Cancer and Relationships
Communication is key.
Posted Feb 12, 2017
Cancer and its treatment have many effects on patients that are relevant to their social and intimate relationships. These include uncertainty, fears about the future, distress, changes in body and self-image, pain, fatigue, and physical and sexual functionality. These can translate into changes in roles and relationships such as occupational status, ability to engage in favorite leisure activities, or capabilities as a partner. For instance, even in a sample of young adult survivors of cancer, many of whom were in a partnership when they were diagnosed, although relationship satisfaction was high, patients reported having sex less often following their cancer diagnosis.1 This is significant because and sexual and relationship quality were also positively related in this sample.
Our social contacts and loved ones can be a balm, and represent sources of support, validation, and information, and our relationships can serve as venues for distraction, enjoyment, and pleasure in the context of cancer. Sometimes however, this can be obstructed by social constraints, the lack of comfort for cancer patients in disclosing authentic feelings to loved ones.2 Sometimes this discomfort is brought about by the discomfort, awkwardness, denial, or even insensitiveness of social network members. This is not always the result of inadequacy on the part of network members, but can also occur when well-intentioned individuals provide support that is not well matched to what a recipient wishes or needs, or when its delivery is clumsy. Each person in the dyad reacts and responds to the other’s feelings, thoughts, and behaviors, forming interpretations and perceptions that can lead to a reluctance to communicate. For example, a cancer patient may attempt to discuss fears about recurrence with a partner, and the partner, hoping to shield themselves and the patient from difficult negative feelings, may try to minimize these fears. This attempt to remain positive may be interpreted as not acknowledging the patient’s fears. Social constraints can result in avoiding talking about and processing thoughts about cancer, leading to intrusive thoughts about cancer, compromised relationships, and elevated psychological distress.
In a sample of male cancer survivors this dichotomy was illustrated clearly.3 One pattern that emerged was good partner sexual communication that emerged in the presence of good partner support and a stable sense of one’s own self-efficacy. Another was poor sexual communication in the context of feelings of a lack of masculinity following sexual dysfunction and accompanying lack of partner support. Research of this type, that investigates communication between couples experiencing cancer, has been hampered because the quality of support and communication are viewed through the lens of the individual reporting on it. Very seldomly has communication between partners been brought into the research lab and observed--perhaps because this has the downside of intrusiveness and perhaps artificiality. Now, with the help of newer technology, an electronically activated recorder that can sample natural conversations unobtrusively outside the laboratory, a more objective view can be obtained. In a study that examined couples’ cancer conversations in this way over one weekend, when spouses’ conversations about cancer were more frequent patients’ levels of avoidance and intrusive thoughts about cancer was reduced.4
Practitioners, who are also valued sources of information and support, can pay an important role in helping patients understand how cancer can alter their relationships and sexuality. How can they best facilitate conversations that will help patients preserve the quality of their intimate relationships? Some of the barriers for physicians include lack of time, privacy, rapport, and the perception that discussions about intimacy and relationships are secondary to conversations about prognosis and survival.5 However, health professionals are key players in dispelling the notion that sexuality is unimportant or frivolous. This can often be as simple as giving partners permission to talk about and prioritize this aspect of their relationship.
1 Geue, K., Schmidt, R., Sender, A., Sauter, S., & Friedrich, M. (2015). Sexuality and romantic relationships in young adult cancer survivors: Satisfaction and supportive care needs. Psycho-Oncology, 24(11), 1368-1376. doi:10.1002/pon.3805
2 Lepore, S. J., & Revenson, T. A. (2007). Social constraints on disclosure and adjustment to cancer. Social and Personality Psychology Compass, 1(1), 313-333. doi:10.1111/j.1751-9004.2007.00013.x
3 Seidler, Z. E., Lawsin, C. R., Hoyt, M. A., & Dobinson, K. A. (2016). Let's talk about sex after cancer: Exploring barriers and facilitators to sexual communication in male cancer survivors. Psycho-Oncology, 25(6), 670-676. doi:10.1002/pon.3994
4 Robbins, M. L., López, A. M., Weihs, K. L., & Mehl, M. R. (2014). Cancer conversations in context: Naturalistic observation of couples coping with breast cancer. Journal Of Family Psychology, 28(3), 380-390. doi:10.1037/a0036458
5 Ussher, J. M., Perz, J., Gilbert, E., Wong, W. T., Mason, C., Hobbs, K., & Kirsten, L. (2013). Talking about sex after cancer: A discourse analytic study of health care professional accounts of sexual communication with patients. Psychology & Health, 28(12), 1370-1390. doi:10.1080/08870446.2013.811242