Being diagnosed with cancer is a frightening event and will impact every member of the family. Family members are often left asking the question, “What do we do now?” With improved treatment strategies, prevention techniques, and early detection tests, a diagnosis of cancer is not as grim as it once was. In fact, cancer has become more of a chronic illness than a fatal disease. With this change comes a focus on quality of life concerns and family therapists can play a key role in improving the quality of life for individuals (including partners and families) who have been diagnosed with cancer.
Effects of Cancer on the Family
For many people, a cancer diagnosis is accompanied with complete shock. No one believes that they or someone in their family will be diagnosed with cancer. However, cancer affects millions of families every year. One of the most challenging aspects of cancer is managing the disruption that occurs in everyday life, in addition to other life stressors (raising children, planning for retirement, working, recent divorce, etc.). When someone is diagnosed with cancer, regardless of the type, the diagnosis can evoke a great deal of worry and fear throughout the family. The uncertainty regarding the type of cancer, prognosis, and treatment options can be overwhelming for patients and family members. In fact, partners and family members often exhibit more distress than the cancer patient. This distress may be a result of losing control, feeling hopeless, financial difficulties and anticipatory loss that are often associated with a cancer diagnosis. While cancer can have a substantial impact on physical health, there are also varying degrees of psychological and social implications that result from being diagnosed and treated for cancer.
How can the problem affect a relationship?
Some problems related to cancer can be specific to the period of life (early adulthood, middle adulthood, late adulthood) that cancer occurs. For instance, a 40-year-old mother of two small children with ovarian cancer could have a number of different challenges than a 70-year-old man with prostate cancer. In addition, some families will thrive in the face of adversity while other relationships deteriorate. Many families do not know how to communicate about illness and often develop maladaptive patterns that can be detrimental to the recovery process and quality of life. However, families who effectively communicate report becoming closer with their loved ones.
In early adulthood, a cancer diagnosis can come as a shock and often involves parents of young or teenage children. Facing cancer while balancing the life demands of raising children, working, and maintaining a marriage can be extremely challenging. Depending on the developmental level, many children are very confused when their parent is diagnosed with cancer. Children will often ask questions that may be difficult to answer and family members are worried that they are going to lose their mother, father, or partner. This threatened loss for the parent could also change the parent-child dynamic and cause additional role changes.
In middle adulthood, individuals are usually employed and may find it difficult to balance work demands with managing illness. In addition, the social support from the children and other family members may be scarce due to other demands. Many couples share fears, worries, and depressive symptoms when a partner is diagnosed with cancer. This can be especially difficult when a partner is one’s primary support system.
In late adulthood, a cancer diagnosis may sometimes even be expected, however this does not change the distress that cancer can have on the family. When cancer occurs in late adulthood, many of the social supports that were present in previous periods of life may be missing. In addition, the adult children of the cancer patient are often faced with difficult decisions associated with treatment and care. Being faced with one's own mortality can be a challenging adjustment for the patient, family members and friends.
What challenges face the individual or loved one?
Cancer patients and their family members may experience some of the following effects:
- Anger or irritability
- Frustration with circumstances
- Loss of hope
- Fear of recurrence
- Anticipatory grief
- Role changes within family
- Sexual dysfunction
- Physical disfigurement
- Decreased self esteem
- Communication difficulties
- Relationship stress
- Loss of sleep
- Decreased appetite
- Loss of income and financial reserves
- Anticipating loss
- End of life concerns and decisions
How do you know when to seek help?
Despite the shock of the initial diagnosis of cancer, many families are capable of adjusting very well without professional help. However, one should seek help if one or more of the following is true:
- Notice significant distress in the individual with cancer, couple relationship, or other family dynamic.
- Have trouble communicating about the illness with family members or partner
- Have trouble with problem solving or decision making during the process
- Notice symptoms of depression (sadness, avoiding others, suicidal thoughts, crying)
- Notice symptoms of anxiety or worry (if worries are impacting everyday life)
- Have trouble managing side effects from cancer, and/or treatment
- If persistent distress is impacting you on a daily basis.
- If you need another support system during the adjustment process to cancer
Many individuals could benefit from seeking out help whenever someone is first diagnosed with cancer in order to make the adjustment to the illness and side effects more efficiently and to prevent long-term implications from maladaptive patterns of dealing with cancer. However, most seek out help when they first notice one of the listed symptoms.
What kinds of interventions are commonly used?
Through understanding how cancer impacts the family, a family therapist is capable of helping family members effectively communicate about the illness, expectations, and adjustments over time. While the treatments do not change the course of the disease, the idea is that the treatment will reduce the amount of distress that the cancer causes the family. MFTs can help the family retake control in their life and effectively make decisions that improve quality of life. Problem solving strategies have been a focus for therapy with cancer patients and families, as decision making during a time of crisis can be difficult. In addition, cognitive-behavioral therapy has been effective in helping individuals, couples, and families manage some of the worries and fears associated with cancer. Couple or family therapy can help the family improve communication and understand how cancer has changed the family.
How can an MFT help the client and family?
Adjusting to an illness within the family is never easy. A family therapist can assist the family in managing role changes, improving communication and relational dynamics, and preparing the family as the disease changes. Understanding and managing the emotional impact that cancer has on a family can create a proactive, positive family environment, especially with regards to problem solving. Decision making can often be challenging in the face of a difficult diagnosis and a family therapist can help families navigate through the hard decisions that they may be facing. A qualified family therapist can help you manage the emotional (depression, anxiety, worries, fear) social (financial, job changes, disability) and relational (communication, role changes, sexual dysfunction) issues associated with cancer. Following treatment, MFTs can help the family adjust to the multiple side effects that often accompany cancer and its treatment. For instance, individuals with breast cancer, prostate cancer, or other pelvic malignancies may have a variety of sexual dysfunction. Sexual dysfunction from illness can disrupt intimacy and cause additional psychological distress that could be remedied from work with a family therapist.
This brochure was written by Patrick Meadors, PhD, and prepared with the assistance of the East Carolina University’s Medical Family Therapy Doctoral Program.
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