Factors on The Quality of Life in Family Caregivers of Elderly Patients with Advanced Lung Cancer During Radiotherapy

  • Authors

    • Lanying Qiu Graduate School, University of St. La Salle, Bacolod City 6100, Philippines; Zhejiang Cancer Hospital, Hangzhou, China
    • Sheilla M. Trajera Chair, Nursing and Education Programs at University of St. La Salle Graduate School; Faculty, BSN, MN, MAN, and PhD in Nursing, University of St. La Salle, Bacolod City, Philippines https://orcid.org/0000-0003-1834-7275
    • Leslie E. Young Faculty, BSN, MN, and PhD Programs in Nursing, University of St. La Salle, Bacolod City, Philippines https://orcid.org/0009-0003-8553-3067
    • Gregory S. Ching Faculty, Graduate Institute of Educational Administration and Policy, National ChengChi University, Taipei City, Taiwan https://orcid.org/0000-0001-9148-0019
    https://doi.org/10.14419/p633d781

    Received date: October 2, 2025

    Accepted date: October 10, 2025

    Published date: October 19, 2025

  • quality of life, caregivers, lung cancer, radiotherapy, caregiving stress

  • Abstract

    The quality of life (QoL) of family caregivers is pivotal to the treatment outcomes and prognosis of elderly patients with advanced lung cancer undergoing radiotherapy. This study assessed the multidimensional QoL of 138 caregivers using the Adult Carer Quality of Life Questionnaire (AC-QoL) and identified significant predictors. A cross-sectional survey design revealed that caregivers experienced a moderate overall QoL, with the highest scores in support for caring, sense of value, and ability to care, while the lowest score was observed in caring stress. Multiple regression analysis indicated that gender (p = .003), hours of care per week (p < .001), and tenure as a caregiver (p < .001) significantly predicted QoL, whereas age was not significant (p = .145). These findings highlight that male gender, longer caregiving hours, and greater tenure were associated with higher QoL, though stress remained prevalent. To address these challenges, the study underscores the need for caregiver-focused interventions such as stress management, skills training, and social support. Integrating caregiver well-being into oncology nursing practice is essential to enhance both caregiver and patient outcomes.

  • References

    1. Alqhtani, S. S., Barry, C., & King, B. (2021). A systematic review of family caregivers of persons with serious mental illnesses in non-Western countries. Saudi Journal of Nursing and Health Care, 4(3), 48-71. https://doi.org/10.36348/sjnhc.2021.v04i03.002
    2. Alyafei, A. H., Alqunaibet, T., Mansour, H., Ali, A., & Billings, J. (2021). The experiences of family caregivers of people with severe mental illness in the Middle East: A systematic review and meta-synthesis of qualitative data. PLoS ONE, 16(7), e0254351. https://doi.org/10.1371/journal.pone.0254351
    3. Applebaum, A. J., & Sannes, T. S. (2025). The importance of honoring family caregiver burden: Challenges in mental health care delivery. Journal of Clinical Psychology in Medical Settings, 32, 193–201. https://doi.org/10.1007/s10880-024-10051-3
    4. Badger, T., Segrin, C., Crane, T., & Morrill, K. (2024). Social determinants of health, psychological distress, and caregiver burden among informal cancer caregivers of cancer survivors during treatment. Journal of Psychosocial Oncology, 42(3), 333-350. https://doi.org/10.1080/07347332.2023.2248486
    5. Bahramia, M., & Nasiri, A. (2024). Behind the scenes of caregiving in patients with advanced cancer: A qualitative study on family caregivers. Asia-Pacific Journal of Oncology Nursing, 11(1), 100330. https://doi.org/10.1016/j.apjon.2023.100330
    6. Benites, A. C., Rodin, G., de Oliveira-Cardoso, É. A., & dos Santos, M. A. (2022). "You begin to give more value in life, in minutes, in seconds”: spiritual and existential experiences of family caregivers of patients with advanced cancer receiving end-of-life care in Brazil. Supportive Care in Cancer, 30, 2631–2638. https://doi.org/10.1007/s00520-021-06712-w
    7. Bevans, M., & Sternberg, E. M. (2012). Caregiving burden, stress, and health effects among family caregivers of adult cancer patients. JAMA, 307(4), 398-403. https://doi.org/10.1001/jama.2012.29
    8. Blom, M., Guicherit, O. R., & Hoogwegt, M. T. (2023). Perfectionism, intolerance of uncertainty, and coping in relation to fear of cancer recurrence in breast cancer patients. Psycho-Oncology, 32(4), 581-588. https://doi.org/10.1002/pon.6102
    9. Borna, S., Maniaci, M. J., Haider, C. R., Gomez-Cabello, C. A., Pressman, S. M., Haider, S. A., Demaerschalk, B. M., Cowart, J. B., & Forte, A. J. (2024). Artificial intelligence support for informal patient caregivers: A systematic review. Bioengineering, 11(5), 483. https://doi.org/10.3390/bioengineering11050483
    10. Bouchelle, Z., Yazdani, M., Dalembert, G., Negro, D., Jenssen, B. P., Virudachalam, S., Shea, J. A., Gwynn, K., Morrow, K., & Kenyon, C. C. (2024). Low-income caregiver perspectives on a state education savings program and receptivity to clinic-based financial counseling. Academic Pe-diatrics, 24(3), 494-502. https://doi.org/10.1016/j.acap.2023.08.008
    11. Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., Bywaters, D., & Walker, K. (2020). Purposive sampling: Complex or simple? Research case examples. Journal of Research in Nursing, 25(8), 652-661. https://doi.org/10.1177/1744987120927206
    12. Cheng, H.-L., & Ting, G. (2022). The experiences, perceptions, and support needs among family caregivers of patients with advanced cancer and eating problems: An integrative review. Palliative Medicine, 36(2), 219-236. https://doi.org/10.1177/02692163211058598
    13. Cohen, L., Manion, L., & Morrison, K. (2007). Research methods in education. Routledge.
    14. Cui, P., Yang, M., Hu, H., Cheng, C., Chen, X., Shi, J., Li, S., Chen, C., & Zhang, H. (2024). The impact of caregiver burden on quality of life in family caregivers of patients with advanced cancer: A moderated mediation analysis of the role of psychological distress and family resilience. BMC Public Health, 24, 817. https://doi.org/10.1186/s12889-024-18321-3
    15. del-Pino-Casado, R., Priego-Cubero, E., López-Martínez, C., & Orgeta, V. (2021). Subjective caregiver burden and anxiety in informal caregivers: A systematic review and meta-analysis. PLoS ONE, 16(3), e0247143. https://doi.org/10.1371/journal.pone.0247143
    16. del Río Lozano, M., del Mar García-Calvente, M., Calle-Romero, J., Machón-Sobrado, M., & Larrañaga-Padilla, I. (2017). Health-related quality of life in Spanish informal caregivers: Gender differences and support received. Quality of Life Research, 26, 3227–3238. https://doi.org/10.1007/s11136-017-1678-2
    17. Elwick, H., Joseph, S., Becker, S., & Becker, F. (2019). Manual for the Adult Carer Quality of Life Questionnaire (AC-QoL). University of Not-tingham.
    18. Fang, M. L., Sixsmith, J., Sinclair, S., & Horst, G. (2016). A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: Findings from a scoping review. BMC Geriatrics, 16, 107. https://doi.org/10.1186/s12877-016-0282-6
    19. Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression anal-yses. Behavior Research Methods, 41, 1149–1160. https://doi.org/10.3758/BRM.41.4.1149
    20. Fernandez-Bueno, L., Torres-Enamorado, D., Bravo-Vazquez, A., Rodriguez-Blanco, C., & Bernal-Utrera, C. (2024). Technological innovations to support family caregivers: A scoping review. Healthcare, 12(23), 2350. https://doi.org/10.3390/healthcare12232350
    21. Gan, G. G., Tey, K. W. F., Mat, S., Saad, M., Bee, P. C., Malik, R. A., Ho, G. F., & Ng, C. G. (2022). Quality of life of family caregivers of cancer patients in a developing nation. Asian Pacific Journal of Cancer Prevention, 23(11), 3905–3914. https://doi.org/10.31557/APJCP.2022.23.11.3905
    22. Graven, L. J., Glueckauf, R. L., Regal, R. A., Merbitz, N. K., Lustria, M. L. A., & James, B. A. (2021). Telehealth interventions for family caregiv-ers of persons with chronic health conditions: A systematic review of randomized controlled trials. International Journal of Telemedicine and Ap-plications, 2021, 3518050. https://doi.org/10.1155/2021/3518050
    23. Gu, Y., Ma, X., Xin, H., Xiang, Z., Chen, Y., & He, C. (2025). Navigating life after gastric cancer surgery: A qualitative exploration of the dyadic patient-caregiver perspective on quality of life outcomes. BMC Cancer, 25, 288. https://doi.org/10.1186/s12885-025-13696-x
    24. Guerra-Martín, M. D., Casado-Espinosa, M. D. R., Gavira-López, Y., Holgado-Castro, C., López-Latorre, I., & Borrallo-Riego, Á. (2023). Quality of life in caregivers of cancer patients: A literature review. International Journal of Environmental Research and Public Health, 20(2), 1570. https://doi.org/10.3390/ijerph20021570
    25. Ho, L.-L., Li, Y., Gray, R., Ho, G. W. K., & Bressington, D. (2021). Experiences and views of carers regarding the physical health care of people with severe mental illness: An integrative thematic review of qualitative research. Journal of Psychiatric and Mental Health Nursing, 29(6), 774-787. https://doi.org/10.1111/jpm.12804
    26. Hoshino, J., Tamakoshi, K., Hori, Y., & Sakakibara, H. (2022). Association between caregivers' health-related quality of life and care recipients' health outcomes. International Journal of Nursing Practice, 28(3), e13044. https://doi.org/10.1111/ijn.13044
    27. Hung, L., Wong, J. O. Y., Ren, H. L., Zhao, Y., Fu, J. J., Mann, J., & Li, L. (2025). The impact of telepresence robots on family caregivers and res-idents in long-term care. International Journal of Environmental Research and Public Health, 22(5), 713. https://doi.org/10.3390/ijerph22050713
    28. Jiang, N., Wu, B., & Li, Y. (2024). Caregiving in Asia: Priority areas for research, policy, and practice to support family caregivers. Health Care Science, 3(6), 374-382. https://doi.org/10.1002/hcs2.124
    29. Jimenez, O.-J. B., Trajera, S. M., & Ching, G. S. (2022). Providing end-of-life care to COVID-19 patients: The lived experiences of ICU nurses in the Philippines. International Journal of Environmental Research and Public Health, 19(19), 12953. https://doi.org/10.3390/ijerph191912953
    30. Kim, S. K., Hwang, Y. S., Jang, J. W., & Jo, H. S. (2022). Evaluation of the effectiveness of social robot by family caregivers nursing for the older adult with cognitive impairment: A randomized controlled trial. Journal of Korean Gerontological Nursing, 24(2), 142-150. https://doi.org/10.17079/jkgn.2022.24.2.142
    31. Kondeti, A. K., Yadala, A., Lakshmi, N. R., Prakash, C., Palat, G., & Varthya, S. B. (2021). Assessment of caregiving burden of family caregivers of advanced cancer patients and their satisfaction with the dedicated inpatient palliative care provided to their patients: A cross-sectional study from a tertiary care centre in South Asia. Asian Pacific Journal of Cancer Prevention, 22(7), 2109-2115. https://doi.org/10.31557/APJCP.2021.22.7.2109
    32. Lee, L.-Y., Huang, B.-S., Lin, C.-Y., Chung, C.-F., Chang, Y.-L., & Chen, S.-C. (2022). Trajectories of resilience and related factors in primary caregivers of patients with advanced head and neck cancer: A longitudinal cohort study. Journal of Nursing Scholarship, 54(2), 191-201. https://doi.org/10.1111/jnu.12728
    33. Li, T., Zheng, L., & Zhang, J. (2025). Legal protection of mental health for family caregivers of people with mental disorders: Challenges, current situation, and legislative response. Psychology Research and Behavior Management, 18, 1893-1901. https://doi.org/10.2147/PRBM.S549280
    34. Li, Y., Li, J., Zhang, Y., Ding, Y., & Hu, X. (2022). The effectiveness of e-Health interventions on caregiver burden, depression, and quality of life in informal caregivers of patients with cancer: A systematic review and meta-analysis of randomized controlled trials. International Journal of Nurs-ing Studies, 127, 104179. https://doi.org/10.1016/j.ijnurstu.2022.104179
    35. Liao, X., Wang, J., Zhang, F., Luo, Z., Zeng, Y., & Wang, G. (2022). The levels and related factors of compassion fatigue and compassion satisfac-tion among family caregivers: A systematic review and meta-analysis of observational studies. Geriatric Nursing, 45(May–June), 1-8. https://doi.org/10.1016/j.gerinurse.2022.02.016
    36. Likert, R. (1932). A technique for the measurement of attitudes. Columbia University Press.
    37. Lim, H. A., Tan, J. Y. S., Chua, J., Yoong, R. K. L., Lim, S. E., Kua, E. H., & Mahendran, R. (2017). Quality of life of family caregivers of cancer patients in Singapore and globally. Singapore Medical Journal, 58(5), 258-261. https://doi.org/10.11622/smedj.2016083
    38. McCauley, R., McQuillan, R., & Foley, G. (2021). Mutual support between patients and family caregivers in palliative care: A systematic review and narrative synthesis. Palliative Medicine, 35(5), 875-885. https://doi.org/10.1177/0269216321999962
    39. McKenna, O., Fakolade, A., Cardwell, K., Langlois, N., Jiang, K., & Pilutti, L. A. (2022). Towards conceptual convergence: A systematic review of psychological resilience in family caregivers of persons living with chronic neurological conditions. Health Expectations, 25(1), 4-37. https://doi.org/10.1111/hex.13374
    40. Mudrazija, S. (2019). Work-related opportunity costs of providing unpaid family care in 2013 and 2050. Health Affairs, 38(6), 1003–1010. https://doi.org/10.1377/hlthaff.2019.00008
    41. Ng, C. Y., Buchanan Lunsford, N., & Lee Smith, J. (2020). Impact of informal cancer caregiving across the cancer experience: A systematic litera-ture review of quality of life. Palliative and Supportive Care, 18(2), 220-240. https://doi.org/10.1017/S1478951519000622
    42. Ng, J. H. Y., Luk, B. H. K., & Lee, N. P. M. (2023). Gender differences in cancer spousal caregiving: A systematic review. Palliative and Support-ive Care, 21(5), 880-889. https://doi.org/10.1017/S1478951523000731
    43. Ng, J. P. Z., Lam, W. Y. H., Pow, E. H. N., & Botelho, M. G. (2023). A qualitative analysis of patient's lived experience on their treatment journey with nasopharyngeal carcinoma. Journal of Dentistry, 134(July), 104518. https://doi.org/10.1016/j.jdent.2023.104518
    44. Ochoa, C. Y., Buchanan Lunsford, N., & Lee Smith, J. (2020). Impact of informal cancer caregiving across the cancer experience: A systematic lit-erature review of quality of life. Palliative and Supportive Care, 18(2), 220-240. https://doi.org/10.1017/S1478951519000622
    45. Palmes, M. S., Trajera, S. M., & Ching, G. S. (2021). Relationship of coping strategies and quality of life: Parallel and serial mediating role of resili-ence and social participation among older adults in Western Philippines. International Journal of Environmental Research and Public Health, 18(19), 10006. https://doi.org/10.3390/ijerph181910006
    46. Pan, Y., Chen, R., & Yang, D. (2022). The relationship between filial piety and caregiver burden among adult children: A systematic review and meta-analysis. Geriatric Nursing, 43(January–February), 113-123. https://doi.org/10.1016/j.gerinurse.2021.10.024
    47. Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health promotion in nursing practice (6th ed.). Pearson.
    48. Peplau, H. E. (1997). Peplau's theory of interpersonal relations. Nursing Science Quarterly, 10(4), 162-167. https://doi.org/10.1177/089431849701000407
    49. Qan’ir, Y., Guan, T., Idiagbonya, E., Dobias, C., Conklin, J. L., Zimba, C. C., Bula, A., Jumbo, W., Wella, K., Mapulanga, P., Bingo, S., Chilemba, E., Haley, J., Montano, N. P., Bryant, A. L., & Song, L. (2022). Quality of life among patients with cancer and their family caregivers in the Sub-Saharan region: A systematic review of quantitative studies. PLoS Global Public Health, 2(3), e0000098. https://doi.org/10.1371/journal.pgph.0000098
    50. Robbins, R., Cole, R., Ejikeme, C., Orstad, S. L., Porten, S., Salter, C. A., Nolasco, T. S., Vieira, D., & Loeb, S. (2022). Systematic review of sleep and sleep disorders among prostate cancer patients and caregivers: A call to action for using validated sleep assessments during prostate cancer care. Sleep Medicine, 94(June), 38-53. https://doi.org/10.1016/j.sleep.2022.03.020
    51. Rostami, M., Abbasi, M., Soleimani, M., Moghaddam, Z. K., & Zeraatchi, A. (2023). Quality of life among family caregivers of cancer patients: An investigation of SF-36 domains. BMC Psychology, 11, 445. https://doi.org/10.1186/s40359-023-01399-6
    52. Sak-Dankosky, N., Sherwood, P., Vehviläinen-Julkunen, K., & Kvist, T. (2022). Interventions improving well-being of adult cancer patients’ care-givers: A systematic review. Journal of Advanced Nursing, 78(9), 2747-2764. https://doi.org/10.1111/jan.15320
    53. Tough, H., Brinkhof, M. W. G., & Fekete, C. (2022). Untangling the role of social relationships in the association between caregiver burden and caregiver health: An observational study exploring three coping models of the stress process paradigm. BMC Public Health, 22, 1737. https://doi.org/10.1186/s12889-022-14127-3
    54. van Wijngaarden, S., Hodes, M. W., Cardinaal, L., Koning, M., & Schippers, A. (2025). Improving quality of life of families headed by parents with intellectual disabilities and their children by means of assistive social robotics. Journal of Applied Research in Intellectual Disabilities, 38(2), e70054. https://doi.org/10.1111/jar.70054
    55. Wali Ahmed, F., Tasawar, A., Maroof, S., Tasawar, A., Mirza, W., Butt, M., Ayaz Khan, J., Bano, S., & Shehzad, R. (2025). Impact of depressive symptoms on antiepileptic drug adherence among epilepsy patients. International Journal of Basic and Applied Sciences, 14(2), 563-571. https://doi.org/10.14419/7meyhn92
    56. Wang, L., Zhou, Y., Fang, X., & Qu, G. (2022). Care burden on family caregivers of patients with dementia and affecting factors in China: A sys-tematic review. Frontiers in Psychiatry, 13, 1004552. https://doi.org/10.3389/fpsyt.2022.1004552
    57. Williams, K. L., Morrison, V., & Robinson, C. A. (2014). Exploring caregiving experiences: Caregiver coping and making sense of illness. Aging & Mental Health, 18(5), 600-609. https://doi.org/10.1080/13607863.2013.860425
    58. Wu, N., Felts, A., Balmuth, A., Lee, C., D’Ambrosio, L., Brady, S., Ashebir, S., & Coughlin, J. (2025). Family caregivers’ experiences with and acceptance of new digital and AI-enabled technologies. In Q. Gao & J. Zhou (Eds.), Human Aspects of IT for the Aged Population (Vol. 15811, pp. 415–431). Springer. https://doi.org/10.1007/978-3-031-92712-6_27
    59. Xu, L., Fields, N. L., Greer, J. A., Tamplain, P. M., Bricout, J. C., Sharma, B., & Doelling, K. L. (2022). Socially assistive robotics and older family caregivers of young adults with Intellectual and Developmental Disabilities (IDD): A pilot study exploring respite, acceptance, and usefulness. PLoS ONE, 17(9), e0273479. https://doi.org/10.1371/journal.pone.0273479
    60. Xu, Y., Liu, Y., Kang, Y., Wang, D., Zhou, Y., Wu, L., & Yuan, L. (2024). Experiences of family caregivers of patients with end-of-life cancer during the transition from hospital to home palliative care: A qualitative study. BMC Palliative Care, 23, 230. https://doi.org/10.1186/s12904-024-01559-4
    61. Zajdel, M., Swan, T., Robinson, T., Keller, K. R., Mountcastle, L., & Koehly, L. M. (2023). Stress, coping, and physical health in caregiving. Trans-lational Issues in Psychological Science, 9(2), 123–136. https://doi.org/10.1037/tps0000349
    62. Zhai, S., Chu, F., Tan, M., Chi, N.-C., Ward, T., & Yuwen, W. (2023). Digital health interventions to support family caregivers: An updated sys-tematic review. Digital Health, 9. https://doi.org/10.1177/20552076231171967
    63. Zhou, W., & Dai, W. (2021). Shifting from fragmentation to integration: A systematic analysis of long-term care insurance policies in China. Inter-national Journal of Integrated Care, 21(3), 11. https://doi.org/10.5334/ijic.5676
    64. Zhu, S., Yang, C., Mei, W., Kang, L., Li, T., Li, J., & Li, L. (2023). Caregiver burden for informal caregivers of patients after surgical treatment of early-stage lung cancer. Journal of Clinical Nursing, 32(5-6), 859-871. https://doi.org/10.1111/jocn.16424

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    Qiu, L., Trajera, S. M., Young, L. E., & Ching, G. S. (2025). Factors on The Quality of Life in Family Caregivers of Elderly Patients with Advanced Lung Cancer During Radiotherapy. International Journal of Basic and Applied Sciences, 14(6), 365-373. https://doi.org/10.14419/p633d781