Psychological distress, caregiver support gaps and associated factors among family caregivers of adults with advanced cancer: A cross-sectional study in a conflict-affected, resource-constrained setting.

BACKGROUND: Family caregivers of people with advanced cancer in conflict-affected settings may experience substantial psychological distress and unmet supportive care needs, yet caregiver-specific evidence remains limited. AIM: To quantify psychological distress, unmet supportive care needs and their associations among family caregivers of adults with advanced cancer in the Gaza Strip. DESIGN: A hospital-based cross-sectional survey (May-August 2022) using the Depression, Anxiety and Stress Scale-21 and the Comprehensive Needs Assessment Tool for Cancer Caregivers. Descriptive statistics, Pearson correlations and a multivariable generalised linear regression model were used. SETTING/PARTICIPANTS: Family caregivers of adults with advanced cancer at the Turkish-Palestinian Friendship Hospital. Of 400 caregivers, 97.0% completed the survey. RESULTS: Severe or extremely severe psychological symptoms were common (depression 33.2%, anxiety 44.1%, stress 29.6%). Information support (80.9%) and practical support (77.7%) were the most prevalent unmet need domains. Total psychological distress was moderately correlated with total unmet supportive care needs (r = 0.543, p < 0.001). In the adjusted model, total psychological distress was higher with greater unmet supportive care needs (β = 0.60, 95% CI 0.51-0.68, p < 0.001), and female caregivers reported higher distress than male caregivers (β = 12.20, 95% CI 6.52-17.88, p < 0.001). CONCLUSION: Caregivers experience substantial psychological distress and unmet supportive care needs. Routine caregiver assessment, structured information provision, navigation, and psychosocial support should be integrated into cancer and palliative care services in resource-constrained, conflict-affected settings.