As any person with cancer knows, a cancer diagnosis also affects your family members and friends. Sometimes, the complex feelings and lifestyle changes caused by cancer and its treatment become as overwhelming for family members and friends as they are for you. Understanding the potential changes in the way you relate to specific family members and friends and in the way they relate to you may help you take steps to foster healthy, mutually supportive relationships during this challenging time.
Spouses and partners
Cancer has the greatest effect on marriages and other long-term partnerships. After a diagnosis of cancer, both partners may experience sadness, anxiety, anger, or even hopelessness. There may be shifts in relationships and in the way spouses organize to take care of household chores or family activities. For some couples, facing the challenges of cancer together strengthens their relationship and commitment. For others, especially those who struggled before the diagnosis, the stress of cancer may create more problems.
Although the effects of cancer vary from couple to couple, here are some changes that occur frequently in relationships.
Roles. Cancer may change your and your partner's roles, often in unexpected ways. Some partners become overprotective or controlling. This tendency may also affect the exchange of information both at home and with the medical team. Although it is may seem normal or even generous to try to spare your spouse some details of the diagnosis or treatment, keeping secrets usually turns out to be isolating for both. Often husbands or wives of those affected by cancer try to gain some control by becoming âexperts' in some area of the disease or by keeping the schedule or treatment and communicating with the medical team. If this is comfortable for both, then it may help in coping with the illness, but it is important to remain flexible and listen to each other's needs.
Adjusting to a shift in roles does not come easily. A person who has always been in charge or served as the caregiver may have trouble adjusting to a more dependent role, while a person who has not served in those roles may struggle to take charge and provide care.
These role changes often affect one's self esteem. Either partner may feel frustrated by the other's overprotectiveness or feel isolated when decisions aren't discussed. It is important to talk with your spouse or partner about your feelings, and work together as best as you can to make decisions about treatment, caregiving, and other issues. It may help you to think about it as teamwork and plan your strategy together. With pen and paper, jot down what tasks or chores need to be done and negotiate who should assume primary responsibility for each. Learn more about how to talk with your spouse or partner about cancer .
Responsibilities. In most relationships, each partner is responsible for specific chores. One partner may do yard work and cook, while the other cleans and pays bills. If the illness leaves a person feeling exhausted or unable to perform his or her usual tasks, they may fall on the shoulders of a spouse or relative. If you must stop working, your partner may need to go back to work or work extra hours, whileâin many casesâtaking on the responsibility of caregiving . These added responsibilities may become overwhelming and lead to feelings of frustration and resentment. Meanwhile, you may feel guilty for burdening your spouse or partner and feel sad and frustrated by your limitations.
Both people in your relationship may benefit from switching domestic or household chores or active jobs. In addition, although it may be difficult for both partners, it is important to accept outside help from friends, family members, or professionals. Talking openly about limitations and brainstorming possible solutions will help both of you feel more comfortable with changes in responsibilities.
Needs. Because physical and emotional needs change frequently as couples cope with cancer, it is important for both partners to communicate their needs. Asking for help with basic activities of daily life, such as getting dressed or washing your hair, may be difficult. At the same time, you cannot assume that your partner or spouse knows or guesses that you need help or simply may not want to offend you by offering. It is important to talk openly and clearly express your needs to avoid the frustration and anger that could result from misinterpreting your spouse's behavior. Sometimes both partners need extra reassurance that they are still loved.
Sexuality and intimacy. Another important aspect of marital life that is often affected by a diagnosis of cancer or its treatment is sexuality . Depression, fatigue, nausea, erectile dysfunction, vaginal dryness, and other physical or emotional problems may lower sex drive or make intercourse difficult or painful. Both partners may feel anxious about this issue, but they may be reluctant to talk about it. Every couple has varying levels of comfort in discussing sexuality and intimacy. If this discussion is especially awkward or uncomfortable for you, consider getting help from a counselor, therapist, your doctor or a social worker. Doctors do not always regularly discuss this topic during office visits, but they should be able to listen to your concerns and provide guidance. Often, they can help facilitate these discussions, provide suggestions for managing sexual side effects, and suggest ways to maintain intimacy.
Future plans. Cancer often changes the hopes and dreams that couples share. Your plans for retirement, traveling, or even parenthood may change, causing feelings of sadness or even anger. The process of working together to meet new, short-term goalsâsuch as finishing cancer treatmentâcan help couples feel more connected. For some, reevaluating priorities may result in a better outlook on life. Things that seemed important before the cancer diagnosis may give way to new priorities, such as enjoying more time together. Putting some goals on hold, rather than abandoning them completely, helps.
Friends and adult family members
The effects of cancer on your relationships with friends and family members vary widely, largely dependent on the closeness of each relationship. We all know that different families have different communication and coping styles. It is helpful to think how your family reacts in a crisis and how you have all dealt with other difficult situations and then plan your strategy for communicating news and asking for support. Here are some suggestions to help you adjust to these relationship changes, based on what has worked well for other families in similar situations.
Put one person in charge of giving medical updates. It is exhausting to phone every family member after every test result or doctor's appointment. Designate a family member to be the go-to person for medical information and have them make the necessary phone calls, post the updates online (if you are comfortable with this mode of communication), and field questions. This person may also be able to assign tasks to family members who offer to help.
Expect relationships to change. Many people have little experience with life-threatening illnesses and don't know what to say or how to act when someone has cancer. It may be frightening to some because it is a reminder that cancer can happen to anyone. Others may have lost a loved one to cancer, and your diagnosis may bring up painful memories. For these reasons, some of your friends or family members may not be able to offer you the support that you expect. Although this is painful, try to remember that their reactions are not just a reflection of how much they care about you, but also may reflect their own past experiences and losses. Although some friends and family members may distance themselves from you, others will surprise you with emotional and physical support throughout your illness.
Take the lead in talking. Some friends and family members may avoid talking with you because they don't know what to say. Others may avoid talking about cancer, fearing that they will upset you. If you feel like talking about your cancer, bring up the subject with your friends and family members and let them know that it's okay for them to talk about it. Reassure them that you don't expect answers; you only want them to listen and try to understand your feelings. It is also okay to tell people when you don't want to talk about your cancer. Sometimes you might prefer to talk about normal things or to laugh with your friends.
Let people help you. Your friends and family members will likely want to help you, but they might not know what you need or how to ask you. Be specific, direct, and explicit about your needs and try not to make assumptions about who will help and who will not. Prepare a list of tasks that people can do for you. For example, ask friends or family members to do your laundry, walk the dog, or keep others updated on your progress. However, if you find that you have a well-meaning but overbearing family member who is complicating your efforts, you or a close family member will need to set limits. This may be difficult but it is best to be direct and let them know exactly what you need and can tolerate. One way to approach this is to say “I appreciate your involvement, but your being here every day is making me tired. The best way you can help me is by coming by onâ¦ [name a specific day or time].”
Stay involved in social activities. As much as possible, try to maintain social contact with friends and family. Your friends might assume that you don't want to be invited to social events, so let them know to keep inviting you, if that is your preference. Meanwhile, let people know about your physical limitations; most friends and family members will be happy to plan quiet activities, such as going to the movies or fixing lunch at your house. And don't be afraid to cancel a date if you are physically or emotionally tired.
Being a parent with cancer presents unique challenges. The demands of cancer and treatment make it difficult to care for young children. For young children, the thought of losing a parent is frightening, which makes many parents try to hide the truth about the diagnosis of cancer from their children. One important concept to remember is that if your children learn about your diagnosis from other adults instead of you or your spouse, they may think it is too awful to talk about. Open and honest communication about cancer or any other illness, in a way that is developmentally appropriate and conforms to your children's temperament and your family values, is the best way forward. It is an investment in your family's mental health and will strengthen your bonds with each other and help your children mature and bear the experience.
In reality, even very young children can sense that something is wrong, and they need honest information to help them cope. Keep in mind your children's ages, and give them truthful and accurate information that they can understand but that won't overwhelm them. Focus on things that will affect them directly, such as changes to their schedules or changes in your appearance, which might be more frightening if the changes are unexpected. Learn about how a child understands cancer , and get more tips on talking with your children .
Expect changes in your children's behavior as they adjust. Younger children may become overly clingy or impulsive. Older children or teenagers, on the other hand, may become angry or distant and withdraw from family activities. Try to keep your children's daily schedules as normal as possible and be patient. Encourage children to ask questions and let them know it is okay to talk about their feelings and fears. Reassure your children that they will always be cared for and that you will always love them.
Meanwhile, adult children may act as caregivers for a parent with cancerâa role reversal that is often difficult for both parents and children. Learn more about caring for a parent with cancer .
The importance of communication
As demonstrated above, good communication is especially important in the relationships that people with cancer have with those who care about them. A lack of communication leads to isolation, frustration, and even misunderstandings. Talking about feelings and personal needs with honesty, sincerity, and openness greatly reduces the stress that cancer places on relationships. If you are having a hard time talking with people, or if others don't seem to want to communicate with you, consider asking for help by joining a support group  or talking with a counselor  or social worker .