October is Breast Cancer Awareness Month – a time to increase awareness of the disease. While women who are currently battling breast cancer, those who have fought the disease and won and loved ones who were lost to breast cancer tend to be the primary focus, breast cancer has victims beyond the afflicted individual – their families.

 

Maureen Davey, PhD, associate professor in the Department of Couple and Family Therapy said, “A lot of oncology providers forget to ask if patients have children or partners/spouses at home. It’s understandable – oncology providers have limited time and tend to focus on case management and treating the cancer. Providers may not know how to help patients and their families cope with the psychosocial aspects of the disease. Couple and family therapists can help families coping with breast cancer.”

 

Couple and family therapists are trained to use relational approaches, partnering with oncologists and patients to help children and partners cope with a diagnosis. “In my opinion, breast cancer affects the whole family, not just patients, so it really is a natural fit for us to help them,” said Davey.

 

An estimated 30% of women diagnosed with breast cancer have one or more school-aged or adolescent child still living in the home. Children and adolescents often report struggling with their parents’ lack of availability, which can lead to developmental and psychosocial issues. For older adolescents, especially girls, when a mother has breast cancer, the risk of being distressed is greater. “If mom can’t go to the school play, mom and dad are busy with doctor’s appointments or mom is sick from her treatment – all of these contribute to making the parent less emotionally and practically available, which affects many kids,” said Davey. 

 

Communication is often impacted by a breast cancer diagnosis. Kids may not tell their parents how they’re feeling because they don’t want to burden them, and similarly, parents may not tell their kids what’s going on because they believe if they don’t tell them it won’t affect them. Davey said that although it is understandable parents want to protect to their children, it has the opposite effect. “It often affects them the worst when you don’t tell them because then they imagine the worse possible scenario.”

 

So how can a couple and family therapist intervene? The best practice for helping children cope with a parental breast cancer diagnosis is working with parents and children both separately and then together. A promising program is the Enhancing Connections program developed by Dr. Frances Marcus Lewis,  a University of Washington Medical Center Endowed Professor in Nursing and Fred Hutch research affiliate, which aims to improve communication between mothers coping with breast cancer and children ages 8-12. This 5-session in-home intervention program primarily works with parents to help them talk more openly to their children and in between sessions parents are encouraged to use workbooks and activity books to help illustrate and initiate conversations about feelings of stress, treatment and the mother’s diagnosis. Several randomized control trials support the positive impact of this program on mothers and their children. 

 

Another factor that heavily impacts children is the quality of their parents’ marriage. Parenting can become impaired because of the understandable stress of navigating the many medical appointments and side effects of treatment (e.g., fatigue, nausea), so kids may experience a less engaged parent as well as decreased supervision, lack of consistency and sometimes more hostility. Approximately 25% of children coping with parental cancer will have behavioral, social and self-esteem issues.

In couples where one partner is diagnosed with cancer, there is often less intimacy and lower relationship satisfaction. A leading cause for this relationship strain is depression in both the patient and partner. “When women are coping with breast cancer, it often leads to feelings of anxiety and depression,” said Davey. “A lot of patients are actually still distressed up to three years post-treatment. 

When breast cancer patients are emotionally distressed, it affects how they’re going to relate to their partner. Couple and family therapists can help couples coping with cancer and improve quality of life for the patient and her partner. It makes sense that you’re scared and depressed. How can you then turn to your partner and be present for your kids as you’re going through this really tough treatment regimen?”

 

There are many interventions for couples coping with cancer, in particular cognitive behavioral and psychoeducation models where the patient is the focus and the partner is a support person.  However, Hold Me Tight (developed by Susan Johnson, 2009) which Davey and her team have adapted for couples coping with cancer in pilot studies, focuses on both partners and uses an attachment framework. Five multiple-couple support groups focus on increasing their connection to each other and facilitating secure attachment so couples are not fighting the cancer alone, but together as a securely attached and emotionally responsive couple. 

 

“A lot of couples may not be as attuned to each other and are unable to recognize each other’s needs at this tough time,” said Davey. “We want them to turn to each other and be more responsive instead of pushing each other away out of feelings of fear.” Again, her recently completed pilot feasibility study with Drs. Lynch, Liu and Komarnicky showed the positive impact -- both partners and patients reported their relationship improved and they experienced less stress about the cancer after completing the 5 couple support group sessions of Hold Me Tight.

 

“Couple and family therapists are relationship experts who put the family at the center of healthcare. How can we help support this person and bring in the people around them to help them through this really tough treatment regimen? It can be as simple as getting someone to drive them to treatment because afterward they’re not feeling well enough to drive home.” The effects of breast cancer are far-reaching. Couple and family therapists have a unique ability to help couples and families cope with cancer which is systemic and considers the individual coping with breast cancer in the context of partners and children at home.