The authors highlighted the importance of viewing cancer from a relationship perspective. This perspective not only considers the marital relationship as a resource that individual partners draw upon but also highlights the importance of focusing attention onto the relationship and engaging in communication

Objective Couples facing metastatic breast cancer (MBC) must learn to cope with stressors that can affect both partners' quality of life as well as the quality of their relationship. Common dyadic coping involves taking a “we” approach, whereby partners work together to maintain their relationship while jointly managing their shared stress. This study prospectively evaluated whether common dyadic coping was associated with less cancer-related distress and greater dyadic adjustment for female MBC patients and their male partners. Design Couples (N = 191) completed surveys at the start of treatment for MBC (baseline), and 3 and 6 months later. Main Outcome Measures Cancer-related distress was assessed with the Impact of Events Scale; dyadic adjustment was assessed using the short-form of the Dyadic Adjustment Scale. Results Multilevel models using the couple as the unit of analysis showed that the effects of common positive dyadic coping on cancer-related distress significantly differed for patients and their partners. Whereas partners experienced slightly lower levels of distress, patients experienced slightly higher levels of distress. Although patients and partners who used more common negative dyadic coping experienced significantly greater distress at all times, the association was stronger for patients. Finally, using more common positive dyadic coping and less common negative dyadic coping was mutually beneficial for patients and partners in terms of greater dyadic adjustment. Conclusion Our findings underscore the importance of couples working together to manage the stress associated with MBC. Future research may benefit from greater focus on the interactions between patients and their partners to address ways that couples can adaptively cope together.

Quality of life (QOL) is a multidimensional construct that includes physical, psychological, and relationship well-being. We conducted a systematic review and meta-analysis of randomized controlled studies published between 1980 and 2012 of interventions conducted with both cancer patients and their partners that were aimed at improving QOL. Using bibliographic software and manual review, two independent raters reviewed 752 articles with a systematic process for reconciling disagreement, yielding 23 articles for systematic review and 20 for meta-analysis. Most studies were conducted in breast and prostate cancer populations. Study participants (N=2645) were primarily middle-aged (Mean = 55 years old) and white (84%). For patients, the weighted average effect size (g) across studies was 0.25 (95% CI = 0.12-0.32) for psychological outcomes (17 studies), 0.31 (95% CI = 0.11-0.50) for physical outcomes (12 studies), and 0.28 (95% CI = 0.14-0.43) for relationship outcomes (10 studies). For partners, the weighted average effect size was 0.21 (95% CI = 0.08-0.34) for psychological outcomes (12 studies), and 0.24 (95% CI = 0.6 - 0.43) for relationship outcomes (7 studies). Therefore, couple-based interventions had small but beneficial effects in terms of improving multiple aspects of QOL for both patients and their partners. Questions remain regarding when such interventions should be delivered and for how long. Identifying theoretically based mediators and key features that distinguish couple-based from patient-only interventions may help to strengthen their effects on patient and partner QOL.

BACKGROUND Advanced lung cancer (LC) patients and their families report low self-efficacy for self-care/caregiving and high rates of distress, yet few programs exist to address their supportive care needs during treatment. OBJECTIVE This pilot study examined the feasibility, acceptability, and preliminary efficacy of a 6-session telephone-based dyadic psychosocial intervention that we developed for advanced LC patients and their caregivers. The program is grounded by Self-determination Theory (SDT), which emphasizes the importance of competence (self-efficacy), autonomy (sense of choice/volition), and relatedness (sense of belonging/connection) for psychological functioning. Primary outcomes were psychological functioning (depression/anxiety) and caregiver burden. Secondary outcomes were the SDT constructs of competence, autonomy, and relatedness. METHODS Thirty-nine advanced LC patients who were within one month of treatment initiation (baseline) and their caregivers (51% spouses/partners) completed surveys and were randomized to the intervention or usual medical care. Eight weeks post-baseline, they completed follow-up surveys. RESULTS Solid recruitment (60%) and low attrition rates demonstrated feasibility. Strong program evaluations (X̄=8.6 out of 10) and homework completion rates (88%) supported acceptability. Participants receiving intervention evidenced significant (p<.0001) improvements in depression, anxiety, and caregiver burden relative to usual medical care. Large effect sizes (d>1.2) favoring the intervention were also found for patient and caregiver competence and relatedness, and for caregiver autonomous motivation for providing care. CONCLUSION These findings support intervention feasibility, acceptability, and preliminary efficacy. By empowering families with skills to coordinate care and meet the challenges of LC together, this intervention holds great promise for improving palliative/supportive care services in cancer.