Communicating With Your Partner: Detailed Information

Partners are usually the primary source of support for individuals facing cancer. Relationships having poor communication may mean low levels of support for both the survivor and the partner.

While cancer can negatively affect the emotional well-being of survivors, it also can negatively affect partners. Some partners actually experience more emotional distress than survivors. Just as survivors can experience emotions such as fear, anger and guilt, their partners can experience them too. Stress is also common for both survivors and their partners.

A decline in the survivor’s physical or emotional status may create a “cycle of distress” for the couple in which one person’s distress makes the other’s distress worse. High levels of emotional distress are likely to strain the couple’s relationship. Good communication may be the most effective strategy for breaking this cycle and may improve both members’ quality of life.

Some ways survivors and partners can both benefit from good communication include:

• Receive emotional support
• Offer emotional support
• Receive help with decision-making
• Receive advice and encouragement
• Learn alternative ways of viewing stressful or difficult situations
• Clarify misunderstandings
• Receive help communicating with the health care team and following their recommendations
• Learn new coping strategies
• Receive support for healthy behaviors (eating properly, smoking cessation, physical activity)
• Plan for the future (includes caring for children, having children after cancer, financial considerations)
• Discuss ways to solve problems with changing roles and responsibilities in the relationship
• Inform partner of survivor’s wishes in case the survivor is unable to communicate these wishes in the future
• Resolve problems regarding changes to sexual relations and expressions of intimacy
• Assist with adjusting to the cancer experience, which will promote emotional well-being
• Maintain the quality of the relationship
• Use the cancer experience to enrich and strengthen the relationship

Overall, partners can play a large role in survivors’ emotional response to the disease and life after treatment. Research shows that survivors who feel they have more support from their partners are more likely to focus on positive aspects of their cancer experience, which may improve their quality of life.

Why is it sometimes difficult for survivors to communicate with their partners?

There are several reasons why it can be difficult for survivors to communicate with their partners.

The partner’s response to the survivor’s discussions may discourage open communication.

Research shows that when a partner uses criticism, withdraws or acts uncomfortable when the survivor tries to share, the survivor may cope using unhealthy and ineffective strategies. Poor coping can cause emotional problems and potentially restart the “cycle of distress” in the relationship.

Other reactions from partners that make communication after treatment difficult include:

• The partner doesn’t want to talk about what the survivor is experiencing because it is too upsetting.
• The partner feels over-protective and won’t let the survivor do anything.
• The partner wants the survivor to “get back to normal” and forget that the cancer crisis ever happened.

Survivorship often requires couples to communicate about topics that they don’t normally talk about.

This is particularly true for side effects of cancer and its treatment. Issues such as incontinence, sexual changes or problems, and body image may be embarrassing to discuss. Further, lasting complications such as fatigue and chronic pain may be especially difficult for partners to understand, particularly when the survivor is in remission and/or looks well. The partner may say that because the survivor does not “look sick,” the survivor should be able to live the way s/he did before cancer.

Examples of other sensitive issues that may be difficult to discuss:

• Living with uncertainty
• Stress
• Feelings of guilt
• Financial difficulties
• Dealing with fear of recurrence
• Changes in outlook on life and death
• Recognizing symptoms of recurrence or other physical problems
• Losses of all kinds: job, friends, abilities
• Changing roles and responsibilities
• New compromises that need to be made
• Feeling overwhelmed
• Anger

Survivors may also feel guilty discussing certain topics with their partners.

Survivors may find it difficult to ask for help, particularly if they are used to being the ones who provide help to others. Survivors may continue doing tasks that are emotionally or physically challenging. They may do this because they feel guilty asking partners to take on new roles and responsibilities, or they don’t think their partners can handle it. Additionally, there are times when partners are as distressed as or more distressed than survivors. Survivors may attempt to “protect” their partners by not sharing information or how they are feeling. Survivors may avoid discussing topics including their own suffering or planning for the future (e.g., a living will) because they do not want to upset their partners.

Survivors and partners may have different priorities.

After treatment, survivors may find that some things that were important to them before treatment are no longer as important. They may be changing the way they view life or want to change certain areas of their lives. Sometimes their partners easily understand the change in priorities and are comfortable with them. Sometimes their partners may not understand why these changes are happening or may not agree with them. Partners also may have changes in priorities after cancer that survivors may or may not understand.

When would survivors and their partners benefit from better communication?

Survivors may encounter situations in which it is difficult to communicate with their partners. During times of stress, effective and healthy communication is often a challenge for couples. This can be especially difficult if there were problems with communication before the cancer diagnosis.

If communication between you and your partner is not what you would like, you may need to work actively on communicating better with your partner, either together or with the help of a counselor. Signs that it is time to work on better communication include:

• You and your partner have frequent misunderstandings.
• You or your partner frequently withdraw or avoid talking.
• You or your partner frequently use criticism, sarcasm or name-calling.
• You find yourself frequently not sharing information with your partner.
• You and your partner frequently disagree over the same issues.
• You or your partner has sexual problems, and other expressions of love and affection (talking, touching and sharing) happen less often.
• You find yourself frequently confiding in others instead of your partner.
• You feel unable to ask your partner for help or support.
• You find that the support you receive from your partner is unhelpful.
• You feel hurt emotionally by your partner.

If ever you or your partner responds with physical aggression, seek immediate professional assistance.

Options for professional assistance:

• If you are in immediate physical danger, call 911.
• Talk with crisis intervention specialists (crisis hotlines, local abuse shelters).
• Talk to a mental health professional (psychologists, psychiatrists, marriage and family counselors).
• Talk with legal professionals to understand your rights (attorneys, law enforcement officials).

How can survivors learn to communicate well with their partners?

Couples facing cancer can learn effective communication strategies. Even though it is difficult to break old habits, learning new skills and developing new communication habits is possible. The key is to practice the new skills regularly. The benefit is that healthy communication can increase the couple’s overall relationship satisfaction and positively affect each member’s quality of life.

Below is a brief list of things to consider. For more detail, see Suggestions.

• Be aware of your and your partner’s communication patterns and behaviors.
• Learn and practice effective communication skills together.
• Take time to discuss difficult topics with your partner.
• Consult a mental health professional about your relationship (psychologist, psychiatrist, marriage and family counselor).

Remember, even with the best intentions, partners can provide the wrong kind of support to survivors and survivors can provide the wrong kind of support to partners. Being able to communicate is important for both of you.

This document was produced in collaboration with:
Cindy L. Carmack Taylor, Ph.D.
Assistant Professor, The University of Texas M.D. Anderson Cancer Center