Supportive Care in Cancer

, Volume 15, Issue 4, pp 405–415

Life after cancer: couples’ and partners’ psychological adjustment and supportive care needs

  • K. Hodgkinson
  • P. Butow
  • G. E. Hunt
  • R. Wyse
  • K. M. Hobbs
  • G. Wain
Original Article


Goals of work

Partners of cancer patients may experience significant distress at the time of treatment and many may experience persistent difficulties, although little research has examined their longer term psychosocial outcomes or supportive care needs.

Materials and methods

One hundred and fifty-four cancer survivors who were 1–11 years post diagnosis and disease-free and their partners completed mailed questionnaires.

Main results

A positive relationship was found between psychological distress and supportive care needs both within and between partner and survivor samples. Partners reported high levels of anxiety and supportive care needs, most frequently concerning relationships and the impact of the cancer illness. Partners within couples reported both shared and unique needs, although agreement on ratings of shared needs was low. Needs did not diminish over time although partners demonstrated psychological resilience and reported positive outcomes. Predictors of distress and unmet needs were explored: physical QOL, relationship satisfaction, and total needs contributed to variability in partners’ distress; relationship satisfaction and total needs were associated with survivors’ distress. Distress and relationship satisfaction were associated with partners’ unmet needs; only distress was associated with survivors’ unmet needs.


Partners are not merely providers of support, but need support themselves many years after a cancer diagnosis and in the context of apparently cured disease. The quality of the dyadic relationship may be critical in determining both partner and survivor distress and needs, and may prove a useful target for psychosocial interventions.


Cancer survivors Partners Couples Supportive care needs 


  1. 1.
    Affleck G, Tennen H, Croog S, Levine S (1987) Causal attribution, perceived benefits, and mortality following heart attack: an eight year study. J Consult Clin Psychol 55:29–35PubMedCrossRefGoogle Scholar
  2. 2.
    Australian Bureau of Statistics (2003) National Health Survey: Mental Health, Australia. Cat. No. 4811.0, ABS, Canberra, AustraliaGoogle Scholar
  3. 3.
    Australian Bureau of Statistics (1990) Socio-economic indexes for areas. Cat. No. 1356.0, ABS, Canberra, AustraliaGoogle Scholar
  4. 4.
    Baider L, De Nour AK (1993) Impact of cancer on couples. Cancer Invest 11:706–713PubMedGoogle Scholar
  5. 5.
    Baider L, De Nour AK (1999) Psychological distress of cancer couples: a levelling effect. New Trends Exp Clin Psychiatry 15:197–203Google Scholar
  6. 6.
    Ben Zur H, Gilbar O, Lev S (2001) Coping with breast cancer: patient, spouse, and dyad models. Psychosom Med 63:32–39PubMedGoogle Scholar
  7. 7.
    Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital anxiety and depression scale. An updated literature review. J Psychosom Res 52:69–77PubMedCrossRefGoogle Scholar
  8. 8.
    Blanchard CG, Toseland RW, McCallion P (1996) The effects of a problem-solving intervention with spouses of cancer patients. J Psychosoc Oncol 14:1–21CrossRefGoogle Scholar
  9. 9.
    Bonevski B, Sanson-Fisher R, Girgis A, Burton L, Cook P, Boyes A (2000) Evaluation of an instrument to assess the needs of patients with cancer. Supportive Care Review Group. Cancer 88:217–225PubMedCrossRefGoogle Scholar
  10. 10.
    Bowman KF, Rose JH, Deimling GT (2006) Appraisal of the cancer experience by family members and survivors in long term survivorship. Psychooncology 15:834–845PubMedCrossRefGoogle Scholar
  11. 11.
    Brown HG (1990) The twenty-first century and the control of cancer? Oncol Nurs Forum 17:497–501PubMedGoogle Scholar
  12. 12.
    Carver CS, Smith RG, Petonis VM, Antoni MH (2006) Quality of life among long-term survivors of breast cancer: Different types of antecedents predict different classes of outcomes. Psychooncology 15:749–758PubMedCrossRefGoogle Scholar
  13. 13.
    Carlson LE, Ottenbreit N, St Pierre M, Bultz BD (2001) Partner understanding of the breast and prostate cancer experience. Cancer Nurs 24:231–239PubMedCrossRefGoogle Scholar
  14. 14.
    Cochrane BB, Lewis FM (2005) Partner’s adjustment to breast cancer: a critical analysis of intervention studies. Health Psychol 24:327–332PubMedCrossRefGoogle Scholar
  15. 15.
    Corney RH, Crowther ME, Everett H, Howells A, Shepherd JH (1993) Psychosexual dysfunction in women with gynaecological cancer following radical pelvic surgery. Br J Obstet Gynaecol 100:73–78PubMedGoogle Scholar
  16. 16.
    Davis-Ali SH, Chesler MA, Chesney BK (1993) Recognizing cancer as a family disease: worries and support reported by patients and spouses. Soc Work Health Care 19:45–65PubMedCrossRefGoogle Scholar
  17. 17.
    Ell KO, Nishimoto RH, Mantell JE, Hamovitch MB (1988) Psychological adaptation to cancer: a comparison among patients, spouses, and non spouses. Fam Syst Med 6:335–348CrossRefGoogle Scholar
  18. 18.
    Foley KL, Farmer DF, Petronis VM, Smith RG, McGraw S, Smith K, Carver CS, Avis N (2006) A qualitative exploration of the cancer experience among long-term cancer survivors: comparisons by cancer type, ethnicity, gender and age. Psychooncology 15:248–258PubMedCrossRefGoogle Scholar
  19. 19.
    Galbraith ME, Arechiga A, Ramirez J, Pedro LW (2005) Prostate cancer survivors and partners’ self-reports of health related quality of life, treatment symptoms, and marital satisfaction 2.5–5.5 after treatment (Electronic version). Oncol Nurs Forum 32:E30–41PubMedCrossRefGoogle Scholar
  20. 20.
    Gilbar O, Steiner M, Atad J (1995) Adjustment of married couples and unmarried women to gynaecological cancer. Psychooncology 4:203–211CrossRefGoogle Scholar
  21. 21.
    Glasdam S, Jensen AB, Madsen EL, Rose C (1996) Anxiety and depression in cancer patients’ spouses. Psychooncology 5:232–239CrossRefGoogle Scholar
  22. 22.
    Gotay CC (1984) The experience of cancer during early and advanced stages: the views of patients and their mates. Soc Sci Med 18:605–613PubMedCrossRefGoogle Scholar
  23. 23.
    Haylock PJ (2006) The shifting paradigm of cancer care: the many needs of cancer survivors are starting to attract attention. Am J Nurs 3:16–19Google Scholar
  24. 24.
    Helgeson VS, Snyder P, Seltman H (2004) Psychological and physical adjustment to breast cancer over 4 years: identifying distinct trajectories of change. Health Psychol 23:3–15PubMedCrossRefGoogle Scholar
  25. 25.
    Hodgkinson K, Butow P, Hunt GE, Hobbs K, Lo SK, Wain G (2006) Assessing unmet supportive care needs in partners of cancer survivors: the development and evaluation of the Cancer Survivors Partners Unmet Needs measure (CaSPUN). Psychooncology (in press)Google Scholar
  26. 26.
    Hodgkinson K, Butow P, Hunt GE, Pendlebury S, Hobbs KM, Lo SK, Wain G (2006) The development and evaluation of a measure to assess cancer survivors’ unmet supportive care needs: the CaSUN (Cancer Survivors Unmet Needs measure). Psychooncology (in press)Google Scholar
  27. 27.
    Ibbotson T, Maquire P, Selby P, Priestman T, Wallace L (1993) Screening for depression and anxiety in cancer patients using the Hospital Anxiety and Depression Scale. Gen Hosp Psychiatry 15:69–74CrossRefGoogle Scholar
  28. 28.
    Jacobsen PB, Donovan KA, Trask PC, Fleishman SB, Zabora J, Baker F, Holland JC (2005) Screening for psychologic distress in ambulatory cancer patients. Cancer 103:1494–1502PubMedCrossRefGoogle Scholar
  29. 29.
    Janda M, Eakin EG, Bailey L, Walker D, Troy K (2006) Supportive care needs of people with brain tumours and their carers (electronic version). Support Care Cancer 1433–7339Google Scholar
  30. 30.
    Kinsinger DP, Penedo FJ, Antoni MH, Dahn JR, Lechner S, Schneiderman N (2006) Psychosocial and sociodemographic correlates of benefit-finding in men treated for localized prostate cancer. Psychooncology (in press)Google Scholar
  31. 31.
    Krol Y, Van Dam FSAM, Horenblas S, Meinhardt W, Muller MJ (2000) The need for information by men with prostate cancer and their partners. Ned Tijdschr Geneesk 144:431–437Google Scholar
  32. 32.
    Lavery JF, Clarke VA (1999) Prostate cancer: patients’ and spouses’ coping and marital adjustment. Psychol Health Med 4:289–302CrossRefGoogle Scholar
  33. 33.
    Lechner SC, Zakowsk SG, Antoni MH, Greenhawt M, Block K, Block P (2003) Do sociodemographic and disease-related variables influence benefit-finding in cancer patients? Psychooncology 12:491–499PubMedCrossRefGoogle Scholar
  34. 34.
    Manne S, Ostroff J, Winkel G, Goldstein L, Fox K, Grana G (2004) Posttraumatic growth after breast cancer: patient, partner, and couple perspectives. Psychosom Med 66:442–454PubMedCrossRefGoogle Scholar
  35. 35.
    Mullen F (1985) Seasons of survival: reflections of a physician with cancer. N Engl J Med 313:270–273CrossRefGoogle Scholar
  36. 36.
    Nijboer C, Triemstra M, Tempelaar R, Sanderman R, Van den Bos GAM (1999) Measuring both negative and positive reactions to giving care to cancer patients: psychometric qualities of the Caregiver Reaction Assessment (CRA). Soc Sci Med 48:1259–1269PubMedCrossRefGoogle Scholar
  37. 37.
    Northouse LL (1988) Social support in patients’ and husbands’ adjustment to breast cancer. Nurs Res 37:91–95PubMedCrossRefGoogle Scholar
  38. 38.
    Northouse LL (1989) A longitudinal study of the adjustment of patients and husbands to breast cancer. Oncol Nurs Forum 16:511–516PubMedGoogle Scholar
  39. 39.
    Northouse LL, Templin T, Mood D, Oberst M (1998) Couples’ adjustment to breast cancer and benign breast disease: a longitudinal analysis. Psychooncology 7:37–48PubMedCrossRefGoogle Scholar
  40. 40.
    Pelusi JL (1999) Cancer survivorship: the other side. The lived experience of partners of long-term breast cancer survivors. Diss Abstr Int B Sci Eng 60:4-BGoogle Scholar
  41. 41.
    Ptacek JT, Ptacek JJ, Dodge KL (1994) Coping with breast cancer from the perspectives of husbands and wives. J Psychosoc Oncol 12:47–72CrossRefGoogle Scholar
  42. 42.
    Rees CEBP, Bath PAB (2000) The information needs and source preferences of women with breast cancer and their family members: a review of the literature published between 1988 and 1998. J Adv Nurs 31:833–841PubMedCrossRefGoogle Scholar
  43. 43.
    Rosner BA (1990) Fundamentals of biostatistics. PWS-Kent, BostonGoogle Scholar
  44. 44.
    Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P (2000) The unmet supportive care needs of patients with cancer. Supportive Care Review Group. Cancer 88:226–237PubMedCrossRefGoogle Scholar
  45. 45.
    Schulz R, Beach SR (1999) Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA 282:2215–2219PubMedCrossRefGoogle Scholar
  46. 46.
    Soothill K, Morris SM, Thomas C, Harman JC, Francis B, McIllmurray MB (2003) The universal, situational, and personal needs of cancer patients and their main carers. Eur J Oncol Nurs 7:5–13PubMedCrossRefGoogle Scholar
  47. 47.
    Spanier GB (1976) Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marriage Fam 38:15–28CrossRefGoogle Scholar
  48. 48.
    Steginga SK, Occhipinti S, Dunn J, Gardiner RA, Heathcote P, Yaxley J (2001) The supportive care needs of men with prostate cancer (2000). Psychooncology 10:66–75PubMedCrossRefGoogle Scholar
  49. 49.
    Surbone A, Peccatori FA (2006) Unmet needs of cancer survivors: supportive care’s new challenge. Support Care Cancer 14:397–399PubMedCrossRefGoogle Scholar
  50. 50.
    Tedeschi RG, Calhoun LG (1996) The Posttraumatic growth inventory: measuring the positive legacy of trauma. J Trauma Stress 9:455–471PubMedCrossRefGoogle Scholar
  51. 51.
    Thewes B, Butow P, Girgis A, Pendlebury S (2004) Asessment of unmet needs among survivors of breast cancer. J Psychosoc Oncol 22:51–73CrossRefGoogle Scholar
  52. 52.
    Thornton AA (2002) Perceiving benefits in the cancer experience. J Clin Psychol Med Settings 9:153–165CrossRefGoogle Scholar
  53. 53.
    Thornton AA, Perez MA (2006) Posttraumatic growth in prostate cancer survivors and their partners. Psychooncology 15:285–296PubMedCrossRefGoogle Scholar
  54. 54.
    Tuinman MA, Fleer J, Hoekstra HJ, Sleijfer DT, Hoekstra-Weebers JE (2004) Quality of life and stress response symptoms in long-term and recent spouses of testicular cancer survivors. Eur J Cancer 40(11):1696–1703PubMedCrossRefGoogle Scholar
  55. 55.
    Twombly R (2004) What’s in a name: who is a cancer survivor? J Natl Cancer Inst 96:1414–1415PubMedGoogle Scholar
  56. 56.
    Wagner CD, Bigatti SM, Storniolo AM (2006) Quality of life of husbands of women with breast cancer. Psychooncology 15(2):109–120PubMedCrossRefGoogle Scholar
  57. 57.
    Ware JE (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233PubMedCrossRefGoogle Scholar
  58. 58.
    Wen KY, Gustafson DH (2004) Needs assessment for cancer patients and their families. Health Qual Life Outcomes 2:1–12CrossRefGoogle Scholar
  59. 59.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370PubMedGoogle Scholar
  60. 60.
    Zahlis EH, Shands ME (1993) The impact of breast cancer on the partner 18 months after diagnosis. Sem Oncol Nurs 9(2):83–87CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • K. Hodgkinson
    • 1
    • 2
  • P. Butow
    • 3
  • G. E. Hunt
    • 2
  • R. Wyse
    • 3
  • K. M. Hobbs
    • 1
  • G. Wain
    • 1
  1. 1.Department of Gynecologic CancerWestmead HospitalWestmeadAustralia
  2. 2.Department of Psychological MedicineUniversity of SydneySydneyAustralia
  3. 3.Medical Psychology Research Unit, School of Psychology, Griffith Taylor Building (A19)University of SydneySydneyAustralia

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