistance for moving physically and they need help with their socio-psychological well-being. With the help of family members and geriatrician assistance is provided physically and maintaining a positive mind set. Besides this, one needs to cater to other health issues and other conditions related to mobility, decline in balance, cognitive issues, weak immune system, audio-visual disorders, insomnia and loneliness. Not only managing these issues caregivers need to take decisions for the elderly person with regard to functioning of the body and other therapeutic treatments [6].

Literature Review

A balance in improving the health and quality of life of cancer patients from supporting the patient with daily activities to emotional support specially at difficult moments of life. It’s the family that observe changes in the patient's condition while caring for the sick which is a long-term care and assisting in developing treatment plans, making decisions, and implementing some parts of treatment. When it comes to end-of-life care, professionals cater on the patient rather than the family members. The care giver may be helpless at times and but are not passive observers but take active part in the treatment of the patients and make decisions for them too. When the family cannot manage the patient effectively, their inability could lead to negative impact on the patient. Therefore, it’s essential to understand family’s attitude towards death and other feelings like fear panic and anxiety as affects the condition of the patient. Caregivers who provide support to the elderly with cancer play a crucial role in enhancing the quality of life for both the patients and their families. Caring for a senior with cancer involves physical, emotional, and practical responsibilities. These caregivers demonstrate compassion, resilience, and dedication in their roles [7].

Elderly individuals facing life-threatening diseases may desire to end their lives due to the unbearable treatment and pain caused by infections. They may also be unwilling to witness their family members suffer alongside them. These individuals are aware of the risks and complexities involved in their treatment and some may simply be tired of living. Research has shown that elderly individuals may experience suicidal thoughts. These studies highlight age-related losses, reduced social interactions, feelings of depression, health problems, and the challenges of treatment [8].

A diagnosis of cancer often leads to physical, mental, and social challenges for both patients and their families, especially the older populations. Caregivers are involved in many aspects starting from dealing with the diagnosis of cancer, treatmentrelated adverse events, disease-related symptoms, recurrence, and end-of-life care [9].

Due to the short duration of hospital stays for active cancer treatment, family members often become the primary caregivers for patients at home. These caregivers spend several hours each day attending to the needs of their loved ones. However, these family members must also balance their own daily responsibilities and obligations. When the elderly individual requires additional care and the caregiver's workload increases, the burden and stress on the caregivers intensify. This caregiving burden negatively impacts the physical, emotional, spiritual, and social well-being of the caregivers. Their health deteriorates and is challenged. There is a mental health disturbance caused for care giver as one keeps playing multiple roles such as work, family, and treatment of the elderly. High financial cost is another important factor that could lead to a huge burden [10].

Methodology

The purpose of this study was to assess the caregiver burdens of older cancer patients in families in Mumbai. The study identified the various factors that led to high burden. The study was made with sixty caregivers of elderly who had advanced cancer who were in and out of hospital for treatment-radiation or chemotherapy and elderly with advanced cancer. Google form was administered after explaining the details of the research [11].

The study recorded and documented the experiences of caregivers, followed by in-depth interviews on various aspects of their lives such as health, well-being, finances, social life and the relationship with the person they are caring for. Interviews also covered topics of their personal health, family and work adjustments, conflicts, feelings of guilt and uncertain emotions. The questionnaire was a combination of open and closed-ended questions where the participants were asked basic questions of their age, marital status, educational level, health, relationship with patient, living situation of patient, employment status, average income, duration of caregiving and details of the patientâ??s health [12].

Quantitative analysis was conducted on negative experiences or neutral experiences related to quality of life, stress, depression, work-life balance, and spiritual life. However, it is important to note that quantitative data alone cannot fully capture the richness of qualitative data, which includes emotions and the underlying feelings behind the quantitative data. As Kramer suggests, a more holistic perspective is needed to identify care experiences [13].

In this particular study, which focuses on family care, equal attention was given to positive experiences, negative experiences, and appraisal. For instance, helping the elderly not only relieved guilt for the caregiver but also felt like a natural responsibility. Considering oneself as someone essential to the patient's wellbeing indicated both self-recognition and satisfaction for the caregiver. Additionally, caregiving promoted self-respect, personal growth, and maturity as individuals reflected on their own lives, akin to the search for meaning through caring [14].

Positive interpersonal experiences, such as rebuilding relationships with other family members through shared patient care, feeling respected by healthcare providers, and receiving support from social networks, served as coping mechanisms and sources of social support. Within the family individuals experienced negative emotions like lack of support from other family members, managing household chores and work life, understanding the technical words of the healthcare system, increased responsibility, family conflict, loneliness, communication with healthcare personnel, lack of support system. It is at these times that one understands the usefulness of family and community support in easing the emotional burden of caregiving. The stress that the care giver goes through determines how social support and strategies need to be planned effectively for end-of-life patientsâ?? family interventions. Family needs, their role in looking after the elderly, guidance is usually over looked in such cases. Generally, caregiver is taken for granted and experience a burn out [15].

The results indicated that most of caregivers were female and in their middle age. Seventy-five percent of patients lived with family. Around twenty per cent lived with spouse and five per cent lived on their own and were single. Most of the caregivers called themselves to be healthy with some minor aches and pains. The care givers were middle income groups and faced some financial issues. They indicated personal strain, privacy conflicts, guilt and mood swings on their part. Guilt is the most frequent factor, followed by mood swings, the strain on personal life, and family or privacy conflicts [16].

Not all caregivers were knowledgeable about palliative care for advanced cancer patients. Due to a lack of hospitals or nursing homes, many elderly patients with advanced illnesses remained at home. This, along with a financial crisis that limited hospitalization options and a lack of palliative services, resulted in an increase in family members assuming caregiver roles. The study found that adult daughters often took on the main responsibility, although in some cases, spouses or sons were also caregivers. Nevertheless, the main responsibilities of taking care of advanced cancer patients remained in the family as palliative care concept was not known [17].

The caregivers were burdened with migraines depression and anxiety. The sociocultural background influences the treatment of the elderly. Taking caring spouse and parents is a willing burden and inevitable duty in the Indian family. All those who are married, divorced or separated took their turns too in looking after the elderly. It is assumed that individuals who are single or never married would cater to elderly parents [18].

Discussion

Quantitative questions were related to quality of life, coping strategies, interests, stress factors and tension, depression, present problems, and overall spiritual well-being. Some caregivers were as young as 30 years and others were between 45 to 70 years. They needed guidance to look after the elderly patient, need emotional and physical support too. The quality of life was extremely low as they faced obstacles in looking after patient and themselves as they lacked support. They kept them busy all the time doing some work or the other as this was the only coping strategy. The caregivers were highly stressed with the patientâ??s situation that led to depression and tension. The study explored families that catered to chronically ill patients and questions ranging from positive to negative experiences were asked. Positive being feelings of looking after the elderly, thinking positive and uplifting experiences, a meaningful episode of satisfaction, maturing through the process of caregiving. On the other side, negative experiences were recorded that were depression, stress, strain and emotional drain out. Proving oneself commitment to look after the patient, responsibility, selfimportance were the feelings experienced by the caregiver. Staying positive and being hopeful of cure, of miracle, of challenge to recovery were some of the feelings experienced. Besides this there were dark moments too which the caregiver experienced. Moments of helplessness, pain, strain, exhaustion, tiredness, anxiety, frustration, fear, uncertainty, depression and sleepless nights. This led to poor state of oneâ??s own health-a burnt out feeling. The caregiver was juggling with work, family on one side and looking after the patient on the other side. Increased responsibility, family conflicts affected oneâ??s own health to a large extent. Those who had the resources looked for alternatives in terms of help and maintains the balance between family and caregiving, between work and caregiving. Spiritual and religious help was sort that brought about some calmness specially at the time of struggle. Questions about death and funeral rites worked subconsciously on the care givers mind [19].

Conclusion

The researcher accepts and concludes that the study has limitations and the study can further develop on palliative care for future study. The findings of the research can help in effective strategies that can bring hope when humanly one sees no light. This hope would help elderly patientsâ?? family and the care giver as they know that health care professionals would help the end-of-life days with hope, peace and comfort. This is the time where there is no recovery, there is a change in the health care provided from cure to care.

Limitations

The study could not explore the burden during the course of the disease or at the end-of-life period, especially palliative care. Patients with very advanced diseases and those who could not tolerate aggressive treatments were occasionally hospitalized for short periods, which often went unnoticed by caregivers. Additionally, the various types of tumours and symptoms experienced by elderly patients made it difficult to analyse their situations. The burden on caregivers of elderly patients receiving palliative care and those who were terminally ill was relatively small. Identifying caregivers who were at greater risk, such as those who were single or siblings of the patients, proved challenging in the study.

The stress and burden of the caregiver is prevalent but over shadowed when it comes to terminally ill patient. Older caregivers experienced higher rates of moderate-to-severe burden than younger caregivers. There was a mixed bag of emotions for the care giver. Feeling of hope, feeling of a miracle, sometimes helplessness, fear, anxiety, exhaustion, tiredness, lack of support from family, plate over flowing all the time were some of the experiences faced by the care giver. The significant factor associated with caregiver burden was being a mother or a brother to the ill patient. Children as caregivers were found to be stressed while looking after their parents as their own family’s needed their attention. In contrast, the caregiver’s relationship with the patients, particularly mothers and brothers, was related to their emotional distress. Size of the sample that prevented indepth analysis was a limitation to the study. Illness of the elderly and paucity of time in caring could also impact the experience of burden in caregivers. In addition, aspects related to religiosity should be considered in future studies since other differences among participants can be drawn from the relation between dehumanization and faith.

The researcher explored the reality of care givers who often face emotional and mental health challenges due to the stress of caring for a loved one with cancer. The emotional burden, coupled with witnessing the struggles of the patient, can lead to burnout, anxiety, and depression among caregivers. The researcher through the paper highlights that though cancer does not restrict itself to any social, cultural or economic standing, the effects of it are based on the accessibility where the rich can afford or access a better medical help whereas the ones who are marginalised, continue to face the wrath of inequality. Throughout the study, the aim of the researcher was to highlight the burden which the care givers face. The result of the study depended on two factors; hiring an experienced care giver who would look after the terminally ill patient without any emotional connection or the naive family members who in their best capacity would take care of their loved ones. Moreover, societal norms and stigma surrounding serious illnesses and end-of-life care made it challenging for patients and their families to seek palliative care. The course of the research also explored the cultural and linguistic reliability wherein providing culturally and linguistically sensitive care is essential the healthcare providers faced challenges in addressing the diverse cultural and linguistic needs of patients and their families during the difficult moments.

Acknowledgment

The completion of this exploration into the spatiotemporal dynamics of nanomedicines in solid tumors and their impact on therapeutic efficacy has been a collaborative effort, and it is with sincere gratitude that we extend our appreciation to those who have contributed to this endeavor.

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