Don't Forget the Partner of a Patient With Cancer

Linda M. Goodfellow, PhD, RN

Associate Professor, Duquesne University School of Nursing,

Pittsburgh, PA.

Family systems theory emphasizes the interrelatedness of family members and their effects on one another¹; from this perspective, the effects of cancer on one member of the family can also affect the health and well-being of other family members. Most spouses experience high levels of stress after their partner has been diagnosed with a potentially life-threatening disease like cancer, and this stress is evident during and after treatment.²

High levels of stress have been associated with profound psychological and physiological disturbances in the spouse of a patient with cancer,³ stemming from uncertainty about the future, fear and lack of knowledge about cancer, its treatment, and symptom management, as well as alterations in daily activities brought about by the patient’s disease and treatment.² In addition, caregiver fatigue is viewed by spouses as a source of stress,⁴ as many worry about who would take care of their ill partner if they, too, should become ill.⁵

A high incidence of respiratory infections, hypertension, and reduction in immune function,^3,6 as well as eating disorders, sleep disturbances, and poor health,^4,7,8 have been found in spouses of patients with cancer. In addition, psychosocial disturbances, such as depression, negative mood, and perceived stress, have been reported as a result of caring for a partner with cancer^9,10; depressive mood and perceived stress also have been shown to be significantly associated with poor natural killer cell activity.⁹ Natural killer cell activity is an excellent measure of overall health and well-being.¹¹

Despite these findings, little attention has been given to helping spouses of patients with cancer reduce the effects of stress associated with their partner’s illness. In my recent study, I found that spouses were indeed willing to use a number of interventions to reduce their stress (Table).¹² Interestingly, male spouses were less inclined to pray than female spouses, but more inclined to exercise when asked how many times per week they used an intervention to reduce stress.

Table. Interventions Used Weekly to Reduce Stress (N = 76)¹²

1-2 times (%)

3-4 times (%)

5-7 times (%)

Total (%)

Talk to Friends

26

26

34

86

Pray*

16

8

55

79

Listen to Music

24

21

29

74

Read a Book

18

22

33

74

Play with a Pet

16

17

25

58

Exercise*

21

16

20

57

Take a Walk

22

18

15

56

*Gender differences: P ≤ .01.

Often the spouse is too concerned with an ill partner to ask for help. It is up to the nurse to ascertain whether or not the spouse may need a referral to a support group or for counseling. A spouse who is highly anxious or depressed may need to see his or her own physician for medical treatment or a behavioral psychologist to learn stress management or relaxation techniques. Some seek spiritual-based resources, whereas others may just need encouragement to rely on what has helped them to cope with stressful events in the past.

Sometimes, spouses do not want to leave their partners for a long period of time to engage in an exercise class or to have a massage,⁵ so it is important to suggest activities that can be done at home, such as listening to music, reading a good novel, gardening, playing with a pet, or taking a walk around the block.¹² It is also important for the nurse to remind the spouse to avoid poor health habits,^7,8 including alcohol, smoking, drinking caffeinated beverages in excess, or eating foods high in sugar and fat. Levels of stress and ways of coping will differ from one spouse to another, so it is important for the nurse to help them identify the best options.

Here at Duquesne, undergraduate nursing students study cancer care during the fall semester of their junior year. They are encouraged to include the spouse and other family members in their patient’s plan of care and given opportunities to apply theory learned in the classroom to patients with cancer in both the hospital and community settings.

Too frequently we forget about the spouse’s vital role in caring for an ill partner. As nurses, we must include the spouse in our plan of care to help maintain their overall health and well-being, so that they remain healthy throughout the cancer experience and are able to provide the care and support their partner needs.

References

1. McCubbin HI, McCubbin MA. Families coping with illness: the resiliency model of family stress, adjustment, and adaptation. In: Danielson C, Hamel-Bissell B. Families, Health and Illness. New York: Mosby; 1993:21-60.
2. Schumacher KL, Dodd MJ, Paul SM. The stress process in family caregivers of persons receiving chemotherapy. Res Nurs Health.1993; 16(6):395-404.
3. Di Gregorio SW, Carpenter KM, Dorfman CS, Yang H, Simonelli LE, Carson WE. Impact of breast cancer recurrence and cancer-specific stress on spouse health and immune function. Brain Behav Immun. 2012;26(2):228-233.
4. Carter PA. Caregivers’ descriptions of sleep changes and depressive symptoms. Oncol Nurs Forum. 2002;29(9):1277-1283.
5. Keir ST. Levels of stress and intervention preferences of caregivers of brain tumor patients. Cancer Nurs. 30(6):E33-E39.
6. Baron RS, Cutrona CE, Hicklin D, Russell DW, Lubaroff CM. Social support and immune function among spouses of cancer patients. J Pers Soc Psychol. 1990;59(2):344-352.
7. Aubrecht V, Arlington R, Gordon H. Family caregivers: health-related changes following patients’ cancer diagnosis. Oncol Nurs Forum. 2006;33(2):417-418.
8. Sarna L, Cooley ME, Brown JK, et al. Quality of life and health status of dyads of women with lung cancer and family members. Oncol Nurs Forum. 2006;33(6):1109-1116.
9. Goodfellow LM. Effects of therapeutic back massage on psychophysiologic variables and immune function in spouses of patients with cancer. Nurs Res. 2003;52(5):318-328.
10. Rhee YS, Yun HY, Park S, et al. Depression in family caregivers of cancer patients: the feeling of burden as a predictor of depression. J Clin Oncol. 2008;26(36):5890-5895.
11. Whiteside TL, Bryant J, Day R, Herberman, RB. Natural killer cytotoxicity in the diagnosis of immune dysfunction: Criteria or a reproducible assay. J Clin Lab Anal. 1990;4(2):102-114.
12. Goodfellow L. Mood, health behaviors, and interventions used to reduce stress in spouses of patients with cancer. Oncol Nurs Forum. 2009;36(1):XI.