Caregivers of cancer patients here feel more burdened and stressed compared with their counterparts in the West, a study has found.
And bucking the trend highlighted by previous such studies, male caregivers were found to have poorer qualities of life than their female counterparts.
The two-year study of 258 caregivers in Singapore involved the answering of 35 questions on their physical and emotional state, as well as on things such as the level of social support they received.
When the results were compared with those of similar studies overseas, Singaporean caregivers were found to fare worse than those in Britain, Canada and the United States, but better than those from Iran and Korea.
The study, where four in 10 participants were men, also revealed that male caregivers were more affected by disruptions to their daily routine and lack of sleep.
They were also more worried about shouldering the financial strain of caring for someone with cancer, and were more overwhelmed by the responsibility of caring for a loved one at home.
Associate Professor Rathi Mahendran of the Yong Loo Lin School of Medicine at the National University of Singapore (NUS), who co-led the study, said cancer patients in the West might rely less on their family, hence their family members are not taxed as much.
"Whereas here, due to principles like filial piety being very strong, the family will come together when an individual has a problem and, as a result, take on a lot of the caregiving burden," she said.
Dr Lim Siew Eng from the National University Cancer Institute Singapore, who also co-led the study, said stronger support services overseas, such as having extended caregiver leave, might also be why caregivers in Western countries fare better.
In Canada, a family caregiver can take up to eight weeks of unpaid but job-protected leave per calendar year for each specified family member. Here, there is no national caregiving leave, although civil servants get two days of parent-care leave each year, and companies like semiconductor firm Infineon Technologies Asia Pacific allow two days of family-care and eldercare leave.
As to why male caregivers fared worse, Dr Lim said male spouses, for instance, face additional strain as they have to take on household duties - such as cleaning, cooking and other duties usually handled by their wives - on top of the responsibility of earning money for the family.
When Mr William Kho, 56, was caring for his cancer-stricken wife Phelane, he often had to use his lunchtime to take her for her appointments, and also took on household chores. A month before she died, he quit his job at a bank to care for her round the clock.
He had eight siblings for support, but noted that younger caregivers are likely to have only one to turn to.
"There is a need for better financial support and better information on the disease and where to seek help," said Mr Kho.
Medical social worker Terina Tan from the National University Hospital (NUH) said work leave for caregivers and caregiving subsidies should be considered.
Building on their study, the researchers are running support groups for caregivers, to provide them with tips on caring for their emotional and mental health.
The NUS medical school, NUH and the National University Health System are also organising a conference in November that will discuss support for cancer patients, their caregivers and the healthcare professionals involved in their care.
The researchers hope the study, which was published online in the Singapore Medical Journal in April, will lead to better support for caregivers by providing evidence of the challenges they face.
"We need to identify and assess not just patients' needs but caregivers' needs (as well)," said Prof Mahendran.
Often doctors and other healthcare professionals are very focused on helping cancer patients through their treatment journey, and at times end up neglecting caregivers.
"If we don't take care of the caregiver, there is no one really to look after the patient," said Dr Lim.