Maria hunched over her coffee and poked at her breakfast. Her husband, Gabriel, had put crusty French bread with cheese and ham in front of her a few minutes earlier, and she had taken two bites of it so far. She picked it up, put it down, glanced at him, picked it up again and took another bite. The negative thoughts scrolled through her mind. “I have incurable cancer. I am such a burden to my husband.”
Maria was right about the cancer, her oncologist had given her the bad news 17 months earlier.
She was completely wrong on her second thought, about being a burden to her husband. In fact, researchers had interviewed Gabriel 4 times in the preceding year, and asked him point blank if “Is caring for the patient, your loved one, a burden for you?” [i] Each time, his answer was a crisp, decisive ‘no’. A couple of times, he expanded on the point, saying that she had been such a good mother to the kids, and he wanted to help her. Yes, it was more work to drive Maria to appointments and do the housework when the chemo had sapped her strength. No, he could not take the trips he wanted to. But caring for her was not fundamentally a burden. It was a reflection of the care she had given him and their children.
Maria was not the only cancer patient who was wrong. 190 of them and their family caregiver had been interviewed 4 times for this study in Brazil. 33% of the patients reported feeling like a burden to their family during the study. When caregivers were asked if caring for their sick family member was a burden, they said ‘no’. They responded it was not a burden 99.4% of the time. A massive difference in perspective.
On the opposite side of the planet, similar questions were asked. In China, 200 people responded to scales on how much of a burden it was to take care of their spouse with cancer. Scores from 0 to 29 indicated it was no burden. The average score was 21.[ii] Which means that overwhelmingly, spouses said it was no burden to care for their ill partner. Unfortunately, the vast majority of cancer patients thought they were a burden (at least sometimes) to their healthy partner.[iii] Whether it is Brazil or China, cancer patients can really overestimate how much of a burden they are to those around them.
When the need for care intensifies, the picture naturally changes. Caregivers had to spend at least 4 hours a day caring for a family member with cancer, which is a lot. The patients had a tube to drain bile from their body that needed frequent attention from the caregiver. Both caregivers and patients agreed that it was a notable burden.[iv] What stands out is how each group felt. Caregivers had one fifth the rate of anxiety that patients had. They also had substantially lower rates of depression than patients did. Yes, caregiving was a real and weighty burden. But no, they were not emotionally crushed by it.
There are serious consequences when cancer patients think they are a burden to their caregivers. Holding this belief is consistently associated with higher levels of anxiety and depression.[v] [vi] [vii] Thinking one is a burden to others can increase the desire for palliative care. [viii] Instead of continuing with active treatment, and possibly going into remission, the belief one is a burden can cause patients to disengage, and opt for an earlier death with palliative care. What is also really worrisome is that it is the best predictor of suicidal thinking in cancer patients.[ix] [x]
When I have a client who is suicidal, it is a marker of how much emotional pain they are in. They genuinely want the pain to stop, and suicide seems like an option. Yet their thinking can become very distorted. They often believe that they are a burden to others, and ending their existence will lift that burden off others. They are completely wrong. In 28 years of full-time private practice, I have never met anyone who said “My father killed himself, and it was a good thing he did.” Everyone wishes that the person who suicided had reached out for help, made crucial changes, and persevered in some way despite their pain. Everyone wishes that the person who suicided could see that their sense of being a burden was their pain twisting their perspective, and that the survivors would infinitely prefer they keep living.
There is another powerful reason for cancer patients to vigorously reject the idea that they are a burden. It is the cancer, not them, who is causing the problems. It is the cells who have run beserk for reasons we dimly understand, buried within the tissue of their bone marrow or their breast, that are disrupting people’s lives. These rogue cells are dividing madly, evading the immune system, hijacking blood vessels, and gobbling up the person’s energy. My family members who have cancer did absolutely nothing to bring this dread disease on themselves. They had no choice whatsoever, their cells went feral on their own.
There is a profound difference between thinking “I am a burden”, and “My cancer is causing huge problems for me and those around me.” The first invites shame and false guilt, that the person is fundamentally bad or flawed. The second puts the problem where it deserves to be, not on the shoulders of the cancer patient, but on the cells that have gone rogue.
So, if you are afflicted with cancer, shift your thinking. It is your cancer that is demanding that you be driven to your doctor’s office by your spouse. It is your cancer that exhausts you, so that you cannot cook a meal, but your children have to do this task. Your cancer is the burden. It just happened to emerge in you, rather than someone else. You are suffering enough from this disease, you do not need a false sense of being a burden to depress your mood even more, or cause you to contemplate ending your life.
[i] Valentino TCO, Paiva CE, Oliveira MA, Lemos Dekker N, Bruera E, Oliveira LC, da Costa Rosa KS, Paiva BSR. (2025). Exploring the anxiety, depression and perceived burden in advanced cancer: A longitudinal view on patients and caregivers. Palliat Support Care. Dec 29;24:e17. doi: 10.1017/S1478951525101156. PMID: 41459620
[ii] Chen X, Wang Z, Zhou J, Lin C, Luo H, Zhao J, Loke AY, Li Q. (2023). The impact of self-perceived burden, caregiver burden, and dyadic coping on negative emotions in colorectal cancer patient-spousal caregiver dyads: a dyadic analysis. Front Psychol. Sep 25;14:1238924. doi: 10.3389/fpsyg.2023.1238924. PMID: 37818420
[iii] The Self-Perceived Burden Scale scores ranged from 30 to 155. A higher score represents more severe SPB. The average SPBS in patients was 66 with a SD of 21. I could not find the cutoffs, but the average patient felt like a burden at least some of the time (Response 2 on a 5 point Likert scale).
[iv] Zhu W, Li J, Fan C. BMC Palliat Care. (2025). Caregiver burden of cancer patients undergoing palliative PTBD: an investigation of patient and caregiver factors. BMC Palliat Care. May 7;24(1):131. doi: 10.1186/s12904-025-01760-z. PMID: 40335943
[v] Chen X, Wang Z, Zhou J, Loke AY, Li Q. (2024). A scoping literature review of factors influencing cancer patients’ self-perceived burden. Eur J Oncol Nurs. Feb;68:102462. doi: 10.1016/j.ejon.2023.102462. PMID: 37995428
[vi] Schellekens, M. P. J., Schoormans, D., Versluis, M., Hoedjes, M., Raijmakers, N. J. H., van derLee, M. L., & Mols, F. (2026). Dyadic risk and protective factors of caregiver burden among partners of patients with advanced cancer: A network approach. Psycho-Oncology, 35(2),e70403. https://pmc.ncbi.nlm.nih.gov/articles/PMC12876055/
[vii] Valentino TCO, Paiva CE, et al. (2025).
[viii] Lee JE, Shin DW, Cho J, Yang HK, Kim SY, Yoo HS, Jho HJ, Shin JY, Cho B, Park K, Park JH. (2015). Caregiver burden, patients’ self-perceived burden, and preference for palliative care among cancer patients and caregivers. Psychooncology. Nov;24(11):1545-51. doi: 10.1002/pon.3827. PMID: 25920720. More research needs to be done in this area, only one other study has been done, it found no association. Tang ST, Hsieh CH, Chiang MC, Chen JS, Chang WC, Chou WC, Hou MM. (2017). Impact of high self-perceived burden to others with preferences for end-of-life care and its determinants for terminally ill cancer patients: A prospective cohort study. Psychooncology. Jan;26(1):102-108. doi:10.1002/pon.4107. PMID: 26950036
[ix] Hirschmiller J, Schwinn T, de Beurs D, Wiltink J, Zwerenz R, Brähler E, Beutel ME, Ernst M. (2026). Perceived burdensomeness and suicidal ideation in cancer patients: A theoretical network perspective. J Affect Disord. Apr 1;398:120908. doi: 10.1016/j.jad.2025.120908. PMID: 41421610
[x] Schomberg J, Teismann T, Gerlach AL, Cwik JC. (2025). Testing the predictions of the interpersonal-psychological theory of suicide in a sample of female cancer patients. Support Care Cancer. Dec 2;33(12):1157. doi: 10.1007/s00520-025-10224-2. PMID: 41329441
Eric Kuelker
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