Relationship processes and symptom burden in couples coping with metastatic lung cancer.

Abstract

169 Background: Attachment style is a complex behavioral control system rooted in neurophysiological processes which guides a person’s ability to elicit and respond to emotional closeness in an intimate relationship. Patients with high attachment anxiety and/or avoidance may engage in interpersonal behaviors that exacerbate their stress response and perhaps symptom burden. We hypothesized that, while patients’ insecure attachment is associated with increased symptom burden, partners’ positive relationship behaviors may protect against this association. Methods: Patients with metastatic NSCLC and their partners completed cross-sectional surveys assessing attachment (ECR) and emotional closeness during cancer-related discusssions (PAIR). Patients completed the MDASI to measure cancer-related symptoms. We used multi-level modeling for the dyadic analyses. Results: 54 patients (51% female; 80% White; µ age = 65 yrs) and their partners (51% female; 68% White; µ age = 64 years; µ relationship length = 27 years) participated. Patients with high attachment avoidance reported significantly higher cancer symptoms compared to those with secure attachment (MDASI µ’s: 2.14 vs .21, respectively; P<.05). Cancer symptoms were also significantly higher for patients whose partners reported low compared to high closeness during cancer-related discussions (MDASI µ’s: 1.08 vs .42, respectively; P<.05). In fact, there was a significant interaction between partners’ perceptions of closeness and patients’ attachment avoidance (P<.01) so that only patients with high avoidance reported significantly greater symptom burden if their partners reported low closeness (high avoidance and low closeness: MDASI µ = 2.73; high avoidance and high closeness: MDASI µ = 1.32). Conclusions: Patients’ attachment avoidance is significantly associated with their symptom burden. Partners who are able to maintain closeness during cancer-related discussions may protect patients with high attachment avoidance from experiencing increased symptom burden. Teaching partners of patients with insecure attachment to stay emotionally connected during cancer-related discussions may be an important target for psychosocial interventions.