Abstract
BACKGROUND:
Cancer is a serious and fatal disease that affects both the patients themselves and their families. This study aimed to investigate the impact of caregiving burden on the quality of life and mental health of family caregivers of cancer patients.
MATERIALS AND METHODS:
This research is a cross-sectional study that further investigates family caregivers for their patients with cancer at babel oncology Center in Babylon, Iraq, from September 2025 to February 2026. A purposive sampling method that was applied to a group of 150 patients. Information was gathered through self-report questionnaire. SPSS version 26 was utilized to analyze the data.
RESULTS:
The results showed that 73.3% of caregivers had a poor caregiving burden and 24.7% had a moderate caregiving burden, with approximately 74% having a fair quality of life, while 52.7% of caregivers had a good level of psychological well-being. The analyses also revealed a statistically significant relationship between caregiving burden and quality of life, and a statistically significant inverse relationship between caregiving burden and psychological well-being (P < 0.001).
CONCLUSION:
The majority of caregivers have a low caregiving burden and a fair level of quality of life, and approximately half have a good level of psychological well-being. The results also showed a relationship between burden and quality of life; any change in burden level was accompanied by a change in quality of life. Furthermore, there is a significant inverse relationship between burden and psychological well-being.
Keywords: Burden of care, cancer, family caregivers, psychological distress, psychological wellbeing, quality of life
Introduction
Cancer is a serious and fatal disease that affects both the patients themselves and their families. The family of a patient with cancer constitutes an essential and indispensable part of both treatment and care.[1,2] The centers for disease control and prevention have classified cancer as a chronic disease that significantly impacts the life of the patient and his family and their quality of life (QoL), starting from the stage of diagnosis.[3,4] In 2018 all over the world, cancer remains one of the leading causes of disease and death, with an estimated 10 million people dying from cancer annually.[5] The International Agency for Research on Cancer In 2020, estimated that 18.1 million people were diagnosed with cancer all over the world, and indicated that over the next two decades this number will increase to 27 million.[6] In 2022, the National Cancer Institute declared cancer the disease of the 21st century, as it is the leading cause of illness and death worldwide.[7] The World Health Organization stated that cancer is the leading cause of death and remains untreated, despite the development and progress in its diagnosis.[8] Several studies have indicated that these individuals bear a significant physical, social, economic, and psychological burden as a result of providing long-term care and support under various circumstances and pressures.[9] An informal caregiver or family caregiver are defined as people who provide both medical care and support to people with cancer, disabilities, or chronic illnesses at home or in community settings. They are often not paid for the care they provide, and because they are sometimes required to provide care beyond their financial means and capabilities, they are exposed to problems including financial, health, and psychological consequences such as burden, anxiety, and depression.[10] The concept of caregiving burden has been defined by previous literature as a series of negative responses that occur during caregiving by the caregiver.[11] The burden of care is studied from two perspectives: subjective and objective. Subjective burden refers to the emotional and behavioral response to the caregiver’s life, while objective burden includes the changes, modifications, and disturbances that occur in various aspects of the caregiver and his family.[1,12,13] The burden of care or the pressures that the caregiver is exposed to, including fatigue or physical exhaustion, psychological distress, withdrawal from social activities, in addition to financial difficulties.[14] The QoL of family caregivers is directly influenced by the care they provide to their patients and the resulting burden. A 2020 study conducted in Turkey on cancer caregivers found that these caregivers experience a high care burden and decreased quality of life, both psychologically and physically.[15] Caregivers’ quality of life and psychological well-being are significantly affected during the cancer journey as they are required to accept the disease, deteriorating health, and imminent death.[16] QoL for caregivers has become an important indicator and is considered one of the family outcomes of caregiving. Caregivers who experience high burden have lower feelings of psychological well-being, increased psychological distress, difficulty continuing to provide care, or reduced effectiveness of care for patient with cancers. Previous studies have indicated that it is not only the burden of caregiving that affects or reduces quality of life for caregivers, but also other factors, such as psychological well-being among family members.[17] This study aims to probe the mediating effect of psychological distress on the relationship between caregiver burden and QoL, as well as the moderating effect of family resilience.
Materials and Methods
Study design and setting
A descriptive cross-sectional study approach was used in this research. From September 2025 to February 2026, the study included family caregivers for their patients with cancer who were Inpatients, those receiving chemotherapy, and those receiving outpatient consultations at the Babylon Oncology Center, Babylon Province, Iraq.
Study participants and sampling
Adult family caregivers of cancer patients (no specific cancer type or stage was selected) receiving treatment at the Babel Oncology Center of Marjan Medical City were considered the baseline study population. The study included willing, healthy family caregivers aged 20 and older. Illiterate caregivers (as the study was self-reported), those with mental or intellectual disabilities, hearing or speech impairments, or other severe illnesses were excluded. The sample size was determined using a single population proportion formula, assuming a 5% margin of error, a 50% sample proportion (i.e., a 50% chance of obtaining the greatest sample size), and a 95% confidence level. The sample size was 150. Participants in the study were chosen by non-probability purposive sampling.
Data collection tools and technique
An Arabic-administered survey was used to gather data from the study population. The data gathering tool was created by examining various works of literature and was divided into four parts. Part I: Sociodemographic details of the caregivers, including age, sex, marital status, educational level, and residence. Part II: The Zarit Standard Questionnaire for the Impact Burdens (12-ZBI) consisting of 12 assess care burden by using a Likert scale with five levels: never, rarely, sometimes, frequently, and nearly always. Part III: comprise 15 questions that assess quality of life of caregivers using a Likert scale with five levels: strongly disagree, disagree, neither between disagree and agree, agree, and strongly agree. Part V: used the world health organization- five well-being index to evaluate the psychological well-being for caregiver (WHO-5) by using a Likert scale with six levels. The data were presented as percentages and frequencies.
Ethical considerations
The procedures followed the guidelines laid down in the Declaration of Helsinki 1964 and as revised later. The respondents were informed that they were free to participate and withdraw from the study at any point in time. The informed consent, including the purpose, benefits, and risks of the study, was explained, and the respondents were requested to sign it before they answered the questionnaires. The respondents were also informed that their participation would remain anonymous and that the details would be kept confidential. The researcher also ensures that physical and psychological harm are kept to an outright minimum.
Statistical analysis
SPSS version 26 was utilized to organize, tabulate, and statistically analyse the data that was gathered. Descriptive statistics, such as frequency and percentages, and mean and standard deviation for quantitative variables, were utilized to present the data. A P value of less than 0.05 was deemed statistically significant, while a P value of less than 0.001 was deemed highly statistically significant.
Results
Table 1 provides description of sociodemographic variables of family caregivers participated in the study (N = 150); The findings indicate that the average age for those family caregivers is 38.53 ± 12.501 years and the higher proportion (29.3%) of them fell within the age group of 20–29 years. The sex distribution reveals that male caregivers (71.3%) are higher than female caregivers (28.7%). The marital status shows that the majority of caregivers (62%) are got married, 33.3% still single, while only 1.3% are widowed and 3.3% are divorced. Higher percentage of them hold diploma (42.7%), while lower percentage was only read and writes (10%), (27.3%) of participants are secondary school graduated and (20%) are primary school graduated. The residency reveals that 54% of caregivers are residing in urban and 46% are residing in rural areas.
Table 1.
Socio-demographical characteristics of family caregivers for patients with cancer (n=150)
| Demographic variables | Study participants (n=150) |
|||||
|---|---|---|---|---|---|---|
| Groups | Frequency | Percentage | ||||
| Age | 20–29 years | 44 | 29.3% | |||
| 30–39 years | 39 | 26% | ||||
| 40–49 years | 38 | 25.3% | ||||
| 50–59 years | 21 | 14% | ||||
| 60 years and above | 8 | 5.3% | ||||
| MS±SD=38.53±12.501 | ||||||
| Gender | Male | 107 | 71.3% | |||
| Female | 43 | 28.7% | ||||
| Marital status | Single | 50 | 33.3% | |||
| Married | 93 | 62% | ||||
| Widowed | 2 | 1.3% | ||||
| Divorced | 5 | 3.3% | ||||
| Educational level | Reads and writes | 15 | 10% | |||
| Primary school graduates | 30 | 20% | ||||
| secondary school graduates | 41 | 27.3% | ||||
| Diploma or above | 64 | 42.7% | ||||
| Residence | Urban | 81 | 54% | |||
| Rural | 69 | 46% | ||||
Table 2 showed a descriptive analysis of the Overall level of burden of care among family caregivers, broken down into their frequencies and percentages. The results showed that the caregivers had poor, moderate, and sever burden of care levels, which were 73.3%, 24.7%, and 2%, respectively.
Table 2.
Level of burden of care among family caregivers for patients with cancer
| Variable | Overall |
|||||
|---|---|---|---|---|---|---|
| Levels | Frequency | Percent | ||||
| Burden of care | Poor | 110 | 73.3 | |||
| Moderate | 37 | 24.7 | ||||
| Sever | 3 | 2 | ||||
| Total | 150 | 100.0 | ||||
Table 3 showed a descriptive analysis of the overall level of quality of life among family caregivers, broken down into their frequencies and percentages. The results showed that the caregivers had poor, fair, and good quality of life levels, which were 8%, 74%, and 18%, respectively.
Table 3.
Level of quality of life among family caregivers for patients with cancer
| Variable | Overall |
|||||
|---|---|---|---|---|---|---|
| Levels | Frequency | Percent | ||||
| Quality of life | Poor | 12 | 8 | |||
| Fair | 111 | 74 | ||||
| Good | 27 | 18 | ||||
| Total | 150 | 100.0 | ||||
Table 4 showed a descriptive analysis of the overall level of psychological well-being among family caregivers, broken down into their frequencies and percentages. The results showed that the caregivers had poor, fair, and good psychological well-being levels, which were 10%, 73.3%, and 52.7%, respectively.
Table 4.
Level of psychological well-being among family caregivers for patients with cancer
| Variable | Overall |
|||||
|---|---|---|---|---|---|---|
| Levels | F | % | ||||
| Psychological well-being | Poor | 15 | 10 | |||
| Fair | 56 | 73.3 | ||||
| Good | 79 | 52.7 | ||||
| Total | 150 | 100.0 | ||||
Table 5 Association of the burden of care and quality of life, which displayed the correlation analysis that there is a statistically significant relationship between caregiving burden and quality of life (r = 0.282, P < 0.01); the lower the caregiving burden, the higher the quality of life (according to the scale coding), indicating a correlational effect of caregiving burden on quality of life.
Table 5.
Relationship between caregiving burden and quality of life
| Pearson correlation | P | Sig. | ||
|---|---|---|---|---|
| 0.282** | 0.000 | Significant |
**The correlation is significant at the 0.01 level
Table 6 Association of the burden of care and psychological well-being which displayed the correlation analysis that a statistically significant relationship between caregiving burden and psychological well-being (r = −0.324, P < 0.01). The higher the caregiving burden, the lower the psychological well-being (according to the scale coding), indicating a correlational effect of caregiving burden on psychological well-being.
Table 6.
Relationship between caregiving burden and psychological well-being
| Pearson correlation | P | Sig. | ||
|---|---|---|---|---|
| –0.324** | 0.000 | Significant |
**The correlation is significant at the 0.01 level
Discussion
This study primarily aimed to investigate the impact of caregiving burden on the quality of life and mental health of family caregivers of cancer patients at the Babylon Oncology Center in Babylon, Iraq. The results showed that the majority of participants were between 20 and 29 years old, with a mean age of 38.53 ± 12.50 years. The findings also revealed that 62% of the caregivers were married, and approximately three-quarters of them were men. Less than half held a diploma or higher, while an even smaller percentage were only literate. More than half resided in urban areas. These results are consistent with many studies indicating that the mean age of patients was 38.98 ± 10.53 years, and that 55.62% had post-10th-grade education. The majority of participants (88.20%) were married.[18,19,20,21,22,23,24,25] In this study, 110 participants (73.3%), 111 participants (74%), and 79 participants (52.7%) showed a low burden, good quality of life, and good psychological well-being. Regarding the level of caregiving burden among participants, our study recorded 110 participants (73.3%) with a low burden, a lower percentage than reported in other studies. For example, the study at Hawassa University Comprehensive Specialized Hospital Oncology Center, Ethiopia, reported a low burden of 33.4%, the Kulkarni study in India indicated that 58.8% of caregivers experienced a light to moderate burden, and studies in Egypt and Saudi Arabia indicated that 59% experienced a heavy burden.[26,27,28,29,30] Quality of life levels were moderate for most participants (74% Fair), with 18% having a good quality of life and 8% a poor quality of life. These findings suggest that a relatively poor caregiving burden may allow caregivers to maintain a fair level of quality of life, despite the daily stresses associated with caregiving. These results are partially consistent with the study by Stenberg et al.,[31] which found that the majority of caregivers had a moderate burden.
Regarding quality of life, most family caregivers have a fair level of quality of life. According to demographic characteristics, male (82.2%) showed a higher percentage of fair quality of life than female. While female had a good level of quality of life (14%) compared to 10.3% of male, this can be explained by female’s greater ability to cope with daily stresses, this aligns with[29,30,31] who found that males report a better quality of life compared to females. The results also showed that older caregivers aged 60 and above had a high percentage of good quality of life, unlike younger caregivers aged 30–39, who had a lower percentage of good quality of life. This may reflect older people’s experience in dealing with stress, which was confirmed by.[32] Regarding marital status, the results showed that married and single individuals had similar levels of moderate quality of life, which is consistent with.[33] The results also showed that the percentage of moderate quality of life was higher for those with a diploma or higher compared to primary school graduates, and this is supported by the results of the Abebe study.[34] Regarding psychological well-being, approximately half of the caregivers had good levels (52.7%) and one and a half quarter had fair levels (37.3%). The results indicate a statistically significant relationship (r = 0.282, P < 0.001), suggesting a significant impact of the burden on the quality of life of family caregivers of cancer patients. This is reflected in the fact that any change in the burden level is accompanied by a change in the quality of life. The results also indicated a statistically significant inverse relationship between the burden of care and psychological mortality among caregivers (r = –0.324, P < 0.001). This means that an increased burden of care leads to a decrease in psychological well-being, which is consistent with the[35,36] study that confirmed the association between an increased burden and higher psychological stress levels among caregivers. In general, the results indicate that the caregiving burden has an impact not only on daily life but also on psychological well-being. Increased burden is associated with decreased well-being and a change in quality of life for family caregivers. This aligns with the findings of cui,[37,38] whose study indicated a negative correlation between both quality of life and psychological well-being on the one hand, and caregiving burden on the other. The results showed that the caregiving burden has a more pronounced impact on psychological well-being compared to quality of life, meaning that the mental health of caregivers is more affected by the stresses of continuous caregiving.
Conclusion
The results of the study showed a statistically significant relationship between caregiving burden and quality of life, and between caregiving burden and psychological well-being. The stresses resulting from caregiving not only affect the daily lives of caregivers but also extend to their psychological well-being. The impact of caregiving burden was more pronounced on the psychological well-being of family caregivers compared to their quality of life.
Strengths and limitations
One of the strengths of this study is its appropriate sample size (150 family caregivers), which enhances the reliability of the results. The study addressed interrelated variables, providing a more comprehensive understanding of several aspects related to the practicalities of daily life and psychological aspects. Furthermore, the use of internationally recognized measurement tools employed in previous studies strengthens the validity and comparability of the results with those of other studies. However, this study has some limitations. For example, it only included caregivers for cancer patients in one governorate, which limits the generalizability of the findings.
Artificial intelligence
Artificial Intelligence (AI) Policy: In the writing of this paper, in the production of tables and figures, and in the collection and analysis of data, no AI tools or programs were used.
Ethical approval
The study adheres to the ethical principles set forth by the research ethical committee of Nursing College for Medical Sciences Institutional Review Board approval number: Ref. No. GTN 13/124 IRB, Date of Approval: 3/11/2025.
Author’s contributions
EHH and HMM: Concepts, design, definition of intellectual content, literature search, clinical studies, experimental studies, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing, manuscript review, guarantor. The manuscript has been read and approved by all the authors, that the requirements for authorship as stated earlier in this document have been met, and that each author believes that the manuscript represents honest work. All authors were involved in initial conception of the paper and in the design. All authors contributed to the preparation of the final manuscript. All authors have agreed on the final version by drafting the article or revising it critically for important intellectual content.
Data availability statement
Data and materials for the study are available upon request from the corresponding author.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
We want to convey our appreciation to For the Babil Health Department and the manager of the Babil Oncology Center, affiliated with Marjan Medical City for granting us permission to carry out this study at their medical facility, and to the study participants for their cooperation.
Funding Statement
Nil.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data and materials for the study are available upon request from the corresponding author.