Unsteady balance: the constraints of informal care

The enduring cultural image of cancer is of an acute and deadly disease that acts swiftly to end life. Although it is the case that cancer mortality rates remain obstinately high in industrial countries, cancers are now seen as a chronic disease with uncertainty in remission, new recurrence, palliation, and death. Caregivers' commitment, emotional involvement, and understanding of the patients' needs demonstrate that caring is a special way of being, thinking and growing within the experience of the illness trajectory. Caring is fundamental to human survival. It is understood to imply a distinct way of being, believing, and acting that calls for commitment, knowledge, and new coping skills. It motivates families and gives meaning and structure to life. Informal family caregivers of cancer patients are required to meet multidimensional needs, including treatment monitoring; treatment-related symptom management; emotional, financial, and spiritual support; and assistance with personal and instrumental care. Families are increasingly replacing skilled healthcare workers in the delivery of unfamiliar complex care to their ill family members despite the other obligations and responsibilities that characterize their lives.