Marriage and Cancer?

For better or for worse, Anna Cluxton, then 32, and her husband, Brian, then 27, discovered a change in a breast lump in early 2001, barely a week into their marriage. In fact it seemed absurd: A healthy, young Midwestern couple forced to deal with a seeming annoyance that Anna thought was “probably nothing.”

Only it wasn’t. The “nothing” they’d believed was a cyst instead was stage 2 breast cancer. And as Anna recalls, she hadn’t even written her wedding gift thank you cards yet. She also remembers thinking, almost immediately: What if her new young husband couldn’t handle it all—including a mastectomy?

“I don’t think he ever thought about leaving me,” she says. “I told Brian, ‘This isn’t what you signed up for’ ”—a sentiment he immediately quashed. Today, nearly seven years later, they are doubly N.E.D.: no evidence of disease; no evidence of divorce.

The numbers are imposing. If up to 50 percent of all marriages end in divorce for a myriad of non-cancer-related reasons, it’s easy to acknowledge the extra stress cancer imposes upon even the strongest couples: loss of routine, loss of dignity, loss (or erosion) of job security, insurance, and savings. Plus a loss of romance and intimacy, amid all the pain and uncertainty. Having some key tools or talking points with which to cope can make a huge difference in both quality of life and quality of relationship.

Terrence Real, LCSW, a Boston-area couples therapist and author of The New Rules of Marriage, urges couples in various crises to air their darkest of feelings early on. “It’s OK that she feels he may leave her,” he says. “And it’s OK for him to say, ‘I’m not going to.’ ”

In fact, most couples, for lack of such expert guidance, choose a “safer” course of action. “One of the things I tell people over and over is, feelings don’t hurt you, but running from feelings can kill you,” says Real. “In our culture, we don’t seem to understand the difference between feeling something and behaving on it. We think we have to deny the feelings—even those as dark as [thinking about] divorce—or we fear we might go there.” But it turns out confronting those fears helps couples to avoid realizing them, he says.

Support groups for both patients and couples are now routinely offered at cancer centers and hospitals nationwide. For those who prefer anonymity, online therapy-oriented resources for couples are offered by the American Association for Marriage and Family Therapy (www.aamft.org), People Living With Cancer (www.cancer.net), CancerCare (www.cancercare.org), and the American Cancer Society (www.cancer.org), which offers audio and video “talk shows” on its Cancer Survivors Network (www.acscsn.org) of couples reconnecting and survivors who’ve divorced.

For Kristi Ferguson, 42, of Columbus, Ohio, a stage 3 breast cancer diagnosis in 2000—for all its debilitating treatment and after-effects—helped her sharpen focus about her marriage. After couples therapy, which perhaps delayed but didn’t prevent her recent divorce, Ferguson realized, “We didn’t have good communication before my diagnosis. Or during or after, either. All of a sudden you’re fighting for your life, day-to-day.”

Ferguson joined a support group that met a few nights each month. “That’s where I let my guard down and talked about those fears, including [fears about] the relationship. It was something we never really did as a couple.”

Even after acknowledging the great comfort cancer support groups can provide, some therapy experts point out one limitation survivors and their partners should note: Cancer patients often become untouchable icons, of sorts, in a relationship instead of a partner in whom their spouse can confide. What happens in support groups often needs to be shared at home but isn’t.

To this day, long after my own diagnosis and treatment of stage 3 colorectal cancer during 2001, I recall attending a hospital-based support group and thinking (but not saying to my wife of seven years): “This is not only hurting my career, but I may be trashing yours.” Was I afraid she would falsely reassure me? Or was I afraid she would agree? Either way, I opted for the uncomfortable uncertainty of keeping silent, just what therapists warn others not to do.

That’s where I let my guard down and talked about those fears, including [fears about] the relationship. It was something we never really did as a couple.

Cancer patients and partners typically don’t have higher-than-average divorce rates, suggests Diane Blum, MSW, executive director of CancerCare, a national nonprofit group that helps patients with counseling and other key needs. In a related study, published in Cancer Practice, researchers from CancerCare Manitoba, Canada, found “no data to confirm the lay belief model … that women with breast cancer are abandoned by their partners.” In fact, their review of studies seemed to indicate, as Blum says, that “the majority of marital relationships remain stable” after breast cancer. “I think you tend to see divorce among couples where the relationship was vulnerable before,” says Blum.

By contrast, therapists believe certain diagnoses, including brain cancer, can cause such major shifts in daily lifestyle and care roles that it’s impossible to predict whether a previously sound marriage will survive intact. In a study that included more than 200 married brain tumor patients, Michael Glantz, MD, a neuro-oncologist who currently practices at the Huntsman Cancer Institute in Utah, found that female brain tumor patients are eight times more likely to have a separation or divorce following diagnosis than are similarly diagnosed men. “Women seem to be more willing or more adept at nurturing their husbands through an illness, while men are not as skilled at doing the same for their wives,” wrote Dr. Glantz.

But Blum notes that countless survivors gain perspective post-cancer. A health crisis can force them to “appreciate each day more; or really get serious with what they are going to accomplish with their lives.”

For Anna and Brian Cluxton, having faced Anna’s cancer in place of planned newlywed bliss added layers to their young marriage in a hurry. “When you’re young and something huge like this happens,” Anna says, “you just don’t have those little life skills yet, the ones that you pick up over time.”

But Anna says she’s thankful for the skills they learned because it added dramatically to the depth of their marriage. “We do actually joke about it,” she says. Instead of buying frivolous or cartoon-laced birthday or anniversary cards for friends and relatives, “we gravitate toward the cards that talk about climbing mountains together. We feel we have lived years and years of marriage in a very short time.”