Addressing Family Caregiver Burden in Breast Cancer Care: Alyson Moadel-Robblee, PhD

Family caregivers are sometimes called the hidden patients of breast cancer as they are present throughout the entire experience, absorbing enormous emotional and logistical weight, but they are not a primary focus of clinical attention. In this interview, Alyson Moadel-Robblee, PhD, makes the case that this needs to change and shares how the Bronx Oncology Living Daily (BOLD) Program, where she is the founding director at Montefiore Einstein Comprehensive Cancer Center, has built a model to address it.

Moadel-Robblee identifies several inflection points where caregiver burden tends to peak. These include the visible physical changes that come with treatment, major transitions in the care plan, and even the shift into survivorship, which is a period that can feel disorienting for families who have been in crisis mode for months. Warning signs she watches for include irritability, withdrawal, and disengagement. Her recommendation to clinicians is direct, as she recommends pulling the caregiver aside, away from the patient, and asking how they are actually doing.

"A caregiver is not going to say, 'this is too much for me' in front of the patient," she explains. "They feel like they're the ones doing the protecting."

Male partners, she notes, are a particularly underserved group. They are more likely to internalize their distress and less likely to seek support, often expressing their strain as anger or emotional shutdown rather than openly asking for help.

The BOLD Program's response to all of this is proactive. Rather than waiting for caregivers to reach out, staff ask patients directly whether someone in their life could benefit from support and then initiate contact themselves. While response rates are sometimes low, those who do connect consistently report feeling seen and acknowledged in a role that is otherwise invisible to the healthcare system.

For hospitals looking to build something similar, Moadel-Robblee explains that the BOLD Program runs largely on volunteerism, which includes over 40 cancer survivor volunteers in the Bronx largely because survivors want to give back.

"It gives them agency and purpose," she says. "It's a win for everyone." The throughline across all of it is community: structured, free, culturally responsive, and built on the understanding that the people caring for patients need care too.