Breast cancer recovery hampered by poor marriage

Breast cancer recovery hampered by poor marriage

Researchers in the US found that breast cancer patients who had a poor relationship with their spouse or partner were likely to recover more slowly and experience worse physiological as well as psychological outcomes.

The study was the work of research associate in psychology Hae-Chung Yang and doctoral student Tammy A Schuler of Ohio State University in Columbo and is to be published in a future print issue of the journal Cancer, with an online early view available now.

Previous studies have linked marital distress to difficulties in adjusting to a diagnosis of breast cancer, but the researchers noted that long terms effects were not well studied.

In this study, Yang and Schuler found that over five years, patients experiencing poor relationships with their spouse or live-in partner had higher levels of stress, lower levels of physical activity, recovered more slowly, and had more symptoms of illness than their counterparts who reported having good relationships.

As Yang explained:

"The quality of the marital relationship may not be the first thing women worry about when they get a cancer diagnosis. But it may have a significant impact on how they cope physically and emotionally."

"Our results suggest that the increases in stress and other problems that come with a distressed marital relationship can have real health consequences, and lead to a poorer recovery from cancer," she added.

Yang and Schuler found the results were unaffected by other potential confounding factors such as how depressed the patients were, how advanced their cancers were, and the type of treatment they had.

"When you're diagnosed, that's devastating for everyone, regardless of the quality of your marriage," said Yang.

"But women in good marriages saw steady reductions in their cancer-related stress, while women in distressed marriages had a much slower recovery," she added.

The researchers took longitudinal data on 100 newly diagnosed breast cancer patients who were taking part in the long running Stress and Immunity Breast Cancer Project at Ohio State. All the women were married or cohabiting at enrollment and throughout the study which followed them for five years.

The patients underwent assessment just after diagnosis and surgery (this gave the baseline data), and then every 4 or 6 months for 5 years for levels of cancer-related stress, overall stress, physical activity, general physical functioning, and symptoms and signs of illness.

At the start, and then every year for the duration of the study, patients also filled in questionnaires about the quality of their relationship with the spouse or partner. Most of them reported little change in marital quality over the period of study, and based on these results they were put into two groups: one with 28 women in distressed relationships and the other with 72 women in non-distressed and stable relationships.

The researchers used a statistical tool called mixed effect modelling to compare the results between the two groups of women, including stress, health behaviour and health outcomes.

The results showed that:

  • Overall, marital distress was linked to slower recovery and poorer outcomes.
  • At baseline, both distressed and stable relationship groups had equivalent high levels of stress, but this diverged afterwards.
  • Stress went down more slowly for the women in distressed relationships, and after 5 years it remained significantly higher than for the women in stable and non-distressed relationships.
  • There were also differences in the extent to which physical activity diminished.
  • The distressed relationship group had a slower recovery in health performance and showed more signs and symptoms of illness and treatment side effects for three years after baseline.
  • All the effects were unchanged after accounting for symptoms of depression, which were also significantly higher among the women in the distressed relationship group.
Yang and Schuler concluded that:

"Marital distress is not only associated with worse psychologic outcomes for breast cancer survivors, but poorer health and a steeper decline in physical activity. These novel data demonstrate recovery trajectories for breast cancer survivors to be constrained for those also coping with ongoing difficulties in their marriage."

Like other studies, Yang and Schuler also found that most women did not see a change in the quality of their marriage after being diagnosed with cancer.

"Whether you have a good or bad relationship before being diagnosed with cancer, that is not likely to change afterwards," said Yang. However, the quality of the relationship has a big impact on recovery from cancer.

"Clearly, marital distress is a risk factor for numerous poorer outcomes and it is never late to work to improve your marriage, not only for your emotional well-being but also for your health," said Yang.

The study was sponsored by the American Cancer Society; Longaberger Company-American Cancer Society Grant for Breast Cancer Research; National Institute of Mental Health; U.S. Army Medical Research Institute; the National Cancer Institute; and OSU Comprehensive Cancer Center.

"Marital quality and survivorship."

Hae-Chung Yang, Tammy A. Schuler.

Cancer Early View Oct 2008.

DOI: 10.1002/cncr.23964

Click here for Abstract.

Sources: journal abstract, Ohio State University press release.

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