Physical well-being after breast cancer: The value of relationships Melissa Curran1, Valerie Young2, Samuel Simmens3, and Karen Weihs1 University of Arizona1 Hanover College2 The George Washington University3
Abstract
The Present Study
Results
The diagnosis of breast cancer can have long-term effects on women’s physical well-being. The question we ask here is “How do differences in close relationship constructs predict physical well-being over time for women with breast cancer?” Our sample included women recently diagnosed with breast cancer and in a romantic relationship (first marriage, remarriage, cohabitation), who were assessed every 3 months for 2 years (N = 103 women; 722 observations). Relationship constructs included relationship biography (i.e., first marriage versus remarriage or cohabitation), partner confiding, and partner support. As expected for relationship biography, women in their first marriage experienced better physical well-being, or fewer symptoms, over time compared to women who cohabited or who remarried. Also as expected, for women in their first marriage, partner confiding explained better physical well-being over time compared to women who cohabited or who remarried. Unexpectedly, partner support was not significant in explaining physical wellbeing on its own, or in conjunction with relationship biography. Our findings suggest that continuity experienced by women in their first marriage is related to better physical well-being, and that this effect is enhanced with partner confiding.
We test how relational constructs explain physical well-being for women with breast cancer over time.
We analyzed three models using Proc Mixed in SAS with a random intercept, given the repeated measurements (up to 9 visits). In model #1, we examined the impact of the three relationship constructs (relationship biography, partner confiding, and partner support) on physical well-being, including control variables. Only relationship biography was significant (B = 1.54, SE = 0.64, p = .0172): Women in their first marriage experienced better physical well-being over time than women who cohabited or who remarried. Thus, we found support for H1. Next, we tested interactions. We included all variables from model #1, and added the interaction between relationship biography and the two relationship moderators: partner confiding in model #2, and partner support in model #3. We centered all continuous variables around their mean before entering them into the interaction (Aiken & West, 1991). We found a significant two-way interaction for partner confiding (model #2; B = -3.27, SE = 1.62, p = .0441), but not partner support (model #3). For women in their first marriage, partner confiding was associated with better physical well-being, or fewer symptoms, over time (see figure below). Thus, we found partial support for H2.
Background The diagnosis of breast cancer can have long-term effects on women’s physical well-being. While adjuvant therapy helps to combat breast cancer, side effects and physical symptoms occur (e.g., short-term loss of appetite, nausea, and vomiting, fatigue, weight gain, joint pain; NCI, 2010). Over 50% of women studied post-treatment reported long-term symptoms like aches, pains, and forgetfulness (Ganz et al., 2004). Three to twelve months after diagnosis, women with breast cancer transition from treatment into routines involving family and/or work. Research shows that marriage has health benefits for women with cancer, including a greater likelihood to survive cancer compared to women going through a break-up (Sprehn et al., 2009). Further, married individuals with cancer are less likely to die as a result of their cancer versus unmarried individuals (Aizer et al., 2013). In particular, “those who married once and remained married are consistently, strongly, and broadly advantaged” in terms of fewer chronic conditions (Hughes & Waite, 2009, p. 356). We also recognize the importance of confiding, supportive relationships. From attachment theory, Bowlby (1969/1982) argued that especially during times of stress or illness, availability of supportive others was imperative for better health. Empirical evidence supports these statements from attachment theory (Ross & Mirowsky, 2002; Uchino et al., 1996).
Acknowledgements We are appreciative of funding from the American Cancer Society Institutional Research Grant and the Frances McClelland Institute for Children, Youth, and Families to Melissa Curran, and from the U.S. Army Medical Research, Breast Cancer Research for the Parent study to Karen Weihs. We thank our participants for taking the time and effort to participate in our study. Also, we thank our study coordinator, Laura Eparvier. A PDF version of this academic poster is available at: http://mcclellandinstitute.arizona.edu/posters
H1: Physical well-being over time will be better (i.e., fewer symptoms) for women in their first marriage versus women who remarry or cohabit. H2: Physical well-being over time will be better (i.e., fewer symptoms) for women in their first marriage who also report their partner is their confidant or who report higher partner support.
Methods Sample. Our sample was comprised of women diagnosed with breast cancer in the past 3 months and who were in a romantic relationship (first or continuous marriage, remarriage, cohabitation), who were assessed every 3 months for 2 years (N = 103 women; 722 observations). Women ranged in ages from 27 to 83 (M = 54.86; SD = 9.60) and were primarily educated (89% reported some college or more). Physical well-being (DV). We used the Functional Assessment of Cancer Therapy, or FACT-PWB (Cella et al., 1993), comprised of 7 items rated on a 0 (not at all) to 4 (very much) scale. After recoding, higher scores indicated better health or fewer symptoms (e.g., lower burden of fatigue and feeling sick; less impairment of daily function from these symptoms; = 86). Relationship constructs (IVs): First, we assessed relationship biography, coded as first or continuous marriages =1, versus cohabiting or remarried relationships = 0. Second, we assessed relationship confiding. During each visit, participants were asked: “In the event of a serious problem or stressful experience, who is the first person you would want to speak to about the situation?” This resulted in a dichotomous variable indicating the presence or absence of confiding partnership. This script was adapted from the Close Persons Questionnaire (Stansfeld & Marmot, 1992). Finally, we assessed partner support (Social Relationships Inventory; Uchino, Kiecolt-Glaser, & Cacioppo, 1992). This scale is comprised of 5 items. One sample item is “In general, how important is your partner to you?” rated on a 1 (not at all) to 6 (extremely) point scale. Higher scores on partner support are considered higher indications of support ( = .85). Finally, to rule out other influences that may otherwise explain our study findings, we control for a number of constructs common to either or both the study of physical well-being for women with cancer and relationships. Controls included demographic (age, education, ethnicity); medical (Nottingham Prognostic Index score of cancer severity based on tumor characteristics, chemotherapy treatment, radiation since last visit, hormone therapy, comorbidity with other medical diagnoses, and linear, quadratic, and cubed terms of months since diagnosis); intrapersonal (attachment style; Collins, 1996); and support outside the relationship (Zimet et al., 1988).
Conclusions and Implications Our findings are important in specifying the relationship constructs that predict health recovery for women with breast cancer over time. Our findings suggest that continuity experienced by women in their first marriage is related to better physical well-being, and that this effect is enhanced with partner confiding. With replication, these results could indicate the need for different relationship-related counseling to promote recovery of physical well-being after treatment for breast cancer, depending on relationship biography and other relationship constructs such as partner confiding.