**10. Conclusion**

There are various factors that may affect caregiver distress. The demographic and geographic factors like distance of travel from home to the hospital, frequency of hospital visits, ease of public or private travel, financial issues, loss of work, level of education. Patient and disease factors like age, stage, prognosis, type of treatment, physical symptoms, presence of stoma or tubes, knowledge of prognosis. Caregiver factors like gender, age, relation to the patient, duration of care-giving, total time spent daily caring, etc. Various psychological and spiritual elements have to be considered as well. In the clinical setting, physicians and medical team do not monitor caregiver burden regularly. Distress in caregivers is usually under recognized, under reported and under treated. In India, first and second degree relatives are the primary source of care and support system for cancer patients, though simultaneously they experience considerable distress themselves.
