Strengthening Informal Cancer Caregiving in Kenya's Health System: Challenges and Support Strategies at Machakos County Referral Hospital

BACKGROUND: Cancer care is complex, prolonged, and resource-intensive, often placing significant physical, emotional, and financial burdens on informal cancer caregivers. In Kenya, as cancer treatment services expand, the responsibility of caregiving increasingly shifts to family members. However, their needs remain largely unaddressed within the healthcare system. AIM: To assess the challenges faced by informal caregivers of cancer patients at Machakos County Referral Hospital (MCRH) and propose context-specific support strategies. METHODS: July 2024) among informal caregivers of patients undergoing cancer treatment for over 3 months at the MCRH. Eligible informal caregivers (n = 74) were randomly selected from a sampling frame derived from hospital cancer treatment registers, with randomization used to minimize selection bias. Data were collected through semi-structured, interviewer-administered questionnaires and analyzed using SPSS version 25. RESULTS: The response rate was 92% (n = 68/74). The mean caregiver age was 46.1 years; most were female (60.8%, n = 45/74), married (75.7%, n = 56/74), and unemployed (56.7%, n = 42/74). Financial constraints were the most reported challenge (56.7%, n = 42/74), followed by delayed diagnosis (43.2%, n = 32/74), caregiver fatigue (30.4% n = 24/74), psychological exhaustion (29.7% n = 22/74), sleep disturbances (28.3% n = 21/74), distress related to prognosis (25.6% n = 19/74), and limited knowledge on symptom management (21.6% n = 16/74). Most patients were diagnosed with breast cancer, 40.5% (n = 30/74), with most of all cancers being diagnosed at stage II, 36.4% (n = 27/74), and the majority receiving only chemotherapy, 24.3% (n = 18/74). CONCLUSION: Caregivers experience significant socioeconomic and psychological strain. There is an urgent need for formal caregiver support programs, targeted education, psychosocial services, and linkages to financial and community resources. Two feasible actions at MCRH include: integrating a brief caregiver needs screening tool and monthly caregiver education sessions into oncology clinic visits, and establishing a clear referral pathway to social work, insurance navigation, and vetted donor/community support. Strengthening caregiver support is critical to improving caregiver well-being and the overall quality of cancer care.