Cancer in the marital context: A review of the literature

The findings from these studies suggest that a small subgroup of patients and spouses are at risk for long-term adjustment problems. For situations that are likely to be resolved with relatively little chance for cancer recurrence, such as early-stage breast or colon cancer surgery, evidence suggests that distress levels are likely to dissipate after surgery. However, for individuals whose prognosis is worsening, distress levels are likely to increase over time. Other than two studies (Dar et al., 1992; Hannum et al., 1991), results consistently point to the similarity in distress responses among couples; if one partner is distressed, the other is likely to respond in a similar manner. It is surprising that more studies did not take into account the role of illness progression or degree of physical disability in their examination of responses of couples, or that more studies have not targeted patients with advanced cancer in palliative care or examined the role of patient pain in couples' distress levels. Cancer recurrence or extreme disability is likely to play a role in level of distress (e.g., Northouse, 1988). A major problem in this literature is that few longitudinal studies have been conducted (approximately 50% of studies reviewed). This type of data can help to understand both the time course of emotional responses and the impact of disease progression or changing levels of physical disability. Another limitation is that the majority of studies target breast cancer patients and their husbands. The examination of cancer populations other than breast cancer patients would provide information about other cancers, as well as allow for the examination of gender differences. As both gender and age of patient and spouse appear to play a role in distress, with younger partners and females (patients and wives) at risk for higher distress, both variables should be included in any analyses. Finally, investigators should be cognizant of special issues in the choice of measures for cancer patients. Many instruments such as the Beck Depression Inventory contain items that have a somatic content. Common symptoms on many scales, such as fatigue or appetite loss, can be caused by the cancer and/or its treatment rather than indicate depression or anxiety (Holland, 1989).