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Connected by Cancer

Posted By John Rolland, Wednesday, April 25, 2012

John Rolland
CFHA's Growing MedFT blog invited
Dr. John Rolland of the Chicago Center for Family Health to provide his insights and reaction to recent research documenting the connection between a wife's cancer diagnosis and the stress/health of her husband. This
link will take you to the original research report.

This study struck me as important on at least four levels.The findings highlight: 1) the impact of the wives’ cancer on the spouse/partner; 2) the impact of disease status on spouse (here recurrence vs non-recurrence of breast cancer), 3) the impact of perceived stress on the spouse/partner (here measured by immune system status), and 4) the mutual relationship between well and ill spouse emotional and physical wellbeing (and for ill spouse - treatment adherence, and the always interesting question of disease course/outcome).The effects of major illness on the spouse/partner and the unique aspects of the experience for couples remain "neglected edges” in both the general biopsychosocial and broader family literature.

Clearly, spouses are affected by both disease status and perceived stress.This is very consistent with the perceived risk research related to genetic risk, where perception of risk of getting a genetic condition and its course/outcome is more strongly associated with psychological wellbeing than actual genetic risk.With cancer and the possibility of recurrence or a fatal outcome (what I have coined as "anticipatory loss”), the perception of risk and associated level of stress is longterm.I have had patients/families, where even 30 years after initial cancer treatment, they still experience terror that any "unclear” physical symptom may be a recurrence.

The study underscores the vital importance of family/couple-oriented consultation close to the time of diagnosis.Also, it highlights the value of including ongoing periodic consultation with a couple in addition to consultation with the broader family system.As part of that process, I always inquire about sensitizing illness experiences in ones past as well as cultural meanings (cancer, genetics) /illness narratives that are imbedded in levels of stress.For me this is not just looking for sources of vulnerability/stress, but more important stories of resilience and relational growth in the face of adversity.The study authors correctly recommend stress management, relaxation techniques, and self-care for the well spouse/partner.As family and collaborative healthcare advocates, when major health conditions occur, we need to advocate that prevention-oriented couple consultation/psychoeducation and, when appropriate, medically-oriented couple therapy be included in routine care.

Dr. Rolland is internationally recognized for his Family Systems-Illness model, clinical work, and research with families facing serious physical disorders and loss. His book,Families, Illness, and Disability: An Integrative Treatment Model(Basic Books), was nominated for book-of-the-year by the American Medical Writer’s Association. He is currently co-author of a new book, Individuals, Families, and the New Era of Genetics: A Biopsychosocial Perspective(Norton). He has given over 250 national and international presentations on topics related to his work.

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Vicki Kennedy says...
Posted Friday, April 27, 2012
This study validates what so many family caregivers have shared over the years about the profound stress associated with intimately sharing the cancer journey with someone they love. We often tend to think that men who are caregivers are stoic and tough. They may be reluctant to ask for help or seek out supportive services. This study drives home the need to provide opportunities for male caregivers to identify their worries and concerns and get the support that would be most helpful. We are challenged as health care professionals to better attend to the needs of all caregivers not underestimating the emotional, physical and social stressors they face.

Vicki Kennedy,
Oncology Social Worker and Vice President, Program Development & Delivery. The Cancer Support Community, Washington, DC.
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Marc Silver says...
Posted Friday, April 27, 2012
This study reminds me of a comment I heard over and over as I researched my book, Breast Cancer Husband. A number of women said to me, “It’s harder on my husband than it is on me.” I don’t quite agree – when my wife went through treatment for breast cancer, I know it was very hard for her. But yes, it was hard for me as well. I was grateful when friends understand that and asked me how I was doing. And I was grateful that my wife understood that a caregiver needs to figure out how to cope as well. Going on a bike ride or a jog – with my wife’s permission – helped me deal with the stress of being a breast cancer husband. I hope this study leads to a greater recognition that breast cancer husbands need support as well, both from friends and from the medical establishment. I jokingly say that the breast cancer husband’s motto is “Shut up and listen” – to his wife! It would be wonderful if people would listen to us, too.

Marc Silver,
Author of Breast Cancer Husband
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