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A longitudinal analysis of intimacy processes and psychological distress among couples coping with head and neck or lung cancers

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Abstract

Individuals diagnosed with lung and head and neck (HN) cancers and their spouses are at increased risk for distress. This study assessed whether the way couples communicate about cancer and their perceptions of relationship intimacy influenced both partners’ adjustment. One-hundred thirty-nine patients and their spouses [For purposes of clarity, we refer to the patients’ intimate partner as the spouse, regardless of actual marital status and we reserve the term partner to refer to the other person in the couple (i.e., the patient’s partner is the spouse and the spouse’s partner is the patient)] completed measures of spousal communication, intimacy, and distress at three time points over 6 months. Using multilevel modeling, an over-time actor-partner interdependence model was specified that examined whether intimacy mediated associations between one’s own and one’s partner’s reports of communication at baseline and later distress. Patients and spouses who reported greater baseline distress reported more negative baseline communication as well as lower levels of intimacy and greater distress over time. Mediation analyses showed patients’ and spouses’ reports of positive spousal communication were associated with less subsequent distress largely through their effects on intimacy. Clinicians working with head and neck or lung cancer patients should assess communication and intimacy because both impact couples’ distress.

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Notes

  1. Given the difference in age for the LC and HNC groups, we conducted a set of analyses examining whether age was a significant predictor in our models. Age was not a significant predictor of distress, and inclusion of age did not affect the results presented in Table 3. Although age did predict intimacy, its presence in the models did not change the pattern of results.

  2. It should be noted that, because there were no significant role differences, Fig. 3 depicts the results using the more generic terms “person” and “partner.”

  3. Mediational analyses were also conducted using the bootstrapping method described by Preacher and Hayes (2008) and conclusions were identical to those from the Sobel test.

References

  • Ayres, J. (1983). Strategies to maintain relationships: Their identification and perceived usage. Communication Quarterly, 31, 62–67.

    Article  Google Scholar 

  • Badr, H., & Taylor, C. L. (2008). Effects of relationship maintenance on psychological distress and dyadic adjustment among couples coping with lung cancer. Health Psychology, 27, 616–627. doi:10.1037/0278-6133.27.5.616

    Article  PubMed  Google Scholar 

  • Badr, H., & Taylor, C. L. (2009). Sexual dysfunction and spousal communication in couples coping with prostate cancer. Psychooncology, 18, 735–746.

    Article  PubMed  Google Scholar 

  • Baile, W. F., Gibertini, M., Scott, L. L., & Endicotte, J. (1992). Depression and tumor stage in cancer of the head and neck. Psychooncology, 1, 15–24. doi:10.1002/pon.2960010104

    Article  Google Scholar 

  • Banthia, R., Malcarne, V. L., Varni, J. W., Ko, C. M., Sadler, G. R., & Greenbergs, H. L. (2003). The effects of dyadic strength and coping styles on psychological distress in couples faced with prostate cancer. Journal of Behavioral Medicine, 26, 31–52.

    Article  PubMed  Google Scholar 

  • Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182. doi:10.1037/0022-3514.51.6.1173

    Article  PubMed  CAS  Google Scholar 

  • Bergquist, H., Ruth, M., & Hammerlid, E. (2007). Psychiatric morbidity among patients with cancer of the esophagus or the gastro-esophageal junction: A prospective, longitudinal evaluation. Diseases of the Esophagus, 20, 523–529. doi:10.1111/j.1442-2050.2007.00741.x

    Article  PubMed  CAS  Google Scholar 

  • Bolger, N., Foster, M., Vinokur, A. D., & Ng, R. (1996). Close relationships and adjustment to a life crisis: The case of breast cancer. Journal of Personality and Social Psychology, 70, 283–294. doi:10.1037/0022-3514.70.2.283

    Article  PubMed  CAS  Google Scholar 

  • Bolger, N., Zuckerman, A., & Kessler, R. (2000). Invisible support and adjustment to stress. Journal of Personality and Social Psychology, 79, 953–961. doi:10.1037//0022-3514.79.6.953OI:10.103//0022-3514.79.6.953

    Article  PubMed  CAS  Google Scholar 

  • Canary, D., & Stafford, L. (1992). Relational maintenance strategies and equity in marriage. Communication Monographs, 59, 239–267.

    Article  Google Scholar 

  • Carmack Taylor, C. L., Badr, H., Lee, J. H., Fossella, F., Pisters, K., Gritz, E. R., et al. (2008). Lung cancer patients and their spouses: Psychological and relationship functioning within 1 month of treatment initiation. Annals of Behavioral Medicine, 36, 129–140. doi:10.1007/s12160-008-9062-7

    Article  PubMed  Google Scholar 

  • Chapple, A., Ziebland, S., & McPerson, A. (2004). Stigma, shame, and blame experienced by patients with lung cancer: Qualitative study. British Medical Journal, 328, 1470. doi:10.1136/bmj.38111.639734.7C

    Article  PubMed  CAS  Google Scholar 

  • Christensen, A. (1988). Dysfunctional interaction patterns in couples. In Perspectives on marital interaction (pp 30–52). Clevedon, England: Multilingual Matters.

  • Cleek, M. G., & Pearson, T. A. (1985). Perceived causes of divorce: An analysis of interrelationships. Journal of Marriage and the Family, 47, 179–183.

    Article  Google Scholar 

  • Fang, C. Y., Manne, S. L., & Pape, S. J. (2001). Functional impairment, marital quality, and patient psychological distress as predictors of psychological distress among cancer patients’ spouses. Health Psychology, 20, 452–457.

    Article  PubMed  CAS  Google Scholar 

  • Graves, K. D., Arnold, S. M., Love, C. L., Kirsh, K. L., Moore, P. G., & Passik, S. D. (2007). Distress screening in a multidisciplinary lung cancer clinic: Prevalence and predictors of clinically significant distress. Lung Cancer, 55, 215–224. doi:10.1016/j.lungcan.2006.10.001

    Article  PubMed  Google Scholar 

  • Greeff, A. P., & Malherbe, H. L. (2001). Intimacy and marital satisfaction in spouses. Journal of Sex and Marital Therapy, 27, 247–257.

    Article  PubMed  CAS  Google Scholar 

  • Haman, K. L. (2008). Psychologic distress and head and neck cancer: Part 1–review of the literature. Journal of Supportive Oncology, 6, 155–163.

    PubMed  Google Scholar 

  • Hopwood, P., & Stephens, R. (2000). Depression in patients with lung cancer: Prevalence and risk factors derived from quality-of-life data. Journal of Clinical Oncology, 18, 893–903.

    PubMed  CAS  Google Scholar 

  • Jenewien, J., Zwahlen, R., Zwahlen, D., Drabe, N., Moergeli, H., & Buchi, S. (2008). Quality of life and dyadic adjustment in oral cancer patients and their female partners. European Journal of Cancer Care, 17, 127–135. doi:10.1111/ecc.2007.17.issue-2

    Article  Google Scholar 

  • Jones, E., Lund, V. J., Howard, D. J., Greenberg, M. P., & McCarthy, M. (1992). Quality of life of patients treated surgically for head and neck cancer. Journal of Laryngology and Otology, 106, 238–242. doi:10.1017/S0022215100119152

    PubMed  CAS  Google Scholar 

  • Kagawa-Singer, M., & Wellisch, D. K. (2003). Breast cancer patients’ perceptions of their husbands’ support in a cross-cultural context. Psychooncology, 12, 24–37.

    Article  PubMed  Google Scholar 

  • Karney, B. R. (2001). Depressive symptoms and marital satisfaction in the early years of marriage: Narrowing the gap between theory and research. In S. R. H. Beach (Ed.), Marital and family processes in depression (pp. 45–68). Washington, DC: American Psychological Association.

    Google Scholar 

  • Kayser, K., & Sormanti, M. (2002). A follow-up study of women with cancer: Their psychosocial well-being and close relationships. Social Work in Health Care, 35, 391–406. doi:10.1300/J010v35n01_04

    Article  PubMed  Google Scholar 

  • Kenny, D., Kashy, D., & Cook, D. (2006). Dyadic data analysis. New York: Guilford.

    Google Scholar 

  • Kim, Y., Duberstein, P., Sorensen, S., & Larson, M. (2005). Levels of depressive symptoms in spouses of people with lung cancer: Effects of personality, social support, and caregiving burden. Psychosomatics, 46, 123–130.

    Article  PubMed  Google Scholar 

  • Kugaya, A., Akechi, T., Okuyama, T., Nakano, T., Mikami, I., Okamura, H., et al. (2000). Prevalence, predictive factors, and screening for psychologic distress in patients with newly diagnosed head and neck cancer. Cancer, 88, 2817–2823. doi:10.1002/1097-0142(20000615)88:12<2817:AID-CNCR22>3.0.CO;2-N

    Article  PubMed  CAS  Google Scholar 

  • Laurenceau, J. P., Barrett, L. F., & Pietromonaco, P. R. (1998). Intimacy as an interpersonal process: The importance of self-disclosure, partner disclosure and perceived partner responsiveness in interpersonal exchanges. Journal of Personality and Social Psychology, 74, 1238–1251. doi:10.1037/0022-3514.74.5.1238

    Article  PubMed  CAS  Google Scholar 

  • Laurenceau, J. P., Barrett, L. F., & Rovine, M. J. (2005). The interpersonal process model of intimacy in marriage: A daily-diary and multilevel modeling approach. Journal of Family Psychology, 19, 314–323.

    Article  PubMed  Google Scholar 

  • Lindau, S. T., Surawska, H., Paice, J., & Baron, S. R. (2010). Communication about sexuality and intimacy in couples affected by lung cancer and their clinical-care providers. Psychooncology. doi: 10.1002/pon.1787

  • Lobchuk, M. M., Murdoch, T., McClment, S. E., & McPherson, C. (2008). A dyadic affair: Who is to blame for causing and controlling the patient’s lung cancer? Cancer Nursing, 31, 435–443. doi:10.1097/01.NCC.0000339253.68324.19

    Article  PubMed  Google Scholar 

  • Manne, S., & Badr, H. (2008). Intimacy and relationship processes in couples’ psychosocial adaptation to cancer. Cancer, 112, 2541–2555.

    Article  PubMed  Google Scholar 

  • Manne, S. L., & Badr, H. (2009). Intimacy processes and psychological distress among couples coping with head and neck or lung cancers: A test of the relationship intimacy model of couples’ psychosocial adaptation. Psychooncology. Advance online publication. doi: 10.1002/pon.1645

  • Manne, S., Badr, H., Zaider, T., Nelson, C., & Kissane, D. (2010). Cancer-related communication, relationship intimacy, and psychological distress among couples coping with localized prostate cancer. Journal of Cancer Survivorship, 4, 74–85.

    Article  PubMed  Google Scholar 

  • Manne, S. L., Ostroff, J., Norton, T., Fox, K., Goldstein, L., & Grana, G. (2006). Cancer-related relationship communication in couples coping with early stage breast cancer. Psychooncology, 15, 234–247. doi:10.1002/pon.941

    Article  PubMed  Google Scholar 

  • Manne, S. L., Ostroff, J., Rini, C., Fox, K., Goldstein, L., & Grana, G. (2004). The interpersonal process model of intimacy: The role of self-disclosure, partner disclosure and partner responsiveness in interactions between breast cancer patients and their partners. Journal of Family Psychology, 18, 589–599. doi:10.1037/0893-3200.18.4.589

    Article  PubMed  Google Scholar 

  • Manne, S. L., Ostroff, J., Winkel, G., Grana, G., & Fox, K. (2005). Partner unsupportive responses, avoidant coping, and distress among women with early stage breast cancer: Patient and partner perspectives. Health Psychology, 24, 635–641. doi:10.1037/0278-6133.24.6.635

    Article  PubMed  Google Scholar 

  • Manne, S. L., Pape, S., Taylor, K., & Dougherty, J. (1999). Spouse support, coping and mood among individuals with cancer. Annals of Behavioral Medicine, 21, 111–121.

    Article  PubMed  CAS  Google Scholar 

  • Manne, S. L., Taylor, K., Dougherty, J., & Kemeny, N. (1997). Social support and negative responses in the marital relationship: Their association with psychological adjustment among individuals with cancer. Journal of Behavioral Medicine, 20, 101–125.

    Article  PubMed  CAS  Google Scholar 

  • Montazeri, A., Sajadian, A., Ebrahimi, M., & Akbari, M. E. (2005). Depression and the use of complementary medicine among breast cancer patients. Supportive Care in Cancer, 13, 339–342. doi:10.1007/s00520-004-0709-z

    Article  PubMed  Google Scholar 

  • Nijboer, C., Triemstra, M., Tempelaar, R., Sanderman, R., & van den Bos, G. A. (1999). Determinants of caregiving experiences and mental health of partners of cancer patients. Cancer, 86, 577–588.

    Article  PubMed  CAS  Google Scholar 

  • Oken, M., Creech, R., Tormey, D., et al. (1982). Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology, 5, 649–655. doi:10.1097/00000421-198212000-00014

    Article  PubMed  CAS  Google Scholar 

  • Pistrang, N., & Barker, C. (1995). The partner relationship in psychological response to breast cancer. Social Science and Medicine, 40, 789–797. doi:10.1016/0277-9536(94)00136-H

    Article  PubMed  CAS  Google Scholar 

  • Pistrang, N., & Barker, C. (1998). Partners and fellow patients: Two sources of emotional support for women with breast cancer. American Journal of Community Psychology, 26, 439–456. doi:10.1023/A:1022163205450

    Article  PubMed  CAS  Google Scholar 

  • Porter, L., Keefe, F., Hurwitz, H., & Faber, M. (2005). Disclosure between patients with gastrointestinal cancer and their spouses. Psychooncology, 14, 1030–1042. doi:10.1002/pon.915

    Article  PubMed  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891. doi:10.3758/BRM.40.3.879

    Article  PubMed  Google Scholar 

  • Reis, R., & Patrick, B. (1996). Attachment and intimacy: Component processes. In E. Higgins & A. Kruglanski (Eds.), Social psychology: Handbook of basic principles England (pp. 523–563). New York: Wiley.

    Google Scholar 

  • Reis, H., & Shaver, P. R. (1988). Intimacy as an interpersonal process. In S. Duck (Ed.), Handbook of personal relationships: Theory, research and interventions (pp. 367–389). New York: Wiley.

    Google Scholar 

  • Rolke, H. B., Bakke, P. S., & Gallefoss, F. (2009). Relationships between hand-rolled cigarettes and primary lung cancer: A Norwegian experience. Clinical Respiratory Journal, 3, 152–160. doi:10.1111/j.1752-699X.2008.00125.x

    Article  PubMed  Google Scholar 

  • Sarna, L., Cooley, M. E., Brown, J. K., Williams, R. D., Chernecky, C., Padilla, G., et al. (2006). Quality of life and health status of dyads of women with lung cancer and family members. Oncology Nursing Forum, 33, 1109–1116.

    Article  PubMed  Google Scholar 

  • Schaefer, M. T., & Olson, D. H. (1981). Assessing intimacy: The pair inventory. Journal of Marital and Family Therapy, 7, 47–60. doi:10.1111/j.1752-0606.1981.tb01351.x

    Article  Google Scholar 

  • Schag, C. A., Ganz, P. A., & Heinrich, R. L. (1991). Cancer rehabilitation evaluation system-short form (CARES-SF): A cancer specific rehabilitation and quality of life instrument. Cancer, 68, 1406–1413. doi:10.1002/1097-0142(19910915)68:6<1406:AID-CNCR2820680638>3.0.CO;2-2

    Article  PubMed  CAS  Google Scholar 

  • Schliephake, H., & Jamil, M. U. (2002). Prospective evaluation of quality of life after oncologic surgery for oral cancer. International Journal of Oral and Maxillofacial Surgery, 31, 427–433. doi:10.1054/ijom.2001.0194

    Article  PubMed  CAS  Google Scholar 

  • Sehlen, S., Lenk, M., Hollenhorst, H., Schymura, B., Aydemir, U., Herschbach, P., et al. (2003). Quality of life (QoL) as predictive mediator variable for survival in patients with intracerebral neoplasma during radiotherapy. Onkologie, 26, 38–43. doi:10.1159/000069862

    Article  PubMed  CAS  Google Scholar 

  • Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and Family, 38, 15–28.

    Article  Google Scholar 

  • Steinberg, T., Roseman, M., Kasymjanova, G., Dobson, S., Lajeunesse, L., Dajczman, E., et al. (2009). Prevalence of emotional distress in newly diagnosed lung cancer patients. Supportive Care in Cancer, 17, 1493–1497. doi:10.1007/s00520-009-0614-6

    Article  PubMed  Google Scholar 

  • Talmadge, L., & Dabbs, J. M. (1990). Intimacy, conversational patterns, and concomitant cognitive/emotional processes in couples. Journal of Social and Clinical Psychology, 9, 473–488.

    Article  Google Scholar 

  • Uchitomi, Y., Mikami, I., Kugaya, A., Akizuki, N., Nagai, K., Nishiwaki, Y., et al. (2000). Depression after successful treatment for nonsmall cell lung carcinoma. Cancer, 89, 1172–1179. doi:10.1002/1097-0142(20000901)89:5<1172:AID-CNCR27>3.0.CO;2-U

    Article  PubMed  CAS  Google Scholar 

  • Veit, C. T., & Ware, J. E., Jr. (1983). The structure of psychological distress and well-being in general populations. Journal of Consulting and Clinical Psychology, 51, 730–742. doi:10.1037/0022-006X.51.5.730

    Article  PubMed  CAS  Google Scholar 

  • Vickery, L., Latchford, G., Hewison, J., Bellew, M., & Feber, T. (2003). The impact of head and neck cancer and facial disfigurement on the quality of life of patients and their partners. Head and Neck, 25, 289–296. doi:10.1002/hed.10206

    Article  PubMed  Google Scholar 

  • Whisman, M. A., & Uebelacker, L. A. (2009). Prospective associations between marital discord and depressive symptoms in middle-aged and older adults. Psychology and Aging, 24, 184–189. doi:10.1037/a0014759

    Article  PubMed  Google Scholar 

  • Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantodosi, S. (2001). The prevalence of psychological distress by cancer site. Psychooncology, 10, 19–28. doi:10.1002/1099-1611(200101/02)10:1<19:AID-PON501>3.0.CO;2-6

    Article  PubMed  CAS  Google Scholar 

  • Zhang, A., & Siminoff, L. (2003). Silence and cancer: Why do families and patients fail to communicate? Health Communication, 15, 415–429. doi:10.1207/S15327027HC1504_03

    Article  PubMed  Google Scholar 

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Acknowledgments

This research was supported by an Established Investigator in Cancer Prevention and Control Award to Sharon Manne by the NCI (K05 CA109008) and by a Cancer Prevention and Control Career Development Award by the NCI (K07 CA124668) to Hoda Badr.

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Manne, S., Badr, H. & Kashy, D.A. A longitudinal analysis of intimacy processes and psychological distress among couples coping with head and neck or lung cancers. J Behav Med 35, 334–346 (2012). https://doi.org/10.1007/s10865-011-9349-1

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