chapter  10
“As God Is My Witness . . .”: What Is Said, What Is Silenced in Informal Cancer Caregivers’ Narratives
Pages 19

Cancer patients, especially those who are in the fi nal stages of life, have multifaceted needs including disease and treatment monitoring, symptom and pain management, medication administration and assistance with personal care, daily activities of living, and emotional distress (van Ryn et al., 2011). In private, for-profi t health care systems, such as the ones found in the United States and in parts of Europe, much of this care has been moved from the in-patient arena to outpatient and ambulatory settings, with a shift in responsibility for the day-to-day care of patients from institutions to their families (Given, Gien & Kozachik, 2001; van Ryn et al., 2011). Informal caregivers in the global north are most likely to be spouses or female relatives who provide these services without pay and often without training or assistance from medical personnel. Hayman et al. (2001) estimate the fi nancial value of the labor provided by US caregivers, 62% of whom are female, for elderly cancer patients at 1 billion dollars annually (p. 3223). Although this unpaid labor helps support the profi tability of health systems, it comes at great costs to those providing the care, who are at higher risk of depression, cardiovascular disease and mortality (Schultz & Sherwood, 2008). Much of the strain of caregiving as well as the suffering of patients is intensifi ed by the relative social isolation of the nuclear family. The caregiver often not only feels responsible for caring for the physical needs of the patient, but also for trying to help the patient emotionally and spiritually.