image, and communication and other problems with family members are common in cancer patients as well (Kornblith, 1998). Patients may also experience more generalized worry; fear for the future; inability to make plans; uncertainty and a heightened sense of vulnerability; and other worries, such as about the possible development of a second cancer, changes in sexual function and reproductive ability, and changes in one’s role within the family and other relationships (IOM and NRC, 2006). Moreover, cancer patients can face spiritual and existential issues involving their faith, their perceived relationship with God, and the possibility and meaning of death. Some cancer survivors report feelings of anger, isolation, and diminished self-esteem in response to such stress (NCI, 2004).

Family members also have psychological needs (Lederberg, 1998). The diagnosis of a life-threatening illness for a family member creates fear of losing the loved one and concern about the suffering he or she will endure. Family members’ psychological distress can be as severe as that of the patient. A meta-analysis of studies of psychological distress in both patients and their informal caregivers (predominantly spouses or partners) found that the psychological distress of patients and their informal caregivers generally was parallel over time, although when the patient received treatment, caregivers experienced more distress than the patient (Hodges et al., 2005). Studies of partners of women with breast cancer (predominantly husbands, but also “significant others,” daughters, friends, and others) find that partners’ mental health correlates positively with the anxiety, depression, fatigue, and symptom distress of women with breast cancer and that the effects are bidirectional (Segrin et al., 2005, 2007). Thus, helping family members to manage their distress may have a beneficial effect on the distress level of patients.

Stress is particularly great for parents of children with cancer. Studies consistently have shown that parents have higher rates of PTSD and PTSS than either their children or adult cancer survivors, suggesting that the experience of parenting a child with cancer may be more traumatic than actually having the illness (Bruce, 2006). Children of cancer patients also are a vulnerable group, with frequent psychological problems, acting-out behaviors, and problems in school (Lederberg, 1998). Moreover, siblings of pediatric cancer patients may experience their own fears and anxieties, and may receive less attention from parents while their brother or sister is in treatment.

Family members (predominantly) and friends of individuals with cancer often provide substantial amounts of emotional and logistical support and hands-on personal and nursing care to their loved ones (Kotkamp-Mothes et al., 2005; Maly et al., 2005). The estimated value of their nonreimbursed care and support exceeds $1 billion annually (Hayman et al., 2001). Further, when their loved ones experience acute or long-term inability to care



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