Letter to the editor concerning the article titled “Depression and anxiety in family caregivers of cancer patients: a cross-sectional study in Nepal”

Dear Editor, We read with great interest the article by Egesh Aryal et al[1] titled “Depression and anxiety in family caregivers of cancer patients: A cross-sectional study in Nepal” published in Annals of Medicine and Surgery (Vol. 87, August 2025). The mental health of caregivers is often overlooked in South Asian families, and we commend the authors for addressing this important issue. However, we wish to highlight several methodological considerations that could enhance the interpretability and generalizability of such studies. The sample size of 101 participants, though feasible, is relatively small compared with similar studies[2,3], potentially reducing statistical power. Additionally, the single-center design and use of non-probability convenience sampling may limit generalizability and introduce selection bias. A multicenter approach, as demonstrated by Sharma et al[3], using purposive sampling could yield more representative findings. Although validated tools such as PHQ-9 and GAD-7 were appropriately used, the study might have benefited from assessing caregiver burden using the Zarit Burden Interview (ZBI). Previous research[4] integrating ZBI with PHQ-9 and GAD-7 has demonstrated stronger associations between caregiver burden, anxiety, and depression. This study is a valuable contribution to understanding caregiver mental health in Nepal. Incorporating larger, multicenter samples and multidimensional assessments of caregiver burden in future research could provide more comprehensive insights.