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					Running Head: CANCER, INFORMAL CAREGIVING, AND EMPLOYMENT

Making it Work: Informal Caregiving, Cancer and Employment Jennifer E. Swanberg1 University of Kentucky

Abstract
Studies of informal caregivers for people with cancer have primarily focused on the family or personal factors that contribute to or mediate the stress associated with providing care to a loved one. However, the majority of research models have failed to consider the role that workplace factors may play in caregivers’ work-family conflict and stress. This qualitative study identifies the workplace factors that inhibit or facilitate the ability of informal caregivers of cancer patients to provide care to a loved one and to determine the aspects of caregiving that hinder caregivers’ ability to meet work responsibilities. Implications for further research are discussed.

Key words: Cancer Informal Caregiving Work-Family

The research for and preparation of this article were supported by the University of Kentucky Cancer Control Program and the University of Kentucky Office for Research.

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Jennifer E. Swanberg, Ph.D., University of Kentucky, College of Social Work, 663 Patterson Office Tower, Lexington, KY 40506-0027; Phone: 859.257.3351; Fax: 859.323.1030; Email: jswanberg@uky.edu

Making it Work: Informal Caregiving, Cancer and Employment 1. Introduction With its push for cost containment, the health care system in the United States has encouraged outpatient care rather than inpatient care. This trend has lead to early discharge of patients with terminal and acute conditions and has increased the need for care in the home. Thus, informal caregivers (i.e., family members and friends) are often charged with the responsibility of providing indirect and direct care to their terminally ill loved ones. The strenuous task of caregiving leads to a variety of physical, psychological, and financial consequences for the caregiver (Jensen & Given, 1991; Scharlach, 1994). The body of literature that addresses the strain associated with caregiving has primarily focused on eldercare and childcare; there is limited literature pertaining to the strain associated with informal caregiving for cancer patients. Furthermore, this limited research has failed to adequately address the consequences of employment on caregivers’ well-being (Thomas & Morris, 2002). The results of studies on caregiving for cancer patients indicate that caregivers engage in tasks requiring a variety of cognitive, physical, and emotional behaviors (Thomas & Morris, 2002). Responsibility for these tasks often results in heightened levels of fatigue, fear, anxiety, distress, financial pressures, and depression (Harding & Higginson, 2003; Jensen & Given, 1991; Thomas & Morris, 2002). A study by Jensen & Given (1991) suggests that these consequences worsen as caregiving duties increasingly interfere with the caregiver’s daily schedule. This finding suggests that a lack of flexibility in schedules leads to an inability to meet the demands of conflicting caregiver roles and subsequently leads to increased tension and role strain for the caregiver (Jensen & Given, 1991; Rose, 1998). More complex theories of family caregiving suggest that the individual appraises environmental demands as potentially stress producing (Lazarus & Folkman, 1984; Lawton et al., 1989). If the demand is assessed as stress producing, and there is a lack of resources available to limit the threat, then the likelihood of negative outcomes increases. Although these stress models acknowledge that there are a variety of contextual factors (such as family context of care) that can potentially impact the stress process among cancer caregivers (e.g. Blood, et al., 1994; Oberst et al., 1989), few models consider the context of work. Caregivers often assume the role of paid employees, yet the contextual consequences of this environment are largely overlooked in research studies. Eldercare research has illuminated the complexity of the link between caregiving and employment and has found that the mutual relationship can lead to either role strain or role facilitation. The findings of research within the social and emotional domains suggest that employment can both positively influence caregiving (provision of respite, social support, stimulation) and negatively influence caregiving (lack of time, drained energy, decreased quality of care) (Scharlach, 1994). Similarly, research investigating the role of workplace supports (flexible work schedules, paid leave, or supportive supervisors) on employee outcomes, such as stress and role strain, has shown that when workplace supports are available to and used by employees, they experience less strain and are better able to meet their caregiving responsibilities. In contrast, when workplace practices are rigid and unsupportive, caregiving can negatively influence employment outcomes by increasing absenteeism and tardiness and decreasing productivity (Fredriksen & Scharlach, 1997; Scharlach, 1994; Scharlach, Sobel, & Roberts, 1991). 2

For instance, a study by Fredriksen & Scharlach (1997) showed that fewer workplace supports and limited job flexibility were predictive of increased role strain. Given the limited amount of research addressing the relationship between caregiving, employment and stress among employees caring for someone with cancer this pilot study set out to identify the workplace factors that inhibitor or facilitate the ability of informal caregivers of cancer patients to provide care to their loved one and to determine the aspects of caregiving that hinder caregivers’ ability to meet work responsibilities. 2. Method 2.1 Participants The total sample was 30 informal caregivers for people diagnosed with cancer (women, n=22 and men, n=8). Participants were interviewed between May and September 2004. Twenty-eight participants identified as White, one as Black, and one as Hispanic. Eight participants completed high school or had some educational experience less than a high school education; 12 participants had some college experience; four had a 4-year college degree, five had a graduate degree, and one participant reported having some other educational experience. Twenty-three participants were married or in a committed long-term relationship, one was widowed, four participants were divorced or separated, and two were single and never married. The mean age was 48, with a range from 25 to 75. 2.2 Procedure This study used individual, semi-structured interviews to collect information from employed informal caregivers for cancer patients and a brief questionnaire to collect demographic information and employment histories. To be eligible for the study, participants had to be currently providing informal care to someone diagnosed with cancer and they had to be employed at least 20 hours per week. Participants were recruited using two methods. First, cancer caregivers who fit the eligibility criteria and who had previously been involved in another cancer caregiving study were contacted to determine their interest in participating in another study. Ten subjects were recruited using this method. The remaining 20 participants were recruited by posting flyers at community based cancer treatment facilities located in central Kentucky. Interviews lasted approximately 60 to 75 minutes and began after informed consent. Participants were compensated for their time. Researchers received consent from all participants to audiotape the interview. Audiotaped interviews were transcribed verbatim in preparation for analysis. 2.3 Analysis Content analysis of transcribed interviews was conducted with the assistance of ATLASti 5, qualitative software program (Scientific Software Development, 1997).2 Grounded Theory (Glaser & Strauss, 1967; Strauss & Corbin, 1990) was the analytic framework used to determine the meaning of the interviews. Specifically, within the parameters of the overall research questions, text was coded according to themes that “emerged” from the qualitative interviews. Two researchers other than lead investigator independently coded the transcripts. Initially, each researcher reviewed and coded four transcripts and then compared coded information and its assigned parameters. There
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The ATLAS software is a qualitative software program that enhances the objectivity and consistency of the qualitative coding process by allowing research to assign strict parameters to each of the codes.

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was 90% agreement on the codes. After some discussion a consensus was drawn on the remaining 10% of the codes. After the codes were established, each of the researchers coded 15 transcripts. As a strategy to maximize inter-coder reliability, researchers exchanged transcripts and reanalyzed the other’s transcripts. If there were discrepancies between the two coder’s perspectives, researchers discussed the content and it’s meaning until a compromise was made. Overall, this double coding process resulted in an 85% independent agreement about the codes. After some discussion, a consensus was drawn about the remaining 15% of the codes. 3. Results 3.1 Informal Caregiving and Cancer Among the 30 participants, 16 were caring for a life partner. Specifically, nine women were caring for their husbands, and seven men were caring for their wives. Six of the caregivers were daughters of and one was a daughter in- law of the cancer patient, while three caregivers were friends of the person with cancer. Two of the caregivers were sisters providing care to their sibling and two women were mothers each caring for their child. On average, participants had been providing informal care to a loved one for 18 months, with a range from one month to six years. Fifteen types of cancer were represented among the participants. The most common types were breast cancer (n=6) followed by ovarian cancer (n=4). Other forms of cancer included cancer of the colon, esophagus, pancreas, lung, brain and skin. Participants either lived with their loved one, near by [within 30 minutes], within a 30 minute to 2-hour range, or far away [more than 2 hours away]. On average, participants provided 22 hours of care per week, with a range from 3 hours to 72 hours of care. The types of care included: 1) activities of daily living, 2) home management [cooking, cleaning, running errands, lawn care, laundry], 3) bill paying, 4) skilled care [i.e. inserting a feeding tube, giving injections’], and 5) transportation to and from medical appointments. The amount of time participants spent providing care to their loved one depended primarily on the severity of the illness and in some cases the proximity of the caregiver to the loved one. For instance, one participant provided as little as one half hour a day of care [she lived in a different state from her loved one] while another participant reported taking care of the person 24 hours a day. Overall, participants living in closer proximity to the cancer patient were more likely than caregivers living further away to be involved with day-to-day care for extended periods of time. That is, caring for their loved one became a routine part of their day. Whereas, caregivers who lived further away provided care by routinely “checking in” with the cancer patient, arranging medical appointments, or paying bills. Long-distance caregivers would, however, take short periods off from work to provide care. For instance, one participant routinely cared for her friend over long weekends. As illustrated by the following participants’ quotes, the type of care and intensity of care was quite significant and it changed from week to week:
“…I had to take care of him 24 hours a day. Sometimes at night I would sleep right next to him...I had to be there…I took time off [from work] at the time…he could not sleep in the bed, he had to sleep right here in the chair…He was in so much pain … if he needed to go to the bathroom or if he needed anything I had to take care of him.” “…making sure that he got the right doses of medicine. I would give him baths and dress him. Making sure he would eat properly. I got a juicer and did all kind of juices, like carrot juice and every kind of vegetable juice you could imagine…Literally [it was] like a baby…]

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“At [that] point it was not much…[However] When he had surgery I had to [bathe and dress him] because he could not move basically his leg and the doctors didn’t want him walking on it…I had to help him bathe and dress and pretty much help him walk, all that kind of stuff.” “It made my day-to-day life pretty busy because I had to get everything done in the four days; I worked hard to get all my work done … so that when I was in Kentucky I wouldn’t have to work I could spend more time helping Ruth. I was working full-time..“

3.2 Earning a Living and Providing Care: An Intentional Balance Twenty-three respondents worked full-time and the remaining seven participants worked part-time. Men and women were equally as likely to work full-time as they were part-time. Twenty-one participants worked a regular daytime shift, three worked nontraditional hours [evenings, nights or rotating shifts], four worked a flexible schedule and two participants worked some other type of schedule. Part-time workers were more likely to work flexible schedules than full-time workers. Nineteen employees identified as professional workers, nine employees as non-professional workers, and two as factory workers. Examples of type of jobs held by employees within the professional category included: accountant, attorney, funeral director, interior designer, special education teacher, mental health counselor and radiologist. Examples of jobs held within the nonprofessional category included: administrative assistant, human resources assistant, domestic worker, and sanitation worker. When asked whether the number of hours they worked changed since providing informal care to their loved one, three participants reported an increase in the number of work hours, nine participants reduced their work hours, and 18 caregivers reported no change in the number of hours they worked. Nearly all employees reported that they had to vary their work hours in some way to adequately care for their friends or relatives. Overall, employed informal caregivers placed a higher priority on providing care, than they did on work. It is not that work was incidental, quite the contrary. Work played an important role in informal caregivers’ lives, because it provided economic security and a respite from the intensity of caring for someone ill. However, when faced with a potential terminal illness, providing care to a friend or family member took precedent over work. This theme is highlighted by the following two quotes:
“I went to him [supervisor] and told him [about the diagnosis] because it was quite a shock…I told him that I was going to try to be in the office as much as I could, but that obviously my husband was my first priority and that if he needed me then that was you know what I was going to have to do and I think in some ways he said –Well okay, just try to be here as much as you can and we’ll work with you and work this out.” “…I didn’t care my family was first the job was second and take the pay if that’s what you want if you feel that’s what you need to do, take it I don’t care. You know I’m going to take care of my family first and they went ahead and paid me for it but they were real reluctant about it…”

Providing care to family members or friends with cancer sometimes interfered with caregivers’ work responsibilities for nearly all employees. Participants reported that they: 1) spent time on the phone with loved ones, family members or from a medical providers; 2) reported late for work when care giving took longer than anticipated; 3) missed work to stay home with the cancer patient or to provide transportation to medical appointments; 4) left work before the end of the work day because of an unanticipated event; resigned or were laid off from jobs; 5) reported increased job-related stress associated with feeling unable to complete work tasks; and 6) complained of reduced productivity as evident by the inability to concentrate on the job. Regardless of the 5

reason for the job interruptions, caregivers appeared to place a high priority on meeting the immediate needs of their loved one. The following quotes highlight some of the situations encountered by caregivers as they tried to meet their multiple and often conflicting home and work responsibilities.
“I would even call her from work right when I got to work because when I left the house she was not acting right, you know. Other times I would just call to talk to her…about other things sometimes other than the cancer.” “I usually get to work by at least 6:30 in the morning, [before leaving] I make sure his medicine is out for the morning… he calls me when he gets up…We probably check in with each other at least three or four times a day. This way I know he’s okay” “I think of him all the time and really he’s there on my mind all the time.” “I was late for work because of caregiving many times, I’m not sure that I was ever on time because of the caregiving…it took time…” “I’m not late any more. But when he was on a feeding tube I would be a little late because I would have to give him medicine.” “I was written up constantly for having to leave. Even though they knew very well what was going on. They basically had no sympathy…I was having to live in constant fear that they would…fire me…” “There was one time when I had gone back to work…he called me and was panicking; he wanted me to come home immediately to take him to the doctor. So there was some times that I had to physically drop everything without giving anybody much notice and just run home and take care of him.”

In addition to worrying about the cancer prognosis and the effects of treatment, participants reported feelings of overall stress associated with meeting the demands of work. From a caregiving perspective, perceived stress levels appeared higher for caregivers of cancer patients with acute symptoms, with more involved cancer-related treatments, or whose medical status fluctuated. On the job, caregivers’ stress symptoms were exhibited by continuous worry, heightened distractibility, or an inability to effectively work.
“…I was worried about him all the time…he was here [home] by himself and while I had to work, you know its like only a couple of hours, but still it’s a couple of hours that were hard for me. Because my mind was always…what if something happened to him or what if he is going to need me, I was always worried.” “…you know when you’re [at work] wondering if he had fallen again. That was the big issues with the brain tumor, it affected his coordination…it was constant…” “…people at work want you to be at work, but your mind is not at work regardless…I mean especially going through what we were going through…in the back of my mind I was like, is she going to live. Should I be home spending time with her? It was a tremendous amount of stress…”

3.3 Resourcefulness & Creative Strategies Participants were extremely resourceful in developing strategies to provide the necessary care for their loved one and to continue working. Upon learning about their loved one’s cancer diagnosis and subsequent treatment, it seemed that nearly all the participants solicited the support of their immediate supervisor. Caregivers felt it was necessary to inform their supervisor because they either needed time off from work 6

immediately or in the future; they were upset from the news and thought it was important that their supervisor know the reason for the distraction; or they simply needed to talk to someone. In return, when possible, almost all caregivers’ supervisors offered informal and formal flexible work schedules or they allowed employees to take sick and vacation time. Informal flexible scheduling allowed for caregivers to adjust their schedule from day to day, or to make up hours at a later date. Formal flexible scheduling entailed changing their job schedule completely. As illustrated in the following quotes, informal and formal work arrangements took many forms.
“My office let me take sick-leave, but if I had deadlines I would work from there [patient’s home] …I mean, I’m a lawyer. So I have litigation deadlines that I had to deal with…I’d try to make up for what I was missing when I wasn’t in the office.” “Although I had a lot of flexibility…they [employers] were very good about allowing me to plan my workday in such a manor that in essence I was putting in what amounted to an eight hour work day but it just wasn’t at the normal eight to five type schedule. I was getting in real early and working past couple five, so that when necessary I was able to use those extra time periods to be able to do what I needed to do to take care of her.” “…I was sort of able to kind of set my schedule to accomplish what I needed to do both from a care giving responsibility and from work responsibility. I put in what was the equivalent of eight hours a day, but I did it in an unusual manner, starting work before anybody got there, being able to leave and go to the hospital or pick her up and take her to the outpatient physician. ..I’d come home for lunch on days when she didn’t actually need to go to the hospital, but I was the one who actually set up the IV fluid that she needed … I still put in the eight hours that most people put in from eight to five although I did it five-thirty or six o’clock until seven o’clock, breaks in between.” “I went [from full-time to] part-time…for probably a month…because the medication he was on he became diabetic. Before I would fix his breakfast… then I would go on into work. But then when he became a diabetic and his meals had to be more balanced and nutritional I asked if I could come into work late and so they agreed to that. Instead of going in at eight I would go in at nine and then we had hospice scheduled to come by and check on him between ten…tenthirty, I took lunch at eleven or eleven-thirty, brought him home something to eat everyday and then I got off work at one. I went to part-time because it progressed to where he couldn’t get up by himself, he couldn’t get around. “ “During the time Doug was in the hospital the first time, I’ve been very fortunate, I have a laptop I can connect I can keep up with my e-mail, check my voicemail…stay in touch. I think I wound up counting my hours as half time…I mean it was a real critical need to be with him…when I was unable to do any work, like the day after his surgery, I’d count that as a sick day.”

Not all participants worked in jobs that were conducive to flexible scheduling. These employees were required to take sick and vacation time or to make do with their schedule regardless of their home situation. It appeared that participants with little or no flexibility experienced greater perceived stress than those with some flexibility. One participant who had exhausted all his personal time had to find another job. His current job would not allow for him to take the time he needed. Another employee adhered to her required shift, but not without worry, while another went a week without pay worrying how she would pay the bills.”
“I used up all my sick leave and my vacation time in those first two months, taking him to appointments. And I was never tardy. I got there at eight o’clock in the morning; it’s just that I had to leave to take him to appointments. I had to come back home and get him…eventually I had to quit, because I could not balance both.”

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“I was having to constantly try to concentrate on accounting…I was always worrying about getting a call or about not getting a call… it was every day, wondering if he was dead when I got home. And the schedules they wouldn’t budge, third shift, there’s no wiggle room. You’re there from eleven at night to seven in the morning. The job has to get done in that time period… there was just no way to work around it. ..you did the job or else. The only times I left were life threatening times and that was pretty uncommon. They just would not; they would not give any room. They would not give an inch. So, it was like I said, it was an impossible situation, they make it worse.” “He was going into cardiac arrest when he was in the hospital. The room was covered in blood, the nurses, the doctors…of course I missed work. I missed for the entire week he was in the intensive care unit. I did not get paid for a week. ..cause they were like you used up all your time, we can’t help you. I’m sitting there saying okay, okay, but worrying how are we going to eat for the next year.”

3.4 Social Support At Work: A Key to Managing it All In addition to schedule flexibility, social support networks at work were critical to participants’ successful handling of their multiple responsibilities. Supervisors and coworkers, alike, assisted employed caregivers in multiple ways. For instance, supervisors perceived as supportive were those that allowed participants to have flexible work schedules or to take vacation/sick time to care of their loved one. As well, they were the supervisors who adjusted employees’ workload according to what she or he was able to handle. In one case, the supervisor held an employee’s job open while she was on a leave of absence. In most instances, supervisors’ support eased the emotional and temporal strain associated with managing work and caregiving. However, among a few employees even with the support, managing both was impossible, leaving them to reduce their work time or leave the job completely.
“…I have a really good supervisor. She’s not breathing down my back. It’s no problem for me to take time off. I’m able to talk to her about my daughter [person with cancer]” “When one certain supervisor is there [at work]… I can change my schedule just about anyway I want to. I can take a day off and work an extra day for it. …I could come in Sunday night….[we work] to get everything ready for Monday morning when production comes in. If I need a day off during the week like Tuesday or Wednesday sometimes I can take that off and come in on Sunday and make up for it. That way I don’t lose any time. But that’s only when one particular supervisor is on…” “I asked her if I could go into part-time. She said I could…. I was working eight hours a day, you know forty hours a week. Then it became hard to do… sometimes I worked four hours sometimes I worked three hours, depending on what he needed. I just decided I could not continue working full-time...” “…when he first got sick I was working for the Police Department and a lot of the times I would have to leave work…Well they was good because when he was real sick he [my supervisor] just let me stay off …then it got to be too much… I decided to quit because it was stressful… I would get to work and would be working…staying about forty-five minutes and I would get a call … eight hours was too much so I had to give that up. I now work part-time.”

The three employees who perceived their employees as unsupportive described their supervisors as individuals who expected life at home to stay at home. These supervisors refused to make any special accommodations for the caregivers. From the data it was unclear whether supervisors were rigidly adhering to workplace policy or if the job itself required rigid work schedules. In one case, the supervisor’s insensitivity to the situation, led the employee to quit his job. This employee felt it was impossible to 8

care for their loved one and maintain the schedule required by the job. In another situation, a caregiver perceived that she was overlooked for a promotion because she was not as “available” as her bossed would have preferred.
“It strained my relationship with my supervisor for a while. Trying to be there at work and provide care for her… I made that [caring for friend] a priority, so it was awkward for a while. While he did not say it, I know he did not like me leaving on days when she needed treatment…it was uncomfortable” “…something would happen and I would have to call in sick very quickly or leave work suddenly. I’d get written up [for leaving or calling in sick] …there was nobody to go to…There was no help from management, no help from HR, there was nothing.” “…during an evaluation, one of my bosses told me that the only thing lacking was in availability, he said I needed to make myself more available…I said my wife is taking chemo for cancer…he knew it. He was just trying to apply a little pressure to alert me they were not happy about my lack of availability.”

Support from co-workers was the other form of social support at work that helped participants manage their work and caregiving responsibilities. Support from co-workers took the form of employees working shifts for the caregivers, switching shifts with the caregivers, taking over caregivers work responsibilities, donating sick time, collecting money to assist with medical related issues, and listening to the caregiver when she or he needed to confide in someone. In some cases co-workers extended support outside the realm of work by visiting the house, bringing food, and just calling at night to provide support.
“When I first took time and I was gone for a week and half they took up a big collection of money. I did not need it, but I took it …yeah, they’re very supportive at work. Anything I need, the people at work are ready to help. “ “…my co-workers ask me about it [partner with cancer] all the time. It helps.” “..some of the guys I work with offered to switch shifts with me if I need to. They are pretty good about that. I have switched shift with them to help them do things in return…” “ …when you have so many people that support you like my group of co-workers…I may feel exhausted and disoriented, but I’m able to sit down and focus on my work because they make me feel safe. Everyone genuinely cared.” “They use to buy me food, like cans…bring it by the house…they all got together and pitched in and gave me some money…I never ran out of food...”

In direct contrast, a few employees implied they worked with co-workers who were unsupportive. One caregiver described how he felt that his co-workers unnecessarily placed a larger part of the blame on him for work-related errors that cost the company money. “All fingers wound up turning to me, saying I made the mistake. They knew I was exhausted, and capable of making errors.” Another employee suggested that there was a general resentment among her co-workers that he was taking so much time off. “It made things harder for me.” In addition to schedule flexibility, social support on the job and personal leave time, participants mentioned several other employee benefits that helped them with meeting caregiving demands: Family Medical Leave; the company’s employee assistance program; support groups located at the workplace and in the community; and family 9

health insurance. The content of participants’ conversations implies that workplace supports and responsive supervisors and co-workers made the entire caregiving experience less stressful. 4. Discussion & Key Concluding Points Within the cancer literature the context of work is often overlooked as a factor in research models seeking to understand the stress, health and well-being of caregivers. Likewise, in the work-family literature, the extenuating circumstances associated with providing informal care to a loved one with chronic, terminal or acute medical problems have also been overlooked. This pilot study suggests that the demands of providing informal care to someone with cancer can directly interfere with work responsibilities, and cause subsequent strain. Likewise, job demands can have a direct influence on caregivers’ capacity to care for their loved one. Qualitative themes suggest that certain workplace supports can help employees tend to caregiving and meet work responsibilities. Caring for someone with cancer has a different “caregiving course” than caring for a young child. To some extent, employed parents are able to predict the type of care their children will need as they mature. In contrast, the caregiving needs of a cancer patient are somewhat unpredictable. The day-to-day status of the patient may change, treatment requirements are often idiosyncratic to each patient, as is the disease progression and prognosis. As a result, employed caregivers experience a significant amount of uncertainty about the type and duration of the care. For instance, if an employee only has two weeks of vacation time, but twice-weekly chemotherapy treatment is indicated for six weeks, how does one do both without compromising work performance or the quality of care? For some employees family medical leave may be an option. However, in the United States most workplace family leave policies are unpaid. As such, few people can afford to take unpaid extended leave. This exploratory study raises more questions than answers and thus, several issues warrant further investigation and thought. 1. The objective demands, [e.g. the temporal requirements of providing all forms of care], and the subjective demands, [e.g. emotional responses associated with the unpredictable nature of the cancer disease process], appear to create significant strain for employed caregivers even before considering the demands of the workplace. One way to provide targeted cancer support services to caregivers is to better understand the various “courses of caregiving” that are required when someone is diagnosed with cancer. Such information would help caregivers plan accordingly within the context of their work and family situation. 2. Expanding caregiving stress process models to include the context of work is necessary to fully understand the factors that influence employed caregivers’ capacity to effectively fulfill their work and caregiving responsibilities. Qualitative findings from this study imply that the context of work [job demands, job schedule, work hours, supervisor relationship, and co-worker relationships] can further escalate or mediate the stress associated with caring for a loved one with cancer. The cancer caregiving and work-family literature would benefit from a quantitative study that includes workplace factors within a stress process model for understanding work-family conflict and the mental and physical health outcomes of cancer caregivers.

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