Quality of Life of Couples Dealing with Cancer: Dyadic and Individual Adjustment among Breast and Prostate Cancer Survivors and Their Spousal Caregivers

  • Youngmee Kim
  • Deborah A. Kashy
  • David K. Wellisch
  • Rachel L. Spillers
  • Chiew Kwei Kaw
  • Tenbroeck G. Smith
Original Article


Background and Purpose

Although evidence suggests that survivors and spousal caregivers tend to experience somewhat similar levels of distress and that the survivor’s distress affects his/her own quality of life, the degree to which each person’s distress has an independent effect on their partner’s quality of life is unknown. Thus, this study aimed to examine the dyadic effects of psychological distress on the quality of life of couples dealing with cancer.


A total of 168 married survivor–caregiver dyads participating in the American Cancer Society’s Study of Cancer Survivors-I and Quality of Life Survey for Caregivers provided complete data for study variables. Participating survivors were diagnosed with either breast or prostate cancer approximately 2 years prior to participating in the study.


Using the Actor Partner Interdependence Model, results revealed that although each person’s psychological distress is the strongest predictor of their own quality of life, partner’s distress and (dis)similarity in distress of the couple also play significant roles in one’s quality of life. In addition, the adverse effect of having a partner who is less emotionally resourceful was especially pronounced on men’s physical health.


Our systematic investigation provided valuable evidence for identifying the subgroup of cancer survivors and their spouses who are vulnerable to poor quality of life due to their mutual psychological distress. These findings suggest that couples may benefit from interventions that enhance their ability to manage psychological distress, particularly the wife’s, which may improve the mental and physical health of both partners when they are dealing with cancer.


Psychological distress Quality of life Dyadic adjustment 



This study was funded by the American Cancer Society National Home Office, intramural research. We wish to extend our appreciation to Dr. Charles Carver for thoughtful comments; to Dr. Corinne Crammer for editorial assistance; and to all the families who participated in this investigation. The first author dedicates this research to the memory of Heekyoung Kim.


  1. 1.
    American Cancer Society. Cancer Facts and Figures, 2006. Atlanta, GA: American Cancer Society; 2007.Google Scholar
  2. 2.
    Hughes SL, Giobbie-Hurder A, Weaver FM, et al. Relationship between caregiver burden and health-related quality of life. Gerontologist. 1999; 39: 534–545.PubMedGoogle Scholar
  3. 3.
    Nijboer C, Triemstra M, Tempelaar R, et al. Patterns of caregiver experiences among partners of cancer patients. Gerontologist. 2000; 40: 738–746.PubMedGoogle Scholar
  4. 4.
    Baider L, Cooper C, De-Nour AK. Cancer and the Family. 2nd ed. New York: Wiley; 2000.Google Scholar
  5. 5.
    Hodges LJ, Humphris GM, Macfarlane G. A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers. Soc Sci Med. 2005; 60: 1–12.PubMedCrossRefGoogle Scholar
  6. 6.
    Nordin K, Berglund G, Glimelius B, et al. Predicting anxiety and depression among cancer patients: a clinical model. Eur J Cancer. 2001; 37: 376–384.PubMedCrossRefGoogle Scholar
  7. 7.
    Roth A, Kornblith AB, Batel-Copel L, et al. Rapid screening for psychologic distress in men with prostate carcinoma: a pilot study. Cancer. 1998; 82: 1904–1908.PubMedCrossRefGoogle Scholar
  8. 8.
    Vanderwerker LC, Laff RE, Kadan-Lottick NS, et al. Psychiatric disorders and mental health service use among caregivers of advanced cancer patients. J Clin Oncol. 2005; 23: 6899–6907.PubMedCrossRefGoogle Scholar
  9. 9.
    Pitceathly C, Maguire P. The psychological impact of cancer on patients’ partners and other key relatives: a review. Eur J Cancer. 2003; 39: 1517–1524.PubMedCrossRefGoogle Scholar
  10. 10.
    Northouse LL, Templin T, Mood D, et al. Couples’ adjustment to breast cancer and benign breast disease: a longitudinal analysis 18. Psycho-Oncol. 1998; 7: 37–48.CrossRefGoogle Scholar
  11. 11.
    Manne SL. Cancer in the marital context: a review of the literature. Cancer Investig. 1998; 16: 188–202.CrossRefGoogle Scholar
  12. 12.
    Manne SL. Coping and social support. In: Nezu AM, Nezu CM, Geller PA, eds. Handbook of Psychology: Health Psychology, vol. 9. Hoboken, NJ: John Wiley & Sons, Inc; 2003: 51–74.Google Scholar
  13. 13.
    Nezu AM, Nezu CM, Felgoise SH, et al. Project Genesis: assessing the efficacy of problem-solving therapy for distressed adult cancer patients. J Consult Clin Psychol. 2003; 71: 1036–1048.PubMedCrossRefGoogle Scholar
  14. 14.
    Nijboer C, Triemstra M, Tempelaar R, et al. Determinants of caregiving experiences and mental health of partners of cancer patients. Cancer. 1999; 86: 577–588.PubMedCrossRefGoogle Scholar
  15. 15.
    Kim Y, Schulz R, Carver CS. Benefit-finding in the cancer caregiving experience. Psychosom Med. 2007; 69: 283–291.PubMedCrossRefGoogle Scholar
  16. 16.
    Holland JC, Reznick I. Pathways for psychosocial care of cancer survivors. Cancer. 2005; 104: 2624–2637.PubMedCrossRefGoogle Scholar
  17. 17.
    Kenny DA, Kashy DA, Cook WL. Dyadic Data Analysis. New York, NY: Guilford Press; 2006.Google Scholar
  18. 18.
    Given BA, Given CW, Kozachik S. Family support in advanced cancer. Ca. 2001; 51: 213–231.PubMedCrossRefGoogle Scholar
  19. 19.
    Kim Y, Schulz R. Family caregivers’ strains: Comparative analysis of cancer caregiving with dementia, diabetes, and frail elderly caregiving. Journal of Aging and Health. 2007 (in press).Google Scholar
  20. 20.
    Hagedoorn M, Kuijer RG, Buunk BP, et al. Marital satisfaction in patients with cancer: does support from intimate partners benefit those who need it the most? Health Psychol. 2000; 19: 274–282.PubMedCrossRefGoogle Scholar
  21. 21.
    Brown SL, Nesse RM, Vinokur AD, et al. Providing social support may be more beneficial than receiving it: results from a prospective study of mortality. Psychol Sci. 2003; 14: 320–327.PubMedCrossRefGoogle Scholar
  22. 22.
    Manne SL, Ostroff J, Sherman M, et al. Buffering effects of family and friend support on associations between partner unsupportive behaviors and coping among women with breast cancer. J Soc Pers Relatsh. 2003; 20: 771–792.CrossRefGoogle Scholar
  23. 23.
    Gilbar O. Gender as a predictor of burden and psychological distress of elderly husbands and wives of cancer patients. Psycho-Oncol. 1999; 8: 287–294.CrossRefGoogle Scholar
  24. 24.
    Given B, Wyatt G, Given C, et al. Burden and depression among caregivers of patients with cancer at the end of life. Oncol Nurs Forum. 2004; 31: 1105–1117.PubMedCrossRefGoogle Scholar
  25. 25.
    Hagedoorn M, Buunk BP, Kuijer RG, et al. Couples dealing with cancer: role and gender differences regarding psychological distress and quality of life. Psycho-Oncol. 2000; 9: 232–242.CrossRefGoogle Scholar
  26. 26.
    Foxall MJ, Gaston-Johansson F. Burden and health outcomes of family caregivers of hospitalized bone marrow transplant patients. J Adv Nurs. 1996; 24: 915–923.PubMedCrossRefGoogle Scholar
  27. 27.
    Baider L, Ever-Hadani P, Goldzweig G, et al. Is perceived family support a relevant variable in psychological distress? A sample of prostate and breast cancer couples. J Psychosom Res. 2003; 55: 453–460.PubMedCrossRefGoogle Scholar
  28. 28.
    Smith T, Stein KD, Mehta CC, et al. The rationale, design, and implementation of the American Cancer Society's studies of cancer survivors. Cancer. 2007; 109: 1–12.PubMedCrossRefGoogle Scholar
  29. 29.
    Shacham S. A shortened version of the Profile of Mood States. J Pers Assess. 1983; 47: 305–306.PubMedCrossRefGoogle Scholar
  30. 30.
    Ware JE Jr., Kosinski M, Keller S. SF-36 Physical and Mental Health Summary Scales: A User's Manual. 2nd ed. Boston, MA: Health Institute, New England Medical Center; 1994.Google Scholar
  31. 31.
    Arbuckle JL, Wothke W. Amos Users’ Guide, Version 6.0. Chicago: SmallWaters Corporation; 2005.Google Scholar
  32. 32.
    Bollen KA, Stine RA. Bootstrapping goodness-of-fit measures in structural equation models. In: Bollen KA, Long JS, eds. Testing Structural Equation Models. Newbury Park, CA: Sage; 1993: 111–135.Google Scholar
  33. 33.
    Jöreskog KG, Sörbom D. LISREL VI User's Guide. (3rd). Mooresville, IL: Scientific Software; 1984.Google Scholar
  34. 34.
    Hu L, Bentler PM. Cutoff criteria for fit indices in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1999; 6: 1–55.CrossRefGoogle Scholar
  35. 35.
    Baker F, Denniston M, Zabora J, et al. A POMS short form for cancer patients: psychometric and structural evaluation. Psycho-Oncol. 2002; 11: 273–281.CrossRefGoogle Scholar
  36. 36.
    McNair DM, Neuchert JWP. Profile of Mood States: Technical Updates. Multi-Health Systems, Inc., 2005.Google Scholar
  37. 37.
    Coyne JC, Smith DA. Couples coping with a myocardial infarction: a contextual perspective on wives’ distress. J Pers Soc Psychol. 1991; 61: 404–412.PubMedCrossRefGoogle Scholar
  38. 38.
    Hooker K, Manoogian-O'Dell M, Monahan DJ, et al. Does type of disease matter? Gender differences among Alzheimer's and Parkinson's disease spouse caregivers. Gerontologist. 2000; 40: 568–573.PubMedGoogle Scholar
  39. 39.
    Miller B, Cafasso L. Gender differences in caregiving: fact or artifact. Gerontologist. 1992; 32: 498–507.PubMedGoogle Scholar
  40. 40.
    Yee JL, Schulz R. Gender differences in psychiatric morbidity among family caregivers: a review and analysis. Gerontologist. 2000; 40: 147–164.PubMedGoogle Scholar
  41. 41.
    Kiecolt-Glaser JK, Newton T, Cacioppo JT, et al. Marital conflict and endocrine function: are men really more physiologically affected than women? J Consult Clin Psychol. 1996; 64: 324–332.PubMedCrossRefGoogle Scholar
  42. 42.
    Baider L, Koch U, Esacson R, et al. Prospective study of cancer patients and their spouses: the weakness of marital strength. Psycho-Oncol. 1998; 7: 49–56.CrossRefGoogle Scholar
  43. 43.
    Burman B, Margolin G. Analysis of the association between marital relationships and health problems: an interactional perspective. Psychol Bull. 1992; 112: 39–63.PubMedCrossRefGoogle Scholar
  44. 44.
    Kiecolt-Glaser JK, Newton TL. Marriage and health: his and hers. Psychol Bull. 2001; 127: 472–503.PubMedCrossRefGoogle Scholar
  45. 45.
    Shumaker SA, Hill DR. Gender differences in social support and physical health. Health Psychol. 1991; 10: 102–111.PubMedCrossRefGoogle Scholar
  46. 46.
    Andrykowski MA, Manne SL. Are psychological interventions effective and accepted by cancer patients? I. Standards and levels of evidence. Annals Behav Med. 2006; 32: 93–97.CrossRefGoogle Scholar
  47. 47.
    Antoni MH, Lechner SC, Kazi A, et al. How stress management improves quality of life after treatment for breast cancer. J Consult Clin Psychol. 2006; 74: 1143–1152.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2008

Authors and Affiliations

  • Youngmee Kim
    • 1
  • Deborah A. Kashy
    • 2
  • David K. Wellisch
    • 3
  • Rachel L. Spillers
    • 1
  • Chiew Kwei Kaw
    • 1
  • Tenbroeck G. Smith
    • 1
  1. 1.Behavioral Research CenterAmerican Cancer SocietyAtlantaUSA
  2. 2.Michigan State UniversityEast LansingUSA
  3. 3.University of CaliforniaLos AngelesUSA

Personalised recommendations