This is the second in a 12-part series on breast cancer. To view the rest of the titles in this series, click here.
No one is ever totally prepared to hear that a woman* close to him or her has breast cancer. For the person with breast cancer, a diagnosis causes her life to suddenly and dramatically change. As treatment progresses, the patient has a multitude of doctor visits, procedures, and often support groups to keep her busy and focused. Her partner's challenges are also significant, but unfortunately they are frequently overlooked. This fact sheet provides perspectives and suggestions for persons who are accompanying a woman through breast cancer treatment.
Relax and Take a Deep Breath
As frightening as breast cancer is, women are living longer than ever following a breast cancer diagnosis due to advances in early detection and treatment. When a tumor is discovered, don't immediately fear the worst; instead, focus on what you can do to support your partner through treatment. This can be a long process, so relax and pace yourself. The series of active treatments, depending on the type of cancer and how far it has progressed, can take four to eight months without complications. Your support will be vital in helping your partner manage and recover from cancer treatment.
Do What You Do Best
There are many supportive roles that a partner can play to help a woman through breast cancer treatments. Start with those things you do best. If you enjoy cooking, prepare foods that she requests; these may or may not be her favorite foods, since certain treatments can affect the sense of taste. (Some patients choose to avoid their favorite foods so they will not associate the dishes with cancer treatment.) If you are not a cook, be willing to pick up foods that she requests from restaurants.
If you are an information-seeker, get on the Internet, go to the library, and start researching her type of cancer, recommended treatments, and options. Seek out multiple sources of information to confirm the accuracy of web-based sources. Be sure to share information with your loved one only as she requests it; not all patients want to know everything about their condition.
Finally, if you are the sort of person who is good at providing distractions or humor, you can use your talent in a very beneficial way. Research suggests that these types of positive interactions can help alleviate stress and depression for those who are experiencing a serious illness.
If you can take time off from work, accompany your partner to doctor visits. Depending on her preference and need, you may be the chauffeur, or you may join her as she presents questions to the doctor. She may find it helpful if you take notes or record the conversations to help both of you remember what the doctor said. There is a lot of information to absorb quickly and decisions may need to be made rapidly.
Help with Decisions
Some women are interested in taking an active role in their medical treatments and want to gather information and make decisions. Even those who aren't as comfortable seeking detailed information about their cancer, however, must make certain choices. The first choice is selecting a treatment regimen. Many individuals seek a second or even a third medical opinion to gather more information or hear the options presented in a different way. The patient may be asked to decide on the sequence of treatments or whether to request additional tests. In some cases, she may have to decide between a mastectomy and lumpectomy, or between a single and double mastectomy.
Many doctors encourage their patients to seek second and third opinions and will help set up appointments with other doctors. If you want to receive this input, accept their assistance, as it will reduce the waiting time for an appointment. Even if it is the patient's suggestion, most doctors consider getting a second opinion a good idea and will not take offense if their patient chooses to do this. When seeking another opinion, look for a doctor who has as much, if not more, experience in the treatment of breast cancer as your primary physician does.
You can be an active partner in the myriad of decisions your partner will make by collecting and organizing information, discussing options, and being a sounding board for her concerns. Maintain flexibility and offer options to help her see new solutions. Together you have an opportunity to shape your future: first by stopping a life-threatening disease, second by restoring her health, and finally by learning how to live with the changes that will occur.
Body Image, Intimacy, and Sex
Body image and sexual functioning are aspects of life that can contribute to physical, emotional, and social well-being. For women, in particular, body image is an important part of self-concept. Consequently, diagnosis and treatment of breast cancer may elicit negative perceptions that can lead to body image dissatisfaction, feelings of unattractiveness and self-consciousness, or loss of a sense of femininity. During these difficult times, it is important for patients to feel supported and loved by their partners.
Some couples may experience changes in intimacy and sexual functioning after surgery, chemotherapy, and/or radiation therapy. Some of these changes may include loss of sexual desire and arousal, reduction in sexual pleasure, anxiety about sexual performance, and pain during intercourse. Although some of these difficulties may be resolved after completion of treatment, difficulties with intimacy and sexual functioning may persist for years. This, however, does not mean couples cannot be intimate. Rather, it may mean finding new ways to be intimate. Many couples have found that discussing aspects of their relationship openly and honestly may actually increase intimacy as they go through the cancer journey together. Other signs of affection may include a kiss, touch, or gentle massage. If specific concerns arise, you can contact a physician or ask for a referral to a licensed psychologist. Although some may find it difficult to discuss sexual issues, speaking with a physician or healthcare provider may be the only way to receive the answers you need.
Coping with Changes in Mood
Some treatments for breast cancer such as chemotherapy, hormonal therapy, and medications can induce menopause, cause changes in hormone levels, and/or bring about mood swings. Furthermore, the stress and emotional issues associated with battling cancer can also lead to mood changes. These changes in mood can be either temporary or lasting side effects of treatment. As your partner deals with these mood changes, it is helpful for you to not take them personally so you can be as supportive as possible.
It is important for your loved one to know that these changes in mood are not unusual, and they can be managed by utilizing various treatment options and techniques. You might encourage her to ask a physician for a referral to see a licensed mental health specialist, who can identify ways to help her manage and cope with these emotional challenges. Additionally, eating healthy foods, sleeping well, spending time in nature, and exercising have been found to be helpful. Other complementary and alternative techniques include yoga, meditation, aromatherapy, massage, and acupuncture. However, it is important for your partner to speak with her physician before engaging in any of these complementary techniques, because some may interfere with medical treatment.
Tips for Managing Social Resources
A partner can be helpful throughout this process in several specific and concrete ways. You can rearrange the house to give your partner space so she can work at home more often. You can encourage her to let go of nonessential commitments and make her own health a priority. You can protect her from well-meaning friends by screening calls if she doesn't feel like talking, and you can organize friends to show up more often if she feels alone and in need of company. You can arrange for child care on the days she can't manage. If the mailbox is bulging from long distance "get well" wishes, you can find a wall or door jamb on which to display the cards—a constant reminder of the love that surrounds her. You might set up an e-mail list or blog to make it easier for either of you to keep others informed of her progress. She probably won't want to write a letter to each person separately. Some websites make it easy to update everyone.
There may be a host of people who offer to help and ask you to let them know what to do. In order to avoid a situation where they all bring lasagna on the same day, you might try to orchestrate the volunteers or have a trusted friend take care of this. Suggest the types of food they can bring, remind them of foods that are off-limits due to treatment or personal preferences, and assign them each a day. There now are websites that make it easy to organize meal delivery!
Set up a schedule so that friends can drive your partner to appointments, drop her off at work, pick up children, or make trips to the supermarket or drugstore. You might also need to ward off well-meaning friends who offer advice about which drugs severely impaired Aunt Betsy or which treatments led to complications for Grandma Ruby. Everyone reacts differently, and while these stories may be true, they offer little wisdom or assistance for others.
Cancer treatments are likely to overwhelm your lives for several months—perhaps up to a year. As you both learn about her tolerance to treatments, the limits she faces, and the speed with which she recovers, you can begin to prioritize opportunities. It may be important to take the vacation you had planned, or it may be appropriate to postpone it until both of you can appreciate it. Travel for work may be more of a hassle than it is worth, or it may be helpful for her to keep up with the career that has shaped her life. Help her to be open to change, flexible about options, and realistic about limits.
Every woman responds differently to the physical and emotional trials of breast cancer. It is not possible to make firm predictions. You and your partner have an opportunity to learn and work together throughout this process. Your support is an important factor in her health, happiness, and recovery. It could very well be the single most important factor in creating a restful, healing home environment and maintaining a positive outlook for a long and healthy life together.
*Since the majority of breast cancer patients are women, we refer to breast cancer patients as females. We acknowledge that about 1% of breast cancer patients are men who face these as well as other challenges.
Appreciation is given to Deidre Pereira, associate professor, Gail Adorno, MSW, Mary Aplin, MD, UF-Shands, and Mandy Robertson, MD, UF-Shands, for helpful suggestions and comments.