Sexual problems, communication patterns, and depressive symptoms in couples coping with metastatic breast cancer

Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .
Psycho-Oncology (Impact Factor: 2.44). 04/2013; 22(4). DOI: 10.1002/pon.3079
Source: PubMed


The treatment of breast cancer tends to result in physical side effects (e.g., vaginal dryness, stomatitis, and atrophy) that can cause sexual problems. Although studies of early-stage breast cancer have demonstrated that sexual problems are associated with increased depressive symptoms for both patients and their partners, comparatively little is known about these associations in metastatic breast cancer (MBC) and how patients and partners cope together with sexual problems. We examined the links between sexual problems, depressive symptoms, and two types of spousal communication patterns (mutual constructive and demand–withdraw) in 191 couples in which the patient was initiating treatment for MBC.
Patients and partners separately completed paper-and-pencil surveys.
Multilevel models indicated that high levels of sexual problems were significantly associated with more depressive symptoms only for patients who reported low levels of mutual constructive communication (p < 0.01) and high levels of demand–withdraw communication (p < 0.0001). In contrast, for partners, greater sexual problems were associated with more depressive symptoms regardless of the communication pattern reported. These associations remained significant when we controlled for patients' reports of average pain and functional and physical well-being and couples' dyadic adjustment.
Sexual problems were associated with depressive symptoms for both MBC patients and their partners. The way in which patients and partners talk with one another about cancer-related problems seems to influence this association for patients. MBC patients may benefit from programs that teach couples how to minimize demand–withdraw communication and instead openly and constructively discuss sexual issues and concerns. Copyright

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    • "This gap in information provision has been especially prominent for those diagnosed with metastatic breast cancer (MBC) who are often assumed to be more concerned with their poor prognosis than their sexual well-being (Bensing, Rimondini, & Visser, 2013; Gaston & Mitchell, 2005; Olsson, Athlin, Sandin-Boj€ o, & Larsson, 2013; Vilhauer, 2011). As studies have found that sexuality remains a central concern for women diagnosed with MBC (McClelland, Holland, & Griggs, 2015a; Milbury & Badr, 2013; Vilhauer, 2008), this patient population may not be provided with the CONTACT Sara I. McClelland information they require or wish for. "
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    ABSTRACT: Research has found that breast cancer and its treatments can have severe consequences for patients' sexual quality of life (SQoL); however, patients often report not knowing about possible impacts of treatment on their sexual well-being. This gap in information provision has been especially prominent for those diagnosed with metastatic breast cancer (MBC). To address the development of resources for patients diagnosed with MBC, the current study examined patients' descriptions of resources needed to support their SQoL in palliative care. Semi-structured interviews were conducted with 32 women diagnosed with MBC, aged 35–77 in a US breast cancer practice. Patients were asked to describe those issues that were most pressing and the supports they would find most valuable to improving their SQoL. Thematic analysis focused on what was missing in their care and what they wished they knew (or wish they had been told) about cancer and their SQoL. Four themes were developed from the interviews: (1) unexpected embodied loss and mourning; (2) silences; (3) desires for others' expertise, and (4) worries about normalcy. Findings across these themes highlighted how patients' psychosexual needs included both pressing instrumental needs as well as desires for support from oncological medical providers concerning the subjective experience of breast cancer.
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    ABSTRACT: Background Metastatic breast cancer patients experience significance distress. Although talking with close others about cancer-related concerns may help to alleviate distress, patients often avoid such discussions, and their partners can engage in social constraints that may limit subsequent patient disclosures and exacerbate distress. Purpose We examined how partner constraints unfold, how they influence patient affect, and whether they exacerbate patient avoidance of cancer-related disclosures. Methods Fifty-four patients and 48 of their partners completed electronic diary assessments for 14 days. Results Partners’ social constraints carried over from one day to the next, but patients’ avoidance of discussing cancer-related concerns did not. When partners engaged in more social constraints one day, patients reported greater negative affect the following day (p < 0.05). Conclusion Findings suggest a temporal link between partner constraints and patient momentary affect. Helping partners to become aware of their constraining behaviors and teaching them skills to overcome this may facilitate patient adjustment to metastatic breast cancer.
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