Image iStock © AtnoYdur

Strong partnerships: an important resource for coping with the effects of cancer

The partners of women suffering from breast cancer show considerable signs of distress, but the more satisfied men are with their relationship, the less heavy their burden seems. What is more, a happy marriage reduces the likelihood that women will suffer from changes to their body image. And although two-thirds of couples report that the illness has changed their sex life, more than half remain sexually active, while others talk of "increased tenderness". These are the main conclusions of a doctoral thesis by Sarah Cairo Notari, which was brilliantly defended on 25 January 2016 at the University of Geneva. The thesis has also inspired several other scientific publications.

Women are not the only victims of breast cancer. Every year in Switzerland there are around 6,000 new cases and it leads to more than 1,000 deaths. But, as with all potentially fatal diseases, it also affects the sufferer’s family and friends – and especially her partner. However, the partner’s feelings are rarely the subject of much attention. In order to understand how this disease affects couples, the National Centre of Competence in Research LIVES funded a study in 2011. Longitudinal data were gathered from 80 women undergoing treatment at Lausanne University Hospital, plus 55 of their male partners. Sarah Cairo Notari, an assistant at the unit for the clinical psychology of interpersonal relationships at the University of Geneva, analysed the data as part of her PhD research in psychology, L’ajustement psychologique de la femme et de son partenaire au cancer du sein (The psychological adjustment of women and their partners to breast cancer).

Psychological distress in men

First of all, Cairo Notari carried out a systematic review of the scientific literature on psychological distress in the partners of women affected by breast cancer. There had not been a lot of research in this field so far. Her summary of 23 selected articles shows that the level of distress experienced by these men is higher than that of the general population. However, "contrary to what is generally believed in this area, the partners do not report higher levels of psychological distress than the patients do," she points out.

The subjective burden of the "partner-carer"

When women have breast cancer, their partner often becomes their main carer within the family, taking on a whole range of tasks including providing practical help and emotional support, looking after the children and running the household. The study showed that the perceived weight of this burden is closely linked to the patient’s physical and psychological condition, and that it declines over time and as the disease goes into remission. But above all, Cairo Notari was able to demonstrate that the higher the level of marital satisfaction, the lighter this burden seems to men, regardless of their partner’s condition. These results will soon be presented in the Journal of Health Psychology.

Changes to the woman's body image

Marital satisfaction can also play an important and lasting role in protecting patients against changes to their body image. The study showed that women who have had a mastectomy and/or chemotherapy have fewer problems with their appearance if they are part of what is considered a positive partnership. This tendency was observable at various points during the study, whether it was two weeks, three months or one year since the participants had undergone surgery. Cairo Notari also noted that women who were cohabiting but unmarried reported a more significant change in their body image than married women did. Her conclusions suggest that "marital satisfaction and the fact of being married can mitigate the impact of treatment, reducing the extent to which women’s body image changes."

Changes to sexual function

The study also looked at couples’ sexual function, given that an intimate relationship is recognised as an important aspect of quality of life. For this part of the study, a semi-structured interview was conducted by a nurse and member of the team with 75 participants during a meeting two weeks after their surgery. It was carried out in addition to the first written questionnaire. The quantitative data suggest that for 64% of the women questioned, their illness and treatment had changed their sexual relations. However, 53% of the patients said that they maintained an active sex life, with or without changes. But for 29% of the patients, sexual relations had stopped completely. The qualitative data made it possible to demonstrate that the cease in sexual activity was not linked to marital difficulties: for 40% of the women who had become sexually inactive following surgery, sexual relations had even been replaced with an "increased feeling of intimacy and closeness", or a "strengthening of emotional bonds".

The partnership as a victim AND a resource

 The disease clearly has a negative impact on partnerships. This is evident from the distress felt by both partners, the woman’s physical and psychological suffering, the subjective burden that the man has to bear and the changes to the couple’s sex life. But Cairo Notari points out that the partnership is not a powerless victim. In the conclusion to her thesis she writes, "The role of the couple’s relationship as a source of strength is without doubt the most significant aspect that we were able to bring to light in this study." She adds that these results have "confirmed that a satisfying relationship plays a role in protecting women and their partners who are dealing with breast cancer." She therefore suggests that it is important to "look after the health of the relationship as well as the woman’s health", although she recognises that the complex nature of marital satisfaction makes it difficult to carry out preventive clinical interventions.

Next steps

This thesis, which was supervised by Professor Nicolas Favez, will soon be followed by further publications on the subject. A fourth set of data, gathered two years after diagnosis of the illness, still needs to be analysed. In addition, French and Belgian teams are interested in sharing their respective research with the Swiss team.

Speaking at Cairo Notari’s public defence of the thesis, Friedrich Stiefel, a professor at Lausanne University and head of the psychiatric liaison service at Lausanne University Hospital, said, "This work opens up a whole new line of research." Another member of the jury, Professor Darius Razavi from the Université libre de Bruxelles, called the research a "marvellous study" dealing with "people in very vulnerable situations". Now financing must be found so that the study can be continued. "It is easier to obtain funding for collecting rather than analysing data," rightly says Nicolas Favez...


>> Cairo Notari, S. (2016). L’ajustement psychologique de la femme et de son partenaire au cancer du sein. / The psychological adjustment of women and their partners to breast cancer. Supervised by Nicolas Favez. University of Geneva

Previous publication:

>> Favez, N., Cairo Notari, S., Charvoz, L., Notari, L., Ghisletta, P., Panes Ruedin, B., Delaloye, J.-F.. (2015). Distress and body image disturbances in women with breast cancer in the immediate postsurgical period: The influence of attachment insecurity. Journal of Health Psychology. 1–10. 2015.