In Sickness and in Health: How a Breast Cancer Diagnosis Affects Our Partners and Our Intimate Relationships
“I felt a hard bubble form inside my heart,” writes Laurence Gonzales about the time he learned his wife had breast cancer. In his book, “The Hero’s Apprentice,” Gonzales describes what it was like to be the husband of a breast cancer patient. For the next few years, Gonzales endured a painful ordeal—his wife’s surgery, chemotherapy, and endless tests and exams.
Few of us know what the partners of women with breast cancer experience. When a woman is diagnosed with the disease, friends and family usually focus on the patient and neglect her partner. But studies have shown that husbands experience as much anxiety and distress as their wives. Partners “are deeply affected and it usually shows up in the area of some emotional distress,” says Laurel Northouse, a University of Michigan professor who has researched the psychological consequences of breast cancer on significant others.
‘I’m Sorry, Your Wife Has Breast Cancer’
“The first response [to the diagnosis] is, ‘It’s a death sentence,’” says Scott Marhanka of Tinley Park, Illinois. Scott’s wife, Connie, was diagnosed with breast cancer in October 1997 at the age of 34. “Everything you can imagine goes through your mind,” says Scott.
Husbands fear they will lose their wives. And if they have young children, that adds to their worries. “It was really scary,” says Greg Detmer of Ann Arbor, Michigan about his wife’s diagnosis in 1993. “I’m looking at three young children and thinking ‘What am I going to do?’”
Many men find it difficult to share these feelings, but experts say it’s important that they deal with them. If a man is uncomfortable talking to his wife or joining a support group, he should try confiding in a close friend or relative. “It’s a hard thing for men, [but they need] to reach out more to people around them,” says David Payne, a clinical psychologist at Memorial Sloan-Kettering’s Evelyn H. Lauder Breast Center in New York.
How Can I Fix This?
One of the most difficult things for men in this situation is the feeling of powerlessness. When most men are faced with a problem, they want to fix it.
But partners can’t “fix” breast cancer and many end up feeling frustrated and angry.
At Y-me, volunteers help partners cope with these feelings. The organization offers support groups (called “open-door meetings”) and a 24-hour Men’s Hotline for partners of women with breast cancer (800-221-2141). They also offer practical suggestions, such as, “Hold her when she cries,” or “Just listen; don’t try to make the feelings go away.”
While some men react to these suggestions with, “Yeah, but I need to do something,” volunteers help them see that they are “doing something,” says Judy Perotti, Y-me Director of Patient Services in Chicago. This new perspective helps men feel more useful and relieves some of their frustration.
Partners also feel a greater sense of control when they know more about the disease. Leonard Thomas of Chicago, whose wife was diagnosed in 1993, said educating himself was “the only thing that fought the fear. It got me … focused.” Organizations such as the American Cancer Society offer information to cancer patients and their loved ones (1-800-ACS-2345). Partners can also visit their local library or search the web for more information. Two good sites are www.webmd.com and www.nlm.nih.gov (for the National Library of Medicine).
After the Surgery
A woman’s breasts are inextricably tied to her sexuality. After breast cancer surgery, whether it’s a mastectomy (removal of the entire breast) or a lumpectomy (removal of the lump and some surrounding tissue), her body image changes and she may no longer think she is attractive. Although studies show that most newly-diagnosed women are primarily concerned with their health and survival, they may also worry that their partners will no longer find them attractive.
At the same time, men may have trouble figuring out how they should behave. A man may be “scared that if, on the one hand, he tries to initiate sex, [he’ll] be seen as lecherous and unfeeling,” but if he doesn’t, he’ll “be seen as not caring,” explains Dr. Susan Love, an author, breast surgeon, and medical director of the Susan Love MD Breast Cancer Foundation.
According to Dr. Love and other experts, the key to returning to a happy sex life is good communication. It isn’t always easy, but couples need to talk about what they’re going through. For example, the woman should let her partner know how she‘s feeling. “You might be in pain, you might be nauseated…your arm may not work so well right after surgery. So …physically, sex may not be comfortable,” says Dr. Love.
Men need to express their feelings, too. A husband should let his wife know she still appeals to him, or admit he’s afraid that making love may hurt her. Openness can prevent misunderstandings and resentment.
Treatments & Exams
Medical treatments other than surgery can also have a negative effect on intimacy. Chemotherapy and radiation usually leave a woman fatigued and uninterested in sex. During treatment, and for about a year afterwards, she may completely lose her sexual desire.
In addition, hormonal and cosmetic changes may affect a woman’s level of desire. “You’ve lost your hair, your breast is altered or gone, you’ve put on weight, you have no energy, you’re tired, you’re nauseated, and you hurt in new places. No wonder you’re not feeling sexy,” say Dr. Marisa C. Weiss and Ellen Weiss in their book, Living Beyond Breast Cancer. Chemotherapy can also throw a woman into menopause, resulting in vaginal dryness and a diminished libido.
But many couples find they can still remain close. Alternatives to intercourse, such as holding each other and talking more, help couples maintain intimacy. During this time, couples “need to be sharing close, intimate time together,” says Barbara Andersen, a psychology professor at Ohio State University in Columbus, Ohio. She suggests setting aside at least 20 to 30 minutes every day to share with each other this way.
When Treatment Ends
Although patients and their partners look forward to the end of chemotherapy or radiation, it can be frightening when the time finally comes. “When the oncologist announces the end of treatment, a patient’s first reaction may be one of anxiety,” say Susan Nessim and Judith Ellis in their book, Can Survive: Reclaiming Your Life After Cancer. The patient may wonder, “How will I live without it?”
Sometimes she misses the routine of treatment and the hospital’s supportive environment. Ongoing treatment provides a kind of “safety factor,” says Barbara Andersen, and when it’s over, some patients experience a letdown.
At this point, conflict arises if the man wants to leave the cancer behind but his wife isn’t ready to let go. When Connie Marhanka’s treatments ended, Scott wanted to move on but Connie couldn’t. “He was going to every appointment…with me…and he was exhausted because he was [also] working full time….And then all of a sudden treatments were over. [His attitude was] ’OK, now I can take a breather,’ but [my attitude was] ‘Wait a minute. I’m not done yet. I’m still struggling here.’”
Connie and Scott made it through this difficult time with the help of a behavioral oncologist. Dr. Alicia Matthews, a psychiatry professor and director of the Psychosocial Oncology Program at the University of Chicago Hospitals, helped them understand their emotions and what the other was going through. “Dr. Matthews helped me realize what I was feeling was normal,” says Scott.
When treatment ends, experts advise couples to express their feelings and talk to each other about what they need. If talking is difficult, they may want to seek the help of a mental health professional. “Even though people may not have psychological problems, it’s often helpful to talk with a [therapist who specializes] in breast cancer just to get some ideas,” says David Payne of Memorial Sloan Kettering. Couples can find therapists at most major cancer centers, or they can call the American Psychiatric Association at 888-357-7924 (www.psych.org) or the American Psychological Association at 800-964-2000 (www.helping.apa.org) for help finding one.
Recurrence: ‘Here We Go Again’
In December 1998, Connie Marhanka learned the cancer she had been fighting for the past year had returned. When she and Scott got the news, she said, “We kind of looked at each other and thought, ‘Here we go again.’”
One of the most difficult aspects of living with any kind of cancer is the possibility of its coming back. Although many patients never experience a recurrence, the worry stays with them and their partners for a long time. “As every woman who is living beyond breast cancer knows, even if doctors have assured you of an excellent prognosis and you feel healthy and “cured,” you are never rid of the knowledge that you had breast cancer and that it can happen again,” say Marisa and Ellen Weiss in Living Beyond Breast Cancer.
Alicia Matthews of the University of Chicago says a recurrence often causes couples to experience conflicting emotions. On the one hand, it may leave them with “greater fears and anxiety about what the illness really means.” But, they may also have a comfort level that comes with having dealt with cancer before. Couples know what to expect and have developed some coping skills, she says.
Matthews suggests couples analyze what methods worked for them before and what needs improvement. They may also want to seek outside support, such as a cancer support group or a mental health professional, if they haven’t already done so.
The important thing for these couples, says Dr. Northouse of the University of Michigan, is to maintain hope. She tells couples facing recurrence to focus on the things in their lives they are happy about. She also suggests they get information about the latest treatments. Increasingly, there are promising new ones for breast cancer.
How Will This Affect Our Relationship?
Almost nothing compares to the challenges a couple faces when one of them has cancer. Although most couples stay together, “What typically happens is the…illness exacerbates any problems [the couple already has],” says Alicia Matthews. “It’s how patients and their partners negotiate those issues that becomes significant.”
Difficulties often arise because men and women approach problems differently. In general, men take an action-oriented approach, while women usually adopt a more emotionally-focused one. So when a man responds to his wife’s tears by analyzing what the doctor said or by logically going over her options, she may feel frustrated and misunderstood. Dr. Payne of Memorial Sloan Kettering suggests that the man “acknowledge how distressed his partner is [before offering solutions]….There needs to be a joining together at a common emotional level first.” This technique “helps couples face the problem together” and facilitates intimacy, says Payne.
Once couples learn more effective ways to communicate and show more empathy for each other, they usually find that cancer brings them closer. By making a commitment to fight the disease together, couples learn new ways of showing their love and gain a greater appreciation for each other and the time they have together.
Last month, doctors told Connie Marhanka her cancer had returned yet again. As the Marhankas do battle with Connie’s third occurrence of breast cancer, Scott says they are tired, but not defeated. “Nothing has really changed for us,” he says. “It’s just a new hill to climb, but as far as the relationship goes, it’s as strong as ever.”
Copyright © Chicago Tribune.