By Erik Ness
In It Together
Cancer takes a toll on survivors and their partners
By Erik Ness
Huddled against me on a swim dock, my wife dared to dream. “Wouldn’t it be great if the cancer just went away? If we could just take a vacation without scheduling around treatments? If we could expand our family like we planned?”
It was a warm thought on a cool day, but we could hardly pull it off. Her initial breast cancer diagnosis at age 40 in 2004 was shocking enough, but nothing compared to the metastatic marathon that began two years later. The constant tug-of-war between treatment and disease had so warped the fabric of our days that the “normal” lives of people on the beach were hard to imagine.
For most couples, a cancer diagnosis begins the most significant challenge of their life together. Yet there is shockingly little research to guide this journey. That’s why two recent reports in the Journal of Clinical Oncology have resonated in the community of survivors and caregivers.
The first study, published April 10, looked at 177 cancer survivors who received bone marrow transplants and at their caregiving partners. Not surprisingly, partners reported better physical health and overall less cognitive dysfunction (measured by alertness, fatigue and social functioning) than the survivors. But mental health issues affected them both—and the caregiver was worse off. While partners and survivors suffered similar levels of depressive symptoms, partners were much less likely to get treated for it (34 percent versus 58 percent). Compared with survivors, partners also scored lower for social support, spiritual well-being, marital satisfaction and loneliness. Furthermore, partners reported little “post-traumatic growth,” which some say is cancer’s silver lining. On average, the group studied was nearly seven years out from the transplant, so these effects were detectable long after treatment ended.
The second study, published Sept. 20, compared 263 prostate cancer patients and their spouses who were dealing with one of three stages of cancer: initial diagnosis, remission or advanced disease. Couples facing advanced disease reported the most difficulty, and it was the spouses of patients with advanced disease who had the lowest emotional quality of life compared with all spouses and patients at any disease stage. Spouses were also less confident than their partners in their abilities to manage their caregiving roles.
“It’s not that spouses want to take support [away] from the patient,” says lead author Laurel Northouse, the co-director of the Socio-Behavior Program at the University of Michigan Comprehensive Cancer Center in Ann Arbor. “It’s just that there is this whole emotional component, and they get very little help dealing with it.”
“We don’t have a system that’s set up really to take care of the caregiver,” says Michelle M. Bishop, a psychologist at the University of Florida in Gainesville and the lead author of the April 10 study. While some caregiving partners get treated for depression, many more cope alone. Even spouses who aren’t clinically depressed frequently need help, she says.