Although being in a close relationship during the cancer journey can dramatically improve outcomes, the stress of treatment and the diagnosis itself can take a toll on couples, sometimes in a negative way.
A diagnosis of cancer can affect every aspect of a patient’s life — including their relationship with their spouse or partner.
In most cases, couples draw closer during the cancer journey and come through the experience with their relationship intact. This is important because studies show that being in a close relationship can dramatically improve patient outcomes. A study published in the Journal of Clinical Oncology, for example, noted that married patients tended to have cancer diagnosed at an earlier stage, when it can be more successfully treated; receive more appropriate treatment; and live longer than patients who are not married.
However, not all relationships are strong enough to survive a cancer diagnosis, and the details of the cancer course can affect this as well. According to a study published in the journal Cancer, a woman with cancer or other serious illness is six times more likely to be separated or divorced soon after receiving her diagnosis than a male patient. “Female gender was found to be the strongest predictor in separation or divorce in each cohort,” the study authors noted. A 2015 study published in the Journal of Health and Social Behavior offered a similar conclusion regarding the impact on female patients.
Penny* of Pompano Beach, Florida, saw her marriage flounder and ultimately collapse after she received a diagnosis of ductal carcinoma in situ in her left breast. Penny underwent a lumpectomy then received chemotherapy and radiation. Her husband, however, became resentful and emotionally absent, leaving Penny to deal with the trauma of treatment and challenges of recovery on her own. “Our marriage was failing, so I knew no support would be forthcoming,” she says.
IMPACT OF DIAGNOSIS
Cancer can damage a marriage or relationship in a number of ways, counselors say.
“A cancer diagnosis often has a ripple effect on how patients see themselves, on their life and on their relationships,” says Cheyenne Corbett, director of cancer support and survivorship at Duke Cancer Institute in Durham, North Carolina. “When you think of it in the context of marriage, it brings additional pressure, distress and changes to how a couple typically operate in terms of their relationship.”
In many cases, communication — which may have been difficult before the diagnosis — suffers further, Corbett notes. A cancer diagnosis also can have a practical impact, negatively affecting job security, finances, basic family dynamics and more. “It can be very difficult to navigate,” Corbett says.
Receiving a diagnosis of cancer also can have a devastating emotional impact on the caregiving spouse or partner. Mark Cantrell, a writer based in Wake Forest, North Carolina, recalls coming home, dropping to his knees and weeping “until there were no tears left,” upon learning that his wife, Maryanne, had been diagnosed with Hodgkin lymphoma in her chest.
Mark unhesitatingly assumed the role of caregiver, doing all he could to help Maryanne. But not all partners are up for the job, which can be physically and mentally grueling. Unable or unwilling to face the challenges, they simply walk away from the relationship.
“In many cases, underlying issues that were preexisting for the couple really come to the surface as a result of the stress of a cancer diagnosis,” notes Jessica Worthington, a licensed marriage and family therapist in Austin, Texas. “It can be really hard for many people.”
STRESS AND TREATMENT
A variety of stressors may erupt as a couple works through cancer and recovery, notes Worthington. One of the biggest stressors tends to be money — especially if finances were an issue prior to the cancer diagnosis. “It may have been something they could manage before, but now it becomes a much bigger issue and much harder to deal with,” Worthington says.
Another significant stressor may be resentment on the part of the caregiver. Although they may not directly express their feelings to the patient, those emotions can fester and manifest in more subtle ways. Penny’s husband, for example, expressed his resentment by refusing to take her to chemo- therapy and radiation appointments, forcing her to ask her parents instead.
“I was receiving an anti-nausea drug called Zofran (ondansetron) as part of my infusion, and it made me so dizzy, I couldn’t drive,” Penny recalls. “(My husband) said he didn’t want to take time off from work. He was also creeped out about medical things, so he didn’t want to be in a medical office. His family was very anti-doctor.”
At one point, he told Penny that he didn’t want to be with her anymore but that he would stay until her treatment was done. “I don’t think I said anything when he said that. I took that as ‘I can count on you for nothing,’” Penny says.
But Penny admits to her role in his resentment and the final breakup of their marriage, noting that she had an affair because she was miserable in the relationship. “You can point fingers at both of us,” Penny says. “I don’t want this to sound like he was the only bad guy, because I earned some of this.”
Intimacy is commonly affected by cancer treatment and recovery. The inability to engage in sex due to vaginal dryness, lack of libido or other issues can put incredible pressure on a relationship. But there are alternatives.
“It takes a conscious effort to figure out what’s right for each couple because intimacy doesn’t have to be intercourse,” says Mary Dev, a licensed clinical social worker and counselor at The University of Texas MD Anderson Cancer Center in Houston. “It can be talking about something that is near and dear to you and having that deep connection. It’s building trust to have a safe space to have that intimacy.”
“I would challenge couples to expand their idea of what sex and intimacy can be,” advises Worthington. “Anything that is pleasurable and helps you feel connected counts as sex, even if it’s just cuddling or a full body massage. Get creative.”
“We didn’t have relations for a very long time, and that hurt our emotional bond,” notes Maryanne Cantrell. “But being in love with each other is exactly what saw us through this. The act of touching, cuddling, giving voice to feelings of gratitude and appreciation for the other; reassurance in stressful moments — this was the glue for us.”
In addition, the effects of cancer treatment may influence a patient’s body image, especially if surgery has left scars and other physical changes. Penny developed body dysmorphia because of her lumpectomy and the negative attitude of her husband, and she was fearful she would be rejected by future partners. However, that proved not to be the case.
“The first man I was with didn’t seem to care about it at all, so that was nice,” Penny says. “The second man I was with was a nudist, and he asked me to accompany him to a nude beach in north Miami. I thought, ‘I know this is baptism by fire, but there is nothing that will help you get over this better than a nude beach, so you need to go.’ I went, and it was magnificent. No one cared. No one looked at me. It was very healthy for me to do that.”
HOW STRESS AFFECTS TREATMENT OUTCOMES
Understandably, stress on the patient can become overwhelming when their spouse or partner leaves the relationship, and that can have a dramatic impact on treatment outcomes. “When divorce or separation occurred, quality of care and quality of life were adversely affected,” wrote researchers in the Cancer report on partner abandonment.
Financial difficulties, for example, may become even more dire, especially if the separation or divorce affects the patient’s access to health insurance. “If the caregiver has the insurance, that may have to be negotiated when a couple goes to divorce,” says Dev. “If it’s not negotiated, it can leave the patient struggling to figure out how they will pay for their care.”
Separation or divorce also can adversely affect the patient’s access to care by leaving them without reliable transportation or child care and forcing them to rely on other family members or friends for comfort and support.
Cancer negatively affects many relationships, but the majority of couples find their way through it. In some cases, says Corbett, the experience even strengthens their bond.
“There are a lot of negative impacts, but you also hear about couples who become closer to one another during that time,” Corbett notes. “Often with a cancer diagnosis and treatment, people talk about the more existential side of it. While they would not have chosen to go through this cancer experience, there are things they gain from it and learn about themselves and their relationships.”
This was true for the Cantrells, who had a complicated on/off relationship for many years before marrying. They had been wed just a year and a half when Maryanne learned that she had cancer.
“Maryanne handled the diagnosis much better than I did,” Mark says. “She’s always been a pragmatist and started gathering information on chemotherapy and radiation treatments as she was recovering from surgery. As a writer, I used to do research on the internet, so I was able to help with that process. I’d never been much of a cook, but now that I was a caregiver, I learned to make a few dishes, started doing laundry for both of us and did all the housecleaning. Basically, I became a housewife for a few months and developed a new respect for homemakers.”
Maryanne was grateful. “Mark supported me in so many ways. He bathed me, fed me, helped me dress. And he also weathered my mood swings, crying jags and inability to help with strenuous chores. He drove me to every appointment.”
KEEPING RELATIONSHIPS HEALTHY
There are ways for couples in crisis to keep their relationships strong during cancer treatment and recovery. Foremost, counselors say, is to maintain open lines of communication. “I always tell people with cancer that it’s not just one conversation, it’s several,” Dev advises. “Keep trying to talk because the minute you stop, that’s when walls get built up, and it’s hard to tear them down.”
If a person is having trouble communicating, reach out to others on the care team who may be able to help, including the oncologist and social worker. And don’t hesitate to see a therapist. “They are a neutral party who will be unbiased,” Dev explains. “Counseling provides a safe space to talk.”
Partner caregivers are especially encouraged to seek outside support to help them deal with the stress of the job, as well as their own emotional turmoil. This may be in the form of a mental health professional such as a therapist or a local support group. “A support group allows you to talk with others who have a loved one facing cancer about how they are navigating all of the changes in their life and their relationship,” says Corbett. “That can be a great resource.”
Worthington agrees, noting, “Caregivers really need a good support system. They are supporting the person with cancer, so they need tons of support themselves. They need so much because they give so much.”
According to the American Society of Clinical Oncology, counseling can help patients and caregivers:
• Feel less overwhelmed and more in control.
• Manage anxiety and depression better.
• Communicate more clearly with each other and their care team.
• Talk with family and friends and adjust to changes.
• Manage fears and worries about the future.
ADVICE FROM LIFE EXPERIENCE
Maryanne Cantrell and Penny are now many years beyond their cancer experiences and doing well. It was a grueling, life-altering journey for both. Although their marriage ended, Penny and her ex-husband have worked through the hurt and have a healthy friendship today.
Reflecting on her journey, Maryanne shared the most important lesson she learned along the way.
“I highly recommend both spouses build a mental and emotional toolbox, something to keep you emotionally resilient,” she advises. “For example, as a patient, I will not always be the same person emotionally and physically. I have to give myself permission to not be OK and also to realize it is temporary. As a caregiver, I must acknowledge that my needs will be put aside to help my spouse win the cancer battle. It is OK to express frustration, but also realize it is temporary.
“As a couple, we will arm ourselves with knowledge. We will ask questions of each other and our medical support staff. And as a couple, we will help each other find ways to affirm our bond throughout the ordeal. Be gentle with yourself and your spouse because the outcome is important to both.”
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