Effects of a Randomized Couple-based Intervention on Quality of Life of Breast Cancer Patients and Their Partners

Abstract

The purpose of this study was to determine the effectiveness of a couple-based intervention on the quality of life (QOL) of early-stage breast cancer patients and their partners. A randomized controlled design was used to assign couples to either the hospital standard social work services (SSWS) or a couple-based intervention, the Partners in Coping Program (HCP). QOL was measured at three times during the first year after the diagnosis. A series of analyses of covariance revealed that QOL of patients and partners in the HCP arm improved at time 2 and time 3 and was consistently higher than the QOL of couples in the SSWS arm, controlling for QOL at time 1. However, differences between the two arms on QOL were not statistically significant. Patients in the HCP who were in relationships of shorter lengths and were receiving chemotherapy made the greatest gains in their QOL, suggesting that these types of patients would benefit more from a couple-based approach to their illness. On the basis of the findings, the authors suggest future directions for intervention research and for social work practitioners who are looking for efficient and effective ways to deliver psychosocial services to cancer patients. KEY WORDS: breast cancer; couples; psychosocial intervention; quality of life ********** Women with breast cancer do not cope with their disease in isolation but, instead, within the context of their interpersonal relationships. Little attention, however, has been given to the partners of breast cancer patients, from whom the women seek support and who are also affected by the illness. Indeed, social work interventions for breast cancer have often excluded the partners. The shift of health care from professionals primarily caring for cancer patients during hospital stays to reliance on family members for provision of care at home underscores the highly compelling need to include partners in the total treatment of the breast cancer patient. LITERATURE REVIEW Breast cancer patients commonly experience emotional and psychological distress in relation to their diagnosis and treatment. Approximately 45% of women newly diagnosed with breast cancer report mild to severe symptoms of anxiety, and 28% of the women report mild to severe symptoms of depression (Dausch et al., 2004). Similar rates of psychological distress have been found when comparing early-stage and advanced breast cancer patients (Kissane et al., 2004). Although breast cancer patients may not have higher rates of psychiatric disorders as defined by DSM-IV (American Psychiatric Association, 1994) than a community sample, they still experience symptoms of anxiety and depression that affect their physical, medical, and sexual quality of life (QOL) (Dausch et al., 2004). The behavioral manifestations of this anxiety and depression can include insomnia, inability to concentrate, loss of appetite, greater use of alcohol and tranquilizers, thoughts of suicide, sexual dysfunction, and disruption of daily activities (Irvine, Brown, Crooks, Roberts, & Browne, 1991). The diagnosis of post-traumatic stress disorder is more commonly found among breast cancer patients than among the general population (Baum & Posluszny, 2001; Dausch et al., 2004). Breast cancer patients are likely to experience stress-related symptoms including repeated, disturbing memories and dreams of their cancer treatment, fears of recurrence, fears of death, and physical reactions when something reminds them of cancer treatment or their experience with cancer (Cordova et al., 1995). The cancer's effect on psychological well-being also extends to partners or spouses. Breast cancer can often expose partners to heightened anxiety, depression, feelings of being unprepared to help their partners, fear of losing their partner, and somatic preoccupations (Given & Given, 1992; Lethborg, Kissane, & Burns, 2003; Northouse & Peters-Golden, 1993; Omne-Ponten, Holmberg, & Sjoden, 1994; Sabo, 1990;Walker, 1997). …