“A caregiver has got to be taken care of also”: A dyadic, qualitative study assessing barriers, facilitators, and unmet needs related to caregiving for patients with metastatic breast cancer.

300 Background: While advances in science have led to improved outcomes and prolonged survival for patients with metastatic breast cancer (MBC), few studies have explored the impact of MBC diagnosis and treatment on patients’ informal caregivers, who experience an extended duration of caregiving due to these advances. This study explored views and perceptions of patients with MBC and their caregivers regarding barriers, facilitators, and unmet needs related to caregiving. Methods: From July 2024-March 2025, 11 patient-caregiver dyads (7 opposite-sex spouse pairs, 1 same-sex spouse pair, 1 opposite-sex engaged pair, 2 daughter-mother pairs) enrolled in this study. Informal caregiver was defined as an individual who is unpaid and provides at least 50% of a patient’s care needs. Semi-structured interviews were conducted separately with each dyad member. Participants were asked about their perspectives regarding experiences with a MBC diagnosis/treatment and barriers, facilitators, and unmet needs associated with caregiving. Following interview transcription, deductive and inductive codes were generated and defined via an iterative process. These codes were then applied using the qualitative data management program MAXQDA 24. Thematic analysis was used to elaborate common themes in the data. Results: Common themes highlighted by both patients and caregivers regarding barriers and challenges related to caregiving included caregivers taking on the majority of tasks (such as household, transportation, and childcare needs), the emotional burden of witnessing the patient deal with health impacts of MBC, and the effects of MBC on their shared quality of life. Conversely, facilitators of caregiving included existing support systems, financial stability, flexible work schedules or being retired, patients’ positive attitudes, prior caregiving experience or opportunities to learn from those with it, periods of normalcy or routine, and viewing caregiving as part of the familial or spousal role. Finally, caregiver themes identified by dyad members regarding unmet needs included more formal (e.g., support group, mental health support) and informal (e.g., social network) support for caregivers, more available and accessible information on caregiving, connection to ancillary services (e.g., helping patient to apply for disability, financial planning), and opportunities for respite from caregiving responsibilities. Conclusions: Findings from this qualitative, dyadic study are foundational for future work needed to improve the quality of life of informal caregivers for patients with MBC. Understanding barriers, facilitators, and unmet needs related to caregiving for patients with MBC will lead to the development of interventions that can reduce caregiver burden and ultimately improve caregiver well-being.