An estimated 65.7 million adults in America provide unpaid care to an individual who is disabled or ill; 7% (an estimated 4.6 million) are caring for a cancer patient. A body of evidence is accumulating that suggests the burden of caring for a family member across a variety of cancer populations can be extremely stressful. The stress of caregiving can have physical and psychological repercussions that can ultimately lead to increased morbidity and mortality. Spousal caregivers of hospitalized individuals are at increased risk of dying within a year of an acute hospitalization, and this risk appears to vary based upon diagnosis. While some evidence suggests caregivers may place the patient s needs above their own and neglect their own health in the process, the evidence regarding whether the stress of caregiving is associated with unhealthy behaviors such as excessive use of alcohol or increased use of tobacco is unclear.

While the evidence clearly shows that caregiving is stressful and may be deleterious to one s health, caregivers are not typically screened for physical and psychological health issues. Most research regarding the stress of caregiving has focused on psychological outcomes including caregiver burden and most research was conducted primarily during the survivorship phase (treatment complete). Because no large studies have examined burden and health outcomes in caregivers over time and across cancer diagnoses during and after the active treatment period, the primary purpose of this study is to assess the feasibility of collecting web-based patient-reported outcomes (PROs) from unpaid informal caregivers of cancer patients that examine the relationships between psychological, health behaviors and health outcomes over time during the active treatment period. A number of secondary objectives will also be addressed including: to explore differences among caregivers across cancer populations and caregiver categories (for example, spousal caregivers versus parent or child caregivers; single caregivers versus multiple caregivers), and to examine whether healthy behaviors ameliorate the relationship between burden and health outcomes. By using a large variety of measures and including a sample of caregivers from multiple cancer patient populations, we hope to identify those populations most at risk as well as those areas (health outcomes and behaviors) where caregivers might be most at risk for negative outcomes.

Subjects will be eligible for this protocol if they are adult informal caregivers to a patient enrolled in a cancer treatment study at the NIH Clinical Center. Once informed consent is obtained, the participant will be provided with information to access the PROMIS assessment center to complete the secure web-based survey. Subjects will complete questionnaires collecting information about caregiver burden and health outcomes at three time points 1) Enrollment, which will coincide with start of treatment for cancer, 2) 3 months after Enrollment, and 3) 6 months after Enrollment. An optionoal "Off-Study" questionnaire completion time point would be offered in the event that the caregiver or the study team requests removal from study participation before the final time point. Questionnaires will capture psychological and behavioral outcomes including: Caregiver Reaction Assessment, NIH Toolbox measures on Loneliness, Self-Efficacy, Meaning \& Purpose, and Perceived Stress, Family Caregiver Inventory Mutuality, Spiritual Perspective Scale, Health-Promoting Lifestyle Profile-II, and PROMIS measures for Global Health, Anxiety, Depression, Sleep Disturbance, Fatigue, and Applied Cognition. A clinician interview will assess basic demographic, health issues, use of alcohol and tobacco and the impact of caregiving at each time point. A brief exit interview will be conducted at the conclusion of participation; there will be no long term follow-up after the study participation period. Exploratory, hypothesis-generating analyses will be performed using parametric and non-parametric statistical techniques.