Psychological adjustment among partners of women at high risk of developing breast/ovarian cancer

Abstract

Purpose: The aim of the current research was to characterize psychological adjustment among partners of women at high risk of developing breast/ovarian cancer and to explore the relationship between women's and partners' adjustment. Methods: A study of 95 unaffected at-risk women and 95 partners was carried out using mailed, self-administered questionnaires with validated measures of psychological outcome. Results: Elevated levels of distress were noted in up to 10% of partners. High monitoring coping style and greater perceived breast cancer risk for their wife were associated with higher distress levels for partners. However, communicating openly with their wife and the occurrence of a recent cancer-related event in the woman's family were related to lower distress for partners. Partners' cancer-specific distress was positively related to their wives' distress. Conclusion: Among partners with elevated levels of distress, the ability to provide effective support to the at-risk women and participate appropriately in their decision making may be compromised. These partners are likely to benefit from targeted clinical interventions designed to reduce their distress levels. The findings emphasize the importance of considering partners of at-risk women in service provision and highlight the need for partners to obtain information and support specifically tailored to their needs. Genet Med 2007:9(5):311-320. Key Words: hereditary breast/ovarian cancer, partners, psychological adjustment, cognitive-social health information processing (C-SHIP) model, couplesApproximately 5% of all breast/ovarian cancers are considered to be attributable to a dominantly inherited breast/ovarian cancer predisposition. 1 In the past decade, two breast/ovarian cancer predisposition genes, BRCA1 and BRCA2, have been identified, with the risk of developing cancer imparted by mutations in these genes estimated to be between 45% and 65% for breast cancer and between 10% and 40% for ovarian cancer by age 70 years. 1 Women who are at increased risk of hereditary breast/ovarian cancer, and in particular those found to be mutation carriers, need to make decisions about how to best manage their risk. Women may opt for frequent screening, prophylactic mastectomy and/or oophorectomy, 2 and/or chemoprevention. Given that having a strong family history of breast/ovarian cancer may result in women experiencing elevated levels of cancer-related distress, 3 social support from the women's families and significant others, particularly their partners, has been identified as a key resource in enabling the women to effectively cope with their increased cancer risk. 4,5 Few studies have explicitly focused on the adjustment of partners of women at high risk of developing breast/ovarian cancer. 2,[5][6][7][8][9][10][11] Investigations of the psychological impact of genetic testing on partners of at-risk women have revealed that the genetic testing process and, in particular, women found to be mutation carriers can be distressing for some partners. 2,[7][8][9] M...

Critical research gaps and translational priorities for the successful prevention and treatment of breast cancer

“…Interventions are also required to support conversations within the family about genetic risk and its implications, given that the onus is often on the patient [29]. Research involving women at increased genetic risk for breast cancer should assess the psychosocial impact on partners and the implications for their relationships [30]. Evidence from this research needs to inform services and direct resources to support those at increased risk of breast cancer.…”

Psychological adjustment among male partners in response to women's breast/ovarian cancer risk: a theoretical review of the literature

“…Studies were considered eligible for inclusion in the literature review if they were published in a peer-reviewed journal and were in the English language. A systematic literature search yielded 10 published studies on at-risk women and their male partners [7,12,24,[41][42][43][44][45][46][47]. All studies either primarily investigated partners of high-risk women or included partners when investigating women themselves; however, one of these studies [45] did not investigate male partner distress as an outcome variable.…”

“…Similar to the findings for HBOC women (for review please see [48][49][50]), the available studies show that mean distress scores reported by partners are not indicative of clinical pathology. However, up to 17% of partners, particularly those who have recently learned that their wife is a mutation carrier, report elevated levels of anxiety, signalling a need for further psychological assessment and possible clinical intervention [42,46]. Importantly, partner distress is associated with distress experienced by the at-risk wife [46], and worry about the chances of one's children developing breast cancer is a common and shared concern [21, 26,43,44,46].…”

“…Through individual interviews, Mireskandari et al [44] found that partners' optimistic beliefs about their wife's chances of developing cancer were commonly accompanied by reports of better partner adjustment. A follow-up quantitative study [46] found that: (a) on average, partners perceived their wife's chances of developing breast cancer as higher compared with the average woman of similar age; and that (b) perceived breast cancer risk was strongly associated with psychological distress reported by partners. These findings suggest a positive association between perceived risk and distress, but the available data are not prospective, so a causal path cannot be delineated at this point in time.…”

Distress and the parenting dynamic among BRCA1/2 tested mothers and their partners.

“…Studies examining the impact of partner support for these women demonstrate that greater partner support predicts improved psychological outcomes among couples, while less support and maladaptive coping (e.g., hiding worries, avoidant behaviors) can lead to poorer outcomes (DeMarco et al, 2008; DeMarco et al, 2010; Tercyak et al, 2001). Although evidence in this area is limited, available data suggest that partners can experience levels of distress similar to women who undergo BRCA1/2 testing (den Heijer et al, 2010; Mireskandari et al, 2007). …”