Coping Strategies Affect Anxiety in Partners of Younger Women with Breast Cancer

Nancy Borstelmann, MPH, MSW, LICSW

Nancy Borstelmann, MPH, MSW, LICSW

Good coping strategies can help the partners of younger women with breast cancer to work through anxiety that otherwise often lingers well after the disease has been treated, according to the authors of a study presented today in advance of the 2017 Cancer Survivorship Symposium.

The study — which found that more than 40% of these partners remain anxious years after their loved ones’ diagnoses — underscores the importance of teaching effective coping strategies to this group of caregivers, reported lead author Nancy Borstelmann, MPH, MSW, LICSW. Borstelmann, who said that replacing ineffective coping strategies in favor of more helpful ones would contribute to better health and quality-of-life for both partners and patients, discussed the findings in a presscast ahead of the Jan. 27-28 symposium to be held in San Diego, California.

Partners of younger adults with the disease may particularly benefit from this help, Borstelmann said, because their often demanding stage of life can make dealing with a cancer profoundly complex.

“Cancer doesn’t just happen to one person; it has an impact on the entire family,” said Borstelmann, director of social work at Dana-Farber Cancer Institute in Boston. “As the number of breast cancer survivors continues to grow in the United States, interventions targeting the concerns of partners — and entire families — are needed to help them cope with the inevitable and often unanticipated changes that come with a cancer diagnosis.”

The study was an analysis of a multicenter online and mailed survey taken by 289 partners of women who had been diagnosed with breast cancer at the age of 40 years or younger. The partners were mostly white, college-educated, employed fathers.

They were asked to complete, just one time, the Brief COPE questionnaire, which polled them about concerns including quality of life, coping, social support, financial insecurity, partnership concerns, parenting concerns, anxiety and depression. The survey assessed how much each partner used specific healthy coping strategies, including accepting the diagnosis, positive reframing, planning and taking advantage of emotional support. Partners completed the surveys a median 5 years after their loved ones were diagnosed.

The primary outcome being measured was anxiety. Thirty-two percent of partners who took the survey reported at least a fair amount of relationship concern, and 42% reported experiencing current symptoms of anxiety.

Looked at individually, a number of factors were associated with anxiety in the partners: full-time employment status, parenting concerns, financial issues, insufficient social support and, most strongly, lower levels of education and maladaptive coping. In a multivariable statistical analysis that took all of those factors into account, only maladaptive coping remained significantly associated with anxiety, the authors reported.

Those who said they were using coping strategies that authors considered “maladaptive” were more than twice as likely to report that they were experiencing anxiety. Strategies deemed maladaptive included emotional withdrawal, denial, drinking, blame and aggression.

Borstelmann speculated about why the lack of a college education might also contribute to anxiety. “It may be a proxy for other issues going on in their lives,” she said. “For example, a lower level of education may have to do with someone’s level of income and thus their ability to access other helpful resources. They may not be socialized to feel comfortable within the health care system to ask questions to get their needs met. Also, sometimes in the health care system we do well at sharing information, but is the information we’re giving understandable to them?”

The researchers concluded that it will be important for the health care community to develop and teach constructive coping strategies that support family members and partners in expressing their needs.

Methods of help could include identifying family and relationship concerns, providing education on issues related to the cancer journey, enhancing social support and boosting other healthy coping strategies, Borstelmann said. A goal would be to engage with partners early in the process, referring them, when called for, to support groups, social workers, psychologists and/or peers who’ve already seen their loved ones through the experience of a younger-adult breast cancer, she said.

“As members of the cancer care team, we can all take immediate steps to ensure that the mental health and other concerns of partners and families are addressed,” Borstelmann said. “It may seem like a small thing, but asking a partner ‘how are you doing?’ has impact, and can open the door to important conversation about how things are going at home and with the patient-partner relationship.”