Cancer is a family disease affecting the patient and family members. To date, few studies have explored the psychological distress of family caregivers and its relation with patient quality of life (QOL), particularly among culturally diverse cancer populations. This study seeks to understand the associations between patient distress, family caregiver distress and patient QOL in a Chinese-speaking population in British Columbia, Canada. Methods: A cross-sectional survey of Chinese-speaking

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... y population) and Anglophone (comparison group) patients (N = 55) and their family caregivers (N = 40) was used to examine patient QOL and correlates. Multiple imputation of missing data for incomplete dyads resulted in data for 29 Chinese-speaking and 28 Anglophone dyads. Multiple linear regression and mediation analyses examined predictors of QOL, and its domains, and mediation effects of patient distress and family caregiver distress. Semi-structured interviews with a subset of the Chinese-speaking survey participants comprising ten patients and six family caregivers, including five patient-family caregiver dyads, were also conducted. Analysis of culturally-embedded experiences of patients and family caregivers regarding their distress and QOL was conducted, to provide further context and explanation for the findings from the quantitative analysis. Results: Patient distress emerged as the key factor in explaining patient QOL. The effects of patient age on patient emotional well-being were mediated by patient distress, such that lower distress in older patients explained better emotional functioning. A key theme that surfaced from the qualitative data analysis was the emotional regulation occurring in the family when coping with cancer. The negative impact of family caregiver distress on patient emotional well-being was acknowledged by both the patients and the family caregivers. Younger and older patient interviewees alike indicated anxiety and worries about the impact of their cancer diagnosis on their [...]