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The assessment of a caregiver's needs is a critical step for determining appropriate support services, providing high quality care, and achieving caregiver satisfaction. However, a systematic assessment of family caregiver's needs is rarely practiced. This study reports the development and validation of a comprehensive needs assessment tool for cancer caregivers (CNAT-C).Items of CNAT-C were generated through literature review and refined through expert consultation and caregiver interview, and pilot test. Final 41-item needs assessment tool for cancer was developed and validated in a large-scale multi-center survey involving 600 cancer patients-family caregiver dyads in 10 cancer centers fairly distributed throughout Korea.The content validity of CNAT-C was established throughout the development process. Principal component analysis resulted in a seven-factor structure explaining 66.4% of the total variance: (1) health and psychological problems (6 items), (2) family/social support (5 items), (3) health-care staff (8 items), (4) information (8 items), (5) religious/spiritual support (2 items), (6) hospital facilities and services (6 items), and (7) practical support (6 items). The Cronbach alpha was 0.96 for the total scale, and those for the subscales ranged from 0.79 to 0.95. Caregiver needs were not highly correlated with patient needs when compared domain-by-domain. Known-group validity was also supported by the tool's ability to detect significant differences according to various patient and caregiver characteristics.The CNAT-C appears to be a valid and reliable measure to assess comprehensive and multidimensional needs in caregivers of cancer patients. Copyright © 2010 John Wiley & Sons, Ltd.