Cancer's Impact on the Couple: An Overview

The stories in the Introduction show the dramatic effect that cancer can have on couples. In this chapter, we'll look at more specific details about how cancer affects both people within a relationship, as well as how different coping styles and cultural backgrounds can affect relationships during stressful times. We explore the psychological impact of cancer by looking at what we know through our experience working with couples, and through research findings. Many of these findings have come from the growing field of "psycho-oncology," or the psychology of cancer.

How Both People Are Affected Throughout the Process

As you undoubtedly realize by now, cancer happens to the couple, not just to the individual. While you and your partner will each react to and cope with the experience of cancer in unique ways, both of you will be affected by it.

Diagnosis

Patients and their partners often react to the diagnosis of cancer with feelings of shock and disappointment, even betrayal. Each member of the couple adjusts priorities to make room for the new, unwanted reality of cancer and its treatment.

Naturally, your reaction to the diagnosis will depend upon the specific medical information you are given. You may feel like you are on an emotional roller coaster as information is revealed concerning the type of cancer, its stage of progression, and the likelihood of a good response to treatment. No matter how hopeful the outlook, it is natural for you and your partner to have fears about what cancer will bring. Despite medical advances in the treatment of cancer, people diagnosed with cancer are forced to consider the possibility of long-term illness, death, and other effects of cancer. One psychiatrist who works with cancer patients, Lynna Lesko, M.D., Ph.D., has described the most common fears as "the six Ds:"

• Death

• Dependence

• Disfigurement

• Disruption

• Disability

• Discomfort

At this point in the process, you probably have strong feelings about the impact cancer may have on both yourself and your partner. Patients typically feel badly for themselves as well as for their partners who are forced to go through this. Healthy partners or spouses feel sad that their loved ones will be going through such a tough experience, and also may feel bereft at the thought of possibly losing their partner and certainly enduring a major disruption in their once peaceful shared life as a couple.

Following on the heels of those feelings are waves of guilt about having "selfish" thoughts that are often experienced by both patients and their partners. The healthy partner — or even the patient — may feel it is wrong to have self-focused concerns. Both partners may blame themselves for the cancer, thinking, "I should have taken better care of myself" or — on the other side of the coin — "I should have taken better care of my partner." It's hard to say which is more difficult — blaming yourself or feeling helpless. Both can be tough and painful.

In addition to the diagnosis and the anxiety it brings, there are a lot of other unwanted hurdles. Both partners may worry about how to tell other family members or children. Immediately following the diagnosis, couples must think about their financial and work situations and how to manage the crisis. Either partner may simply feel angry about having to go through cancer (we'll talk more about dealing with anger in Chapter 5).

After the diagnosis, there are a lot of decisions to be made. Who will offer a second opinion or treat the person diagnosed with cancer? What type of treatment should he or she receive? How will we handle the treatment schedule? Do we need genetic counseling if genetic inheritance for the disease is suspected? Are there any complementary treatments to consider? It can seem nearly impossible to make all of these decisions calmly and cooperatively as a couple just when you are feeling on edge from the stress of the diagnosis.

Treatment

During the treatment phase, the particular challenges you will face depend on the specific treatment process, its length, and anticipated side effects. Few side effects impact couples more than fatigue, which is one of the most common side effects of cancer treatment. Every aspect of a couple's life is affected by how much energy the person with cancer has to cope with household tasks. If the person with cancer has minimal energy, the healthy partner will need to pick up the slack. When the healthy partner is doing more to help out at home, there can be a "ripple effect" throughout the family and even with coworkers at the office, as older children and coworkers may scramble to relieve some of the burden for the healthy partner. In the first couple described in the Introduction, Alicia picked up all the slack for Keith, who was both depressed and physically less able to do daily household maintenance. As a result, Alicia felt frustrated, angry, and guilty.

Just as in the diagnosis phase, the treatment phase may bring many ups and downs, and even small crises. These include things like an unexpected hospitalization, an unusual and troublesome side effect of treatment, or an unexpected finding on a scan. Each hurdle requires cooperative problem solving and mutual support between you and your partner.

These stresses often challenge even a strong relationship. Fred and Bonnie (the second couple described in the Introduction) had several of these "bumps in the road" to contend with throughout Bonnie's treatment. Unlike younger couples, Fred and Bonnie had more than thirty years of experience dealing with life's "curve balls" together before Bonnie's diagnosis with cancer. So when Fred got terribly upset and nervous in the face of an unexpected hospitalization, Bonnie knew from years of experience how to deal with his distress. She allowed him to express his feelings, and then (when the timing was right) would gently ask him to try to relax. This worked for them as it had so many times before.

What works for you and your partner will depend on your personalities and how each of you tends to cope with stress and strong feelings. It is probably helpful to assume that you and your partner differ in your preferred ways of coping. One of you may express feelings loudly, while the other may be silent or withdrawn. We will talk more about understanding differences in coping later in this chapter. Specifically, we will talk about how your coping styles may...