Failure to attend to patients’ psychosocial needs can have ripple effects throughout the family, and may also affect the larger community. Some of these effects can rebound and create additional psychosocial problems for the patient.

Adverse Effects on Families

As described in Chapter 1, family members of patients with cancer experience higher-than-normal stress for multiple reasons, including fear of losing their loved one, concern about the suffering of their family member, and the additional demands of providing emotional and logistical support and hands-on care during times of acute illness (Hodges et al., 2005; Kotkamp-Mothes et al., 2005). Further, when loved ones experience acute or long-term inability to care for themselves or carry out their familial roles, family members often must assume these roles.

Providing this emotional, logistical, and hands-on care and assuming roles previously carried out by the patient require considerable adaptation (and readaptation as the course of the disease changes) on the part of family members. These experiences can add to the stress resulting from concern about the ill family member. This cumulative stress, especially in caregivers compromised by morbidity accompanying their own aging (Jepson et al., 1999), can be so substantial that family members acting as caregivers themselves have an increased likelihood of experiencing depression, other adverse health effects, and earlier death (Schultz and Beach, 1999; Kurtz et al., 2004).

Moreover, high stress levels in caregivers can interfere with their ability to provide the emotional or logistical support patients need. Problematic family relationships that predate the onset of cancer also can lead to inadequate support from the family (Kotkamp-Mothes et al., 2005). Both of these situations can exacerbate the patient’s stress, which in turn can contribute to the patient’s poorer adjustment to the illness. Thus, attending to the needs of the families of patients not only will benefit family members, but also may help patients with their own emotional responses and management of their disease.

Adverse Effects on the Larger Community

As described in Chapter 1, a significant percentage of adults stop working or experience a change in employment (reduction in work hours, interruption in work, change in place of employment) subsequent to a

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