Objective This study provides a longitudinal assessment of distress in longer‐term oesophageal cancer carers, while examining illness perception schema as a possible determinant of change in distress over time. Methods Oesophageal cancer carers (n = 171), 48 months post‐diagnosis, were assessed at baseline and 12 months later with the Illness Perception Questionnaire‐Revised, Cancer Coping Questionnaire, Hospital Anxiety and Depression Scale and Concerns About Recurrence Scale. Results Findings report deterioration from normal to probable anxiety in 35.7% of carers and probable depression in 28.7% carers over time. Fear of recurrence remained stable. Changes in control, consequence and cause beliefs were identified as key determinants of a change in psychological morbidity. Conclusions Illness beliefs appear to be valuable targets for psychological intervention to improve wellbeing among carers of people with oesophageal cancer. Copyright © 2015 John Wiley & Sons, Ltd.