Adjustment of husbands and wives to breast cancer

The purpose of this descriptive study was to explore selected elements within the spousal relationship on fear of recurrence and emotional distress among women treated for breast cancer within the past 3 years and their husbands.

Fifty-eight married couples completed questionnaires designed to investigate the association between three relationship elements and adjustment (fear of recurrence and emotional distress) among husbands and wives. The relationship elements investigated were 1) adaptability and cohesion of the couple; 2) perceptions of support from the spouse; and 3) communication about the illness. The influence of the wife's age, treatment, and time since treatment also were considered.

Both husbands and wives reported similar perceptions of dyadic functioning, level of support received from the spouse, and extent of communication about the illness. Interdependent elements within the couple relationship were associated with both fear of recurrence and emotional distress. Overall, the amount of communication about the illness explained the most variance in adjustment for both spouses, with communication increasing as fear of recurrence increased. There was some suggestion that current or past membership in a support group was related both to more communication by wives and to husbands' greater satisfaction with communication. For wives, age was the demographic variable most highly correlated with adjustment; the younger the wife, the greater was her fear of recurrence. Significant emotional distress was observed in a small subset of husbands. In addition, when either the husband or wife scored in the top 25% of the sample on fear of recurrence, the fear of recurrence score for the corresponding spouse was elevated in only two cases. This same pattern was true for emotional distress.

This study adds to a growing body of information supporting the need to view women who have had breast cancer and their spouses as a unit. Four areas for heightened clinical assessment were noted; 1) greater fear of recurrence in younger women; 2) significant emotional distress in a small number of husbands; 3) the demonstration of compensation mechanisms by one spouse when the other is experiencing elevated fear of recurrence or emotional distress; and 4) an increased fear of recurrence in association with increased communication about the illness. Further investigation is necessary to determine whether communication between spouses is directed at problem solving or is an expression of emotional distress.