By Shauna Mazenes
Darci Palter's life changed overnight when her husband, Mike, was diagnosed with Stage 4 cancer.
Almost immediately, Darci took on a caregiving role. She administered his medications, documented his symptoms, took notes at every appointment — all while taking care of their seven-year-old daughter.
"It was all consuming," says Darci. "The only thing on your mind is how to keep your loved one pain free, comfortable and living as long as possible."
At Princess Margaret Cancer Centre's Psychosocial Oncology Clinic, Darci found the caregiving support she needed to guide her family through the experience. The clinic helped her develop coping strategies, manage her fears and embrace the time she had left with her family.
"With any advanced disease diagnosis, the family is the main unit of care," says Dr. Sarah Hales, psychiatrist and researcher at the Psychosocial Oncology Clinic. "The health care system can't function without them."
Yet, Dr. Hales says health care in North America is designed to support the patient individually. The role of the family is often overlooked.
Princess Margaret Cancer Centre recognizes family caregivers by offering support tailored to their unique emotional, practical and mental health needs. Through referral to Psychosocial Oncology, caregivers can either attend sessions together with their loved ones or receive individual support through the Caregiver Clinic.
Supporting caregivers and family members
The Caregiver Clinic, established in 2017, provides one-on-one therapy for caregivers and connects them with resources to help manage their daily caregiving demands. It's the only clinic in Canada dedicated to exclusively supporting cancer caregivers.
The clinic also leads research to better understand the important role that caregivers play in a patient's health and how to best support them.
"Our research found that caregivers were struggling with their own distress and needs just as much — if not more — than the patients themselves," says Dr. Hales, who co-directs the clinic with UHN psychologist Dr. Rinat Nissim.
They also lead educational and training programs for oncology professionals.
Dr. Nissim recently presented some of the Caregiver Clinic's strategies and solutions at the 2025 Canadian Caregiving Summit, held in Ottawa from Nov. 3 to 4, to strengthen support for caregivers across the country. The clinic works with cancer centres around the world to adopt a similar model, including the Peter Mac Cancer Centre in Australia.
As people with advanced disease live longer, there's an even larger burden on caregivers, who don't typically ask for help.
"Many caregivers feel guilty taking time for themselves," says Dr. Nissim. "We want them to know they have permission to care for themselves, too. It's not selfish, it's essential.
"It's what allows them to keep showing up with strength and love for the person they're caring for."
Providing care throughout cancer diagnosis
Darci knows that burden well.
Her husband was diagnosed at 50. With no prior symptoms other than hiccups, the news came as a total shock.
Mike struggled to come to terms with his illness, and Darci worried about how her daughter would handle the situation.
Darci found herself overwhelmed, trying to support both of them while still dealing with her own grief and uncertainty.
"I was terrified," says Darci. "Terrified my husband would suffer. Terrified about what my daughter would see and if it would traumatize her."
Mike's care team referred the couple to the Psychosocial Oncology Clinic.
During the first session, when Mike was too nervous to join, Darci went in his place and shared Dr. Hales' advice when he was ready. He eventually attended virtual appointments with Darci from the comfort of their own home.
Dr. Hales helped shift Mike's perspective from 'dying with cancer' to 'living with cancer,' encouraging him to be present with his family.
"Every time we had an appointment with her, Mike walked away feeling stronger in his resolve to keep fighting," Darci says. "He always felt more focused on the importance of staying well, one day at a time."
Dr. Hales also guided them through one of the most difficult conversations they would ever have: telling their daughter her father has cancer.
Together, through discussions and the resources Dr. Hales provided, they crafted a script to deliver the news in a way a child could understand.
"As a teacher, I thought it would be easier for me," Darci recalls. "But it wasn't. It was a whole different ball game. If it weren't for Dr. Hales, I would have been lost."
Beyond communication skills, Dr. Hales encouraged Darci to include her daughter in Mike's care as a way of helping her process his illness. Some days, that meant fetching a pillow for him; others, it was simply sitting by his side.
Perhaps more than anything, Dr. Hales prepared Darci for some of her daughter's toughest questions: What if he dies? What will we do?
Seventeen months later, when Mike would soon be transitioning from their home to hospice, she relied on Dr. Hales' advice to have that conversation.
"She gave me the tools to support my daughter through her emotions and pain," she says.
Today, Darci describes her now 13-year-old daughter as "blossoming," "thriving," and excelling at everything she does, even winning awards in school.
As for her husband, Darci says she was able to help him cope, thanks to the support provided by Dr. Hales.
"What Dr. Hales did for me was unbelievable," says Darci. "I will never forget the impact she had on my family for as long as I live."
