Journal of the National Cancer Institute, Vol. 93, No. 15, 1127-1129, August 1, 2001

NEWS

Female Cancer Patients at Higher Risk of Marital Problems
Renee Twombly

A study of married patients with malignant brain cancers has found that female patients are eight times more likely to undergo a separation or divorce than are men with brain tumors. The results raise questions about the impact of cancer on a patient’s social life as well as how prepared neuro-oncologists are to deal with such issues.

The study of more than 500 patients also found a high rate of marital discord among women patients used in "control" groups—women with multiple sclerosis were seven times more likely to separate or divorce than were male patients, and the rate for women diagnosed with systemic cancer was 12 times higher.

Time Differences

But the big difference between brain tumor patients and the other groups is the time it took for the marriages to dissolve, said the study’s lead researcher, Michael Glantz, M.D., a neuro-oncologist at the Barrow Neurological Institute in Phoenix, who presented the study at this year’s annual meeting of the American Society of Clinical Oncology. Patients in the control groups often lived for a decade or longer, and it took years for marital problems to develop.

Not so for glioma patients. From diagnosis to death, patients in the study lived an average of 13 months, and many marriages ended within that short period.

"That’s an extraordinary high rate of marriage problems in about a year, and it occurs just when patients, usually women, need support the most," Glantz said. He said he undertook the study when he was at the University of Massachusetts, with help from colleagues at four other medical centers, because he had noticed in his own practice that there was a high rate of divorce and separation in his female patients. Glantz said he found the results a "staggering" validation of a casual insight.

Julia Rowland, Ph.D., director of the Office of Cancer Survivorship at the National Cancer Institute, said, "Clinically, it makes a lot of sense. As research, it is ground-breaking and profoundly disturbing."

Follow-up studies are examining whether marriage counseling and other interventions help improve such marital problems between brain tumor patients and their spouses.

High-Maintenance Patients

Cancer affects social relations in unique ways, depending, in part, on the type of disease, according to Rowland. For example, although many people believe husbands commonly desert wives who have breast cancer, a 1999 Canadian study published in the Journal of the National Cancer Institute concluded that divorce rates in these patients was not increased—even up to 8 years after diagnosis.

In fact, women can be empowered by a diagnosis of breast cancer, Rowland said. "There are great resources and support for women with breast cancer, more so than for most other cancers," she said.

Malignant brain cancer patients, on the other hand, can experience significant dysfunction and disability, such as dementia, which makes it difficult to maintain social contacts and puts an added burden on partners, she said. "Most men are not equipped to be caregivers to such high-maintenance patients, which may make it easier for them to ultimately walk away. Women are much more adept and skilled at taking care of others," Rowland said.

Greater Risk

A 1996 study in Cancer Practice found that husbands of terminally ill patients are at higher risk of depression than wives with ill husbands and cannot adjust to the burden of caring for their wives during illness. The authors attribute this finding to less social support in mens’ networks than in women’s.

"As a society, we don’t equip men with the same capacity or resources to provide the kind of care they really want to provide," said David Cella, Ph.D., director of the Center for Outcomes Research and Education at Evanston Northwestern Healthcare, Evanston, Ill.

He said that while it might be tempting to sum up Glantz’s study by proclaiming that "men are cads," such break-ups are often the result of unbearable pressures on couples that have not been married for a long time. "Each couple has a story, an explanation that goes beyond simple irresponsibility," he said.

Glantz, Cella, and Rowland all agree that one approach to the problem is to provide the support that couples need to see their marriage through. At the least, health providers can refer couples who seem to be at risk to a social worker or therapist trained in couples therapy. "We need to recognize that there are families in distress and bring resources to bear to provide a helping hand," said Rowland.

Easier Said Than Done

That may be easier said than done, said Renee Hinsley Dunn, Ph.D., a clinical neuropsychologist at Duke University Medical Center, Durham, N.C., which has one of the country’s largest brain tumor programs. While such problems should be addressed, very few neuro-oncology teams have a psychologist or social worker that they can call on for help. "I do not think care providers can realistically make assessing for marital distress a priority," she said.

Dunn agrees that female brain tumor patients have high rates of marital difficulty and suggests the problem may be far more prevalent than a mere count of separations or divorces can reveal. For many couples in her clinic who would rather split, Dunn said "the primary reason for continuing the marriage often has to do with maintaining insurance coverage."