Marital problems lead to poorer outcomes for breast cancer patients

December 8, 2008

Breast cancer patients who have a poor relationship with their spouse may face a more difficult road to recovery than would other women, according to a new study.

Researchers found that, over five years, patients in distressed marriages had higher levels of stress, less physical activity, slower recovery and more symptoms and signs of illness than did similar patients who reported good marriages.

"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," said Hae-Chung Yang, co-author of the study and research associate in psychology at Ohio State University.

"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."

Yang noted that the advantages for women with good relationships held true even though the researchers took into account the patients' depression levels, cancer stage, treatment, and other factors that could have influenced the results.

The study appears online now, and will be published in a future issue of the journal Cancer. Yang conducted the study with Tammy Schuler, a doctoral student at Ohio State.

The study involved 100 women who have participated in the long-running Stress and Immunity Breast Cancer Project at Ohio State. All of the women were married or cohabitating at the time they entered the study and remained so during the five years they were followed.

Participants completed a questionnaire that measured the quality of the relationship they had with their spouse every year for the five-year study period. The majority of participants reported very little change in marital quality over the course of the study and, based on these results, they were split into two groups – those who had a distressed relationship (28 women) and those who did not (72 women).

Participants were regularly measured on levels of cancer-related stress and overall stress, diet, physical activity, general physical functioning, and symptoms and signs of illness.

The results showed that women with good marriages had plenty of advantages, Yang said.

Women in both groups started the study with high and nearly equal levels of cancer-related stress.

"When you're diagnosed, that's devastating for everyone, regardless of the quality of your marriage," Yang said. "But women in good marriages saw steady reductions in their cancer-related stress, while women in distressed marriages had a much slower recovery."

In terms of overall stress, women in distressed marriages saw levels remain stable over the five years, while those in better relationships experienced a steady decline in stress levels.

Women with strong marriages had better dietary habits than those in distressed relationships, and that continued through the course of the study.

Women in strong marriages also maintained adequate levels of physical activity for a longer period of time compared to the women with distressed relationships, whose physical activity dropped steadily.

As far as overall health performance, women in bad relationships saw a significantly slower recovery than did other women. Distressed women also started with significantly higher levels of symptoms and signs of illness compared to women in good relationships, although they recovered over time to the lower levels experienced by the women with good relationships.

Yang said while other studies have looked at how a cancer diagnosis affected the quality of a marriage relationship, this may be the first study to look at how the marital relationship affects long-term recovery from cancer.

She noted that this study found, as did others, that most women do not see a change in the quality of their marital relationship after a cancer diagnosis.

"Whether you have a good or bad relationship before being diagnosed with cancer, that is not likely to change afterwards," she said.

But the nature of that marital relationship will have 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," Yang said.

Source: Ohio State University