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Single Mothers with Breast Cancer: Relationships with their Children
Abstract
PurposeThis chapter explores the relationships between 12 single mothers with breast cancer and their children, a subtheme of a larger qualitative study.
Design/methodology/approachQualitative data were collected via interviews. The study used the ecological systems theoretical framework to explain findings.
FindingsIn speaking with women about how they constructed and altered their social networks post-diagnosis, many talked about their relationships with their children. This chapter explains how these mothers discussed their diagnoses with their children in age-appropriate ways; how they relied on their children during treatment for informational and emotional support; and how relationships with their children changed during treatment and recovery.
Research and practical implicationsBased on findings from this study, family scientists, public health professionals, and oncology care providers may have a better understanding of the specific concerns and experiences related to the children of breast cancer patients without partners.
ValueThis study yields new information about the support needs of single breast cancer patients and their children, and offers insight into what researchers and medical teams can do to better support families affected by breast cancer.
... Mothers of patients are likely impacted in a variety of ways by their daughters' diagnoses, but to date, little research has addressed the perspectives of this population (Manning & Radina, 2015). Prior research on the mother-daughter relationship in the context of breast cancer has largely centered on mothers as breast cancer patients (Fisher et al., 2014;Ginter & Braun, 2014;Ginter & Radina, 2014) or, when the daughters were the patients, from the daughters' perspectives (Ali et al., 2014). Some research on the mother-daughter relationship in the context of mothers' breast cancer suggests that mothers and daughters may share levels of stress about mothers' diagnoses (Boyer et al., 2002). ...
... The evolution of empirically based understanding of how breast cancer impacts the family, in particular, family quality of life, is ongoing (Ginter & Radina, 2014;Keitel, Lamm, & Moadel-Robblee, 2017;Mellon, 2002;Mellon & Northouse, 2001;Nissen, Trevino, Lange, & Prigerson, 2016;Raveis & Pretter, 2005). The research that explores family roles and relationships in the context of breast cancer focuses on issues such as participation in treatment decision making (Barbosa Lopes et al., 2018;Fobair & Zabora, 1995;Ginter & Braun, 2014), family communication patterns both prior to and after the breast cancer diagnosis (Asbury, Lalayiannis, & Walshe, 2014;Barnes et al., 2000;Ginter & Braun, 2017), relatives' coping mechanisms post-diagnosis (Manning & Radina, 2015;Radina & Armer, 2001;Weingarten & Worthen, 2017), negotiating self-care and time management during treatment for side effects of breast cancer (Radina, Armer, & Stewart, 2014), and the family's role as either a supportive or distressing unit (Ginter & Braun, 2017;Northouse, Katapodi, Schafenacker, & Weiss, 2012;Spencer et al., 1999). ...
The purpose of this qualitative study was to examine the experiences of mothers of breast cancer patients. The theory of health-related family quality of life informed data collection and data analysis. Thirty women were interviewed about their perceptions of family quality of life following their daughters’ diagnoses. Themes included historical perspectives on cancer, familial role changes, determining how to best support daughters, mothers’ support systems, mothers’ coping mechanisms, and positive outcomes of daughters’ breast cancer. Mothers also discussed the challenge of reconciling how different family members reacted to their relatives’ diagnoses, treatment, and prognoses. Implications for research and practice are discussed.
Purpose/objectives:
With a growing number of young women with metastatic breast cancer (MBC) in the United States, it is important to consider how their diagnoses affect their relationships with others. The dual identities of being young and having MBC create unique challenges for women's relationships. However, there is little extant research on the relationship experiences and needs of young women with MBC. The purpose of this study is to understand how young women describe their lived experiences with social and intimate relationships following their diagnoses of MBC.
Design:
A cross-sectional qualitative study with a life course theoretical framework was employed.
Sample/participants:
Purposive sampling yielded nine participants who took part in semi-structured interviews. Phenomenology informed understanding of the lived experience of young women with MBC.
Findings:
The findings describe how young women with MBC made meaning out of their relationships to other people following their diagnoses, via themes of feeling alienated from other women with breast cancer, friendship trajectories, managing intimate relationships, how much to share with children, losing the dream of (more) children, and finding a voice in the MBC community.
Conclusion:
MBC links participants' lives to individuals from their preexisting relationships, new friendships, and the breast cancer community in irrevocable ways.
Implications for psychosocial providers:
These findings present new information about the social and relationship needs of young women with MBC. Psychosocial providers and medical team members should not presume MBC patients' disinterest in fertility preservation.
This qualitative study investigated how women without partners navigate social support challenges following their breast cancer diagnoses. In-depth interviews were used for collection. Twenty women without partners discussed the supportive and unsupportive roles their relatives, peers, and colleagues played during diagnoses and treatment. Family systems theory guided the construction of interview questions. Thematic analysis uncovered the following themes: reactions to diagnosis, managing social networks, negotiating appropriate forms of social support with loved ones, and expanding social networks postdiagnosis. Participants discussed the personal challenge of unexpectedly unsupportive friends and family and how they established boundaries with these individuals. Participants also discussed needing age-relevant and cancer stage-specific breast cancer support groups. These findings are relevant to oncology care providers and therapists. Additional implications of these findings for patients, practice, and research are discussed.
This qualitative study examined how female breast cancer patients without partners conceptualized their relationship status. Qualitative data were collected from 20 participants who did not have partners during diagnosis and treatment. Phenomenology informed the methodology and thematic analysis. Breast cancer patients without partners discussed how they made meaning of their relationship status within the context of their cancer experience and barriers they faced dating post-diagnosis or treatment. Oncology care providers, public health professionals, and family scientists can use the study results to better understand the specific concerns and experiences of breast cancer patients without partners. Additional implications of these findings for patients, practice, and research are discussed.
Literature suggests that parental cancer can provoke aversive emotional arousal in adult children, who may perceive caregiving as a traumatic experience. Limited research has been conducted on emotional and physiological impact of family caregiving for cancer patients undergoing chemotherapy. The aim of the present study was to examine psychological and physiological responses in parental cancer's caregivers. Two matched groups of adult children, with 78 participants each (parental cancer vs. control), completed psychological measures of distress, post-traumatic stress disorder (PTSD) symptoms, and burden. Additionally, each participant visualised standardised pictures with different emotional valences, while cardiovascular (heart rate) and electrodermal responses (skin conductance) were recorded. Between-group analysis showed significant differences on all psychological variables, and on skin conductance for all types of pictures. However, for the heart rate responses, differences were found only for pictures with unpleasant emotional arousal. In the parental cancer group, the heart rate peak response stood out as a predictor of PTSD symptoms, after controlling for distress and burden. This study highlights the important role of psychophysiological measures of family caregiving in oncology. Physiological responses may explain a higher prevalence of PTSD symptoms. Therefore, biofeedback combined with targeted psychosocial interventions for relaxation could be of great clinical value for this population.
This research sought to identify what has been helpful for young people who have a parent diagnosed with cancer. Semistructured telephone interviews were conducted with young people (N = 15, age: M = 15.9 years) who had a parent diagnosed with cancer within the last 5 years. A phenomenological thematic data analysis distinguished three superordinate themes, identifying what helped adolescents cope with their parent's cancer diagnosis. These were parental behavior, specific coping strategies used by the young person, and community support. These results contribute to our knowledge of what can help young people whose parent has been diagnosed with cancer.
At least 14% of cancer patients live with minor children. Being a parent with cancer has far-reaching consequences for individual treatment decision-making and quality of life in patients and their families. Even though the majority of children and adolescents do not show clinically relevant symptoms of psychopathology, worries about the survival of the parent and the future development of the family are present, and experienced as distressing, in most children. Open communication by parents and clinicians has been found to be of major importance for children and adolescents in adjusting to parental cancer. Support for parents with cancer on relevant parenting issues, starting in the diagnostic phase, should be acknowledged as an important facet of cancer care to reduce the psychosocial burden for cancer patients and their families.
A 2-phase, mixed methods study was conducted to develop a Parenting Concerns Questionnaire (PCQ) for adults with cancer. Limited information about this area of psychosocial distress highlights the need for a measurement tool that can identify adult oncology patients with heightened parenting concerns who could benefit from additional intervention.
Telephone focus groups were conducted with 16 oncology patients who had children 18 years old and younger. Group interview transcripts were analyzed to generate qualitative themes and candidate items for the PCQ. A 38-item version of the questionnaire was completed by 173 oncology outpatients who had children 18 years old and under. Participants also completed the Distress Thermometer, HADS (Hospital Anxiety and Depression Scale), and FACT-G (Functional Assessment of Cancer Therapy–General). Exploratory factor analyses revealed the emergence of 3 subscales of 5 items each, yielding a 15-item questionnaire. Associations between total PCQ scores, standardized measures of distress, depression, anxiety, quality of life, and demographic and illness characteristics were examined.
The 15-item PCQ demonstrates good internal consistency (Cronbach's α = .83). PCQ scores were significantly associated (P < .01) with standardized measures of psychosocial distress (Distress Thermometer, HADS, and FACT-G) in the expected directions. Higher PCQ scores were associated with female sex, single parenthood, metastatic or recurrent cancer, subjective understanding of incurable disease, comorbid chronic health condition, and current mental health treatment.
The PCQ proved a reliable and valid measure of parenting distress among cancer patients, and thus merits further study. Cancer 2012.
Though larger social networks are associated with reduced breast cancer mortality, there is a need to clarify how both social support and social burden influence this association. We included 4,530 women from the Women's Health Initiative who were diagnosed with breast cancer between 1993 and 2009, and provided data on social networks (spouse or intimate partner, religious ties, club ties, and number of first-degree relatives) before diagnosis. Of those, 354 died during follow-up, with 190 from breast cancer. We used Cox proportional hazards regression to evaluate associations of social network members with risk of post-diagnosis mortality, further evaluating associations by social support and social burden (caregiving, social strain). In multivariate-adjusted analyses, among women with high but not low social support, being married was related to lower all-cause mortality. By contrast, among women with high but not low social burden, those with a higher number of first-degree relatives, including siblings, parents, and children, had higher all-cause and breast cancer mortality (among caregivers: 0-3 relatives (ref), 4-5 relatives, HR = 1.47 (95% CI: 0.62-3.52), 6-9 relatives, HR = 2.08 (95% CI: 0.89-4.86), 10+ relatives, HR = 3.55 (95% CI: 1.35-9.33), P-continuous = 0.02, P-interaction = 0.008). The association by social strain was similar though it was not modified by level of social support. Other social network members were unrelated to mortality. Social relationships may have both adverse and beneficial influences on breast cancer survival. Clarifying these depends on understanding the context of women's relationships.
Emerging adulthood is proposed as a new conception of development for the period from the late teens through the twenties, with a focus on ages 18-25. A theoretical background is presented. Then evidence is provided to support the idea that emerging adulthood is a distinct period demographically, subjectively, and in terms of identity explorations. How emerging adulthood differs from adolescence and young adulthood is explained. Finally, a cultural context for the idea of emerging adulthood is outlined, and it is specified that emerging adulthood exists only in cultures that allow young people a prolonged period of independent role exploration during the late teens and twenties.
This study examined the relationship between temperament and internalising and externalising problems among children of parents diagnosed with cancer, beyond the effects of socio-demographics, illness-related variables and life events.
Three hundred and forty adolescent children and their 212 parents diagnosed with cancer participated. Children and parents completed the Youth Self Report and the Child Behaviour Checklist, respectively. Children completed also the Early Adolescent Temperament Questionnaire.
Daughters of parents with cancer were reported as having more internalising problems than their counterparts did. Prevalence of problems did not depend on children's and parents' age or educational level. Recurrent disease and number of life events experienced by children and parents affected the problems reported. The most important temperament dimensions in the prediction of internalising problems in children were shyness and fear/worry, to a lesser extent, frustration and perceptual sensitivity (children only) and lower scores on pleasure intensity (parents only). Externalising problems were associated with effortful control and in children's reports with frustration. Temperament seemed to be a more important predictor of problems reported by children than parents.
Findings suggest that temperament is useful in determining the relative vulnerability of children of parents who have been diagnosed with cancer. Social workers may help parents to recognise individual differences between children and to support children by using techniques that are compatible with the temperament of children.
Research has indicated spirituality buffers the adverse effect of stress, but few studies have examined the role of spirituality in the context of providing cancer care.
This study examines the moderating effects of spirituality on the relation between caregiving stress and spousal caregivers' mental and physical health. In addition, gender differences in the target moderating effects are explored.
A caregiver survey was mailed to familial caregivers nominated by their respective cancer survivors including measures of spirituality (Functional Assessment of Chronic Illness Therapy-Spirituality), caregiving stress (Pearlin Stress Scale), and mental and physical health (MOS Short Form-36). Four hundred and three spousal caregivers provided valid information on these measures.
Hierarchical regression analyses supported the hypothesized moderating effects of spirituality but in different patterns. Caregiving stress was associated with poorer mental functioning, which was less prominent among caregivers with a high level of spirituality (stress-buffering effect). Caregiving stress was also associated with poorer physical functioning but was only significant among caregivers with a high level of spirituality (stress-aggravating effect). The same stress-buffering or aggravating effects were found for both sexes.
The findings suggest maintaining faith and finding meaning in cancer caregiving buffer the adverse effect of caregiving stress on mental health. Highly spiritual caregivers should also be encouraged to pay more attention to their physical health while providing cancer care.
The aim of this study was to investigate the financial effects of cancer on families in which a parent has cancer and lives with his/her children, to identify financial hardship risk factors, and to describe the children’s experiences regarding the impact of cancer on their socioeconomic situation. A mixed-methods research approach was applied. Norwegian cancer patients living with their children (≤18 years) completed a questionnaire (n = 386). Ten children (≤18 years) of cancer patients were given in-depth interviews regarding their experiences associated with the family’s socioeconomic situation. Eight percent of the cancer patients reported a poor financial situation. Fourteen percent of the patients had to minimize their expenditures on goods and activities for their children because of costs attributed to cancer. Risk factors for cancer-related financial hardships affecting children were single parenthood, not working, metastasis, chemotherapy and additional health impairments. Qualitative descriptions suggest that parents shield their children from financial hardships. The children were generally not concerned with their family’s financial issues, but certain older children took responsibility for the household financial situation by obtaining employment and declining expensive gifts and activities. The children were more preoccupied with caring for the sick parent and coping with their own emotions. Despite some families being at greater risk for financial hardships when a parent is diagnosed with cancer, most Norwegian families with children are not seriously affected by the parents’ cancer status. These children should be regarded as significant informal caregivers. The family’s financial situation should be included in a holistic assessment during the cancer follow-up period.
Today, ethnographers and qualitative researchers in fields such as urban poverty, immigration, and social inequality face an environment in which their work will be read, cited, and assessed by demographers, quantitative sociologists, and even economists. They also face a demand for case studies of poor, minority, or immigrant groups and neighborhoods that not only generate theory but also somehow speak to empirical conditions in other cases (not observed). Many have responded by incorporating elements of quantitative methods into their designs, such as selecting respondents `at random' for small, in-depth interview projects or identifying `representative' neighborhoods for ethnographic case studies, aiming to increase generalizability. This article assesses these strategies and argues that they fall short of their objectives. Recognizing the importance of the predicament underlying the strategies — to determine how case studies can speak empirically to other cases — it presents two alternatives to current practices, and calls for greater clarity in the logic of design when producing ethnographic research in a multi-method intellectual environment.
Objective
This pilot intervention study assessed the impact of a 3-week inpatient program for mothers with primary breast cancer and their children. The program combined rehabilitative treatment and preventive, psychosocial, child-centered interventions. MethodsA total of 116 mothers (age 29-57years, mean=41.1) with primary, non-metastasized breast cancer completed standardized questionnaires before (Pre1), at the beginning of (Pre2), and at the end of (Post) a 3-week inpatient intervention. The standardized scales included mothers' and children's quality of life and children's psychological symptoms. Mothers' emotional functioning and their 116 children's (age 3-14years, mean=7.4; 47% female) psychological health and emotional symptoms were defined as primary outcome measures. A within-subject-control-group design was used to compare changes before the intervention (measurements Pre1-Pre2) to changes during the intervention (measurements Pre2-Post) via dependent one-sided t-tests. Additional exploratory analyses for further outcome variables were performed. ResultsChanges during the intervention period were significantly greater than changes during the waiting period for all primary outcome measures (mothers' emotional functioning: p<0.0001; children's psychological health: p=0.0035; and children's emotional symptoms: p=0.0005). Conclusions
Data suggest that the family-oriented intervention getting well together' seems to be beneficial to mothers' and children's quality of life and psychological well-being. Combining oncological rehabilitation and preventive child-centered interventions might be a feasible approach to supporting breast cancer patients and their children and improving their emotional state. Further research is warranted. Copyright (c) 2013 John Wiley & Sons, Ltd.
The publication of a special section of 8 qualitative studies in the
Journal of Counseling Psychology marks a growing recognition of the contribution that qualitative research can make to the discipline. The researchers of the 8 studies used an adaptation of the grounded theory method as their design. The theories generated by the studies are positively evaluated with constructivist criteria. Reactions to the data collection include suggestions that intensive interviews, triangulation, and theoretical sampling may have strengthened the data sets. Response to the data analyses include recognition of the creative and rigorous manner in which the analyses were carried out. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The theoretical framework addresses the life course human development of diverse groups. It acknowledges that all humans are vulnerable, and that patterned and unique outcome variations emerge given perception-linked and context-based interactions between culture and ethnicity. The perspective emphasizes not only the “what” or outcomes of development but also the “how.” The theory explores the many paths for obtaining both resiliency (i.e., positive outcomes independent of significant challenge) and unproductive outcomes given structured inequalities. In providing an identity-focused cultural ecological (ICE) perspective as applied to diverse humans, the framework examines the broad patterns of coping processes and identity formation that result.
Keywords:
coping processes;
cultural diversity;
ecological contexts;
human vulnerability and resiliency;
identity formation;
social cognition and perception
Aims:
(i) To investigate the availability, perceived importance and roles of informal caregivers in the recovery of patients treated at day oncology centres and (ii) identify differences between patients with and without informal caregivers in the extent to which they experienced symptoms, and the level of bother symptoms caused.
Method:
Patients from three Australian hospitals (n = 122) were recruited during cycles 1 or 2 of adjuvant chemotherapy. Participants completed a modified version of the Rotterdam Symptom Checklist (RSCL) each day for 5 days after chemotherapy. A telephone interview conducted 10 days post-treatment explored the availability, importance and roles of caregivers. During the interview, participants also completed the modified RSCL in which they were asked about the extent to which they experienced, and were bothered by, each symptom over the prior 5 days combined.
Results:
Overall, 71% of participants had an informal caregiver in the 5 days postchemotherapy, commonly a partner. More women (71%) than men (48%) had a caregiver (p < 0.05). Caregivers were perceived to be highly important; they were more important for women than men (U = 213.50, p < 0.01). The most common assistance caregivers provided was meal preparation and emotional support and companionship. On days 6-10 postchemotherapy, the extent to which overall physical symptoms were experienced was higher for patients with a caregiver than without (U = 987.50, p < 0.05); similarly their symptoms caused more bother (U = 966.00, p < 0.01).
Conclusions:
These findings highlighted the importance of informal caregivers to patients postchemotherapy. It is imperative that patients are informed of the importance of this support so a caregiver can be arranged, if possible. Understanding the needs of patients following chemotherapy would enable health professionals to advise patients, with or without caregivers, how to best prepare for and manage their recovery at home.
This article provides a conceptual framework for thinking about the system created at the interface of chronic illness with the family life cycle. First, a psychosocial typology and time phases of illness schema is described as a necessary, preliminary step to create a common language that bridges the worlds of illness, individual, and family development. This schema organizes similarities and differences between diseases in a manner useful to psychosocial-developmental rather than biomedical inquiry. Then, drawing on several major life-cycle theories in the literature, key concepts (periods of transition, life-structure building and maintaining, centripetality, and centrifugality) are used in a complementary fashion to link these three lines of development. Equipped with these psychosocial languages, consideration is given to transgenerational aspects of illness, loss, and crisis, and the interwoven threads of illness, family, and individual development. Clinical vignettes are provided to highlight this conceptual framework.
Women following the stress resulting from the diagnosis and treatment for breast cancer draw resources from their network of friends and relatives. These resources include both emotional support and instrumental resources such as getting a ride to a medical appointment. Emotional support buffers the effects of the stresses they face and improves their mental well-being while the existence, rather than the use, of instrumental supports is positively related to physical well-being. These hypotheses are tested on a population-based cohort of 336 women in the United States, diagnosed and treated for breast cancer when aged 50 or less. Most are married (65%), work (75%), have dependent children (63%), are white (70%), and had a mastectomy (51%). Results of the multi-variate analyses indicate that consistent with predictions, controlling for socio-demographic and treatment-related variables, the size of the social network was related to greater emotional and instrumental support, and greater emotional support was related to better mental well-being. Contrary to predictions, greater use of instrumental resources was related to poorer physical well-being. The results indicate the importance of social resources on well-being following life-threatening illness.
The purpose of this study was to examine the nature and potential effects of disclosure patterns and unsupportive social interactions in breast cancer patients. Disclosure, the thoughts and feelings people communicate to others, and unsupportive social interactions, the upsetting or unsupportive responses people receive from others, have been infrequently studied in breast cancer patients. Sixty-six early stage breast cancer patients diagnosed less than one year completed a written questionnaire. Results indicated that the women reported confiding in family and friends more than in mental health workers. Fears of recurrence and worries about the effects of the illness on family members were the most important concerns, whereas concerns about body image were the least troublesome. Failure to disclose concerns was associated with low social support, high unsupportive social interactions, and low emotional well-being. Most of the unsupportive responses received from other people were either behaviors of minimizing or distancing. Unsupportive reactions were significantly associated with greater role limitations due to emotional problems and decreased social functioning. Implications for interventions and future research are discussed.
Daughters caring for a mother with breast cancer represent a vulnerable population. They are confronted with having to integrate their emotional reactions to their mother's illness while simultaneously processing concerns about their own personal susceptibility. Through their caregiving, daughters obtain intimate knowledge of their mother's breast cancer experience. As part of a study of breast cancer survivorship and the family, in-depth interviews were conducted with a diverse sample of adult daughters caring for their mother with breast cancer. Analysis of the daughters' narratives documents that their mother's cancer diagnosis subjects them to a period of crisis fraught with severe emotional distress and life and death concerns that parallels the 'existential plight' that patients encounter following the cancer diagnosis and inception of treatment. Specifically, the daughters' accounts demonstrate that the diagnosis intensified their bond with their ill mother, while also presenting challenges in their relationship. It precipitated a re-definition of personal values and altered their perceived future. Their mother's illness prompted recognition of increased family risk and rendered daughters with a heightened sense of personal vulnerability. Clinicians need to appreciate the extent to which daughters can be impacted by their mother's cancer experience.
This study explored how women with a diagnosis of cancer (lymphoma) deal with moral concerns related to their responsibility as parents. Ten women with cancer and who had children living at home were interviewed. The interviews were analysed according to the constant comparative method used in grounded theory. In order to provide a focus for the analysis, the ethics of care and the concept of mothering were used as sensitizing concepts. The core concept 'experience of dealing with moral responsibility of being a parent with cancer by redefining oneself as a mother was identified. The processes involved were: interrupted mothering; facing the life-threatening illness and children's reactions; striving to be a good mother; attempting to deal with moral responsibility; and coming to terms with being a mother.
The stresses and uncertainties of cancer can be overwhelming for families. The Family System Illness model offers a psychosocial map to address these challenges and to make the inevitable strains more manageable. It provides a set of terms and a common language within a framework that attends to the longitudinal, psychosocial pattern of a health condition within a multigenerational, life cycle, and belief system context. Such a psychosocial framework can facilitate collaborative, effective coping and adaptation, thereby enhancing the quality of life for families affected by cancer. The model's utility is discussed for research, preventive screening, family assessment, treatment planning, and service delivery in a wide range of healthcare settings.
Cancer affects not only the quality of life (QOL) of individuals with the disease but also that of their family members and close friends. The impact on various aspects of the family caregivers' QOL is significant throughout the trajectory of the illness. The authors reviewed literature on the QOL of family caregivers at the acute and middle- to long-term survivorship phases as well as the bereavement phase.
By using several databases, the authors searched the literature published in English from 1996 through July 2007. Keywords searched included cancer, carcinoma, family, family member, caregivers, and quality of life. Several criteria were used to guide the literature review: Articles had to be published in refereed journals and had to use rigorous methods, sample, and validated measures.
The findings suggested that the QOL of family caregivers of individuals with cancer varies along the illness trajectory. This highlights were importance of assessing the ongoing adjustment of the caregivers over time. However, there were few theory-driven studies, and significant gaps remain in the current understanding of the effects of family caregiving beyond the time of diagnosis and treatment.
Accumulating evidence has supported the concept that cancer affects not only the patients/survivors but also their family members. However, theoretically and methodologically rigorous research on various aspects of the family's QOL, including not only the psychological but also the physical, spiritual, and behavioral adjustment to cancer in the family, remains sparse. Family-based interventions across the trajectory of the illness also are needed.