Insight into cancer caregiving
When compared to their Western counterparts, caregivers of cancer patients in Singapore and Asia have a lower quality of life (QOL), with male caregivers experiencing more stress. Researchers at NUS Yong Loo Lin School of Medicine and National University Cancer Institute, Singapore (NCIS) of National University Health System (NUHS), found that filial piety and obligatory care motivated caregiving in an Asian family, but external expectations imposed on the care could further strain the caregivers.
Led by Associate Professor Rathi Mahendran from NUS Psychological Medicine, 258 family caregivers of cancer patients in Singapore were recruited between 2012 and 2014 for this study, the first in Singapore. They fell mainly in the 31 to 60 years age group, with almost 60 per cent females. About 40 per cent of the respondents looked after their parents and 36 per cent their spouses.
The participants completed a Caregiver Quality of Life Index-Cancer (CQOL-C) questionnaire used worldwide and a sociodemographic survey. Their scores were compared with published data from Canada, Iran, South Korea, Taiwan, Turkey, UK and US.
The Singapore score was lower, which means lower QOL, than the West. It was comparable to Taiwan and Turkey, but higher than Iran and South Korea. This observation could be attributed to the more comprehensive resources and support available to patients in the West that enable them to be independent, pointed out team member Dr Lim Siew Eng. Most countries in Asia do not offer such services and patients often have to rely on carers, said Dr Lim, who is the Associate Director (Clinical – Education) and Senior Consultant of Haematology-Oncology at NCIS.
Assoc Prof Rathi (left) and Dr Lim were part of the team that conducted the two-year study
Male respondents in Singapore had a more impaired QOL than female peers, likely because as main bread winner, men have to juggle both home and work spheres. However, caregivers of advanced cancer patients perform better in the burden domain, which could be due to home hospice services.
Assoc Prof Rathi, who is also with Duke-NUS Medical School, highlighted that respondents cited filial piety and obligatory care as reasons for caregiving. These could be intrinsic motivating factors, arising from personal value and fulfilment; external motivating factors due to societal expectations; and practical needs.
Dr Lim, a co-author of the report published in Singapore Medical Journal in April this year, noted that developed countries’ community and home support provides more services. Additional incentive such as extended leave to patients and caregivers also lessen their burden.
The researchers noticed that caregiving experiences are largely dictated by available resources and support, family dynamics and sociocultural beliefs. The individuals’ personality, emotional and mental attributes also determine the journey.
When treating cancer patients, the study could increase healthcare staff’s awareness of the issues faced by caregivers, such that the needs of both patients and carers can be assessed. It allows NUHS to leverage its specialty cancer centre and academic resources to develop better healthcare solutions. There are also implications in identifying support for caregivers, such as provision of information, help line, counselling and financial assistance.
The investigators plan to run support or sharing sessions that address the emotional and mental health of caregivers and their care recipients.
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