Elsevier

Gynecologic Oncology

Volume 118, Issue 3, September 2010, Pages 268-273
Gynecologic Oncology

Partners of long-term gynaecologic cancer survivors: Psychiatric morbidity, psychosexual outcomes and supportive care needs

https://doi.org/10.1016/j.ygyno.2010.05.019Get rights and content

Abstract

Objective

To describe long-term psychological morbidity, unmet supportive care needs, positive changes, sexual outcomes and relationship satisfaction in partners of gynaecologic cancer survivors, as compared with respective survivors.

Method

Self-report measures were administered to a cross-sectional sample of 68 partners recruited via patient survivors.

Results

Rates of depression and anxiety among partners were 8.8% and 10.3%, respectively. Anxiety was higher among survivors than partners (P = 0.003). Partners reported a mean of 3.25 unmet needs and 48.5% had at least one unmet need. At least one positive change was reported by 66.2% of partners. Greater number of unmet needs was the most important predictor of both anxiety (β = 0.39; P = 0.001) and depression (β = 0.45; P < 0.001). Poor relationship satisfaction independently predicted greater anxiety (β =  0.28; P = 0.01). Perceptions of relationship satisfaction did not differ within couples. Half of couples had been sexually active in the preceding month. Most reported no change in interest in physical contact (76.4%) or sex (70.6%), had excellent sexual function and high levels of satisfaction with sex life. Compared to partners, survivors perceived worse vaginal stenosis and dryness (both P = 0.002) and worse satisfaction with (survivors') appearance (P < 0.001). Partner outcomes were not associated with demographic variables or survivors' clinical characteristics.

Conclusion

The majority of partners reported excellent sexual outcomes and little perceived change since the survivors' diagnosis. The association between unmet needs and psychological morbidity suggests a useful target for further intervention. Despite methodological limitations, these data are novel and present a starting point for further investigation to improve outcomes for survivors and partners.

Introduction

Elevated rates of psychological distress in partners of cancer patients have been reported [1], [2] and prevalence is found to equal or exceed the rates experienced by patients [3], [4], [5]. Distress in partners may have far-reaching implications for both partner and cancer patient with recently published findings showing increased health care costs among partners following cancer diagnosis [6] as well as marked changes in neurohormonal and inflammatory processes that may predispose to further morbidity [7]. Partner mood disturbance has also been associated with increased patient distress [8], [9] which in turn impacts treatment adherence [10] and health care costs [11]; and can have deleterious effects on immune function [12], [13].

Despite recognition of the interdependence of psychological adjustment within couples [14], [15], [16] and the care burden undertaken by partners, to date, only one study has specifically investigated psychological morbidity in partners of women with gynaecologic cancer [5]. Similarly, while sexual outcomes and relationship (marital) satisfaction from the gynaecologic patient's perspective have been extensively described [17], [18], [19], no prior studies have described these outcomes from the partner's perspective or compared patient and partner data. Furthermore, despite evidence that partners of cancer survivors have unique needs [20], [21] and may have more unmet supportive care needs than patients [22], there are no specific data on the care needs of partners of women with gynaecologic cancer.

In this study, we sought to address these gaps and extend the literature beyond its predominant focus on partners in breast and prostate cancer and the acute phase of treatment by describing long term psychological morbidity, unmet supportive care needs, positive changes, sexual outcomes and relationship satisfaction in partners of women previously diagnosed with gynaecologic cancer. We hypothesized that psychological morbidity would be predicted by past history of mental illness, younger age [23], poorer relationship satisfaction [24], greater unmet needs, shorter length of relationship with the survivor [24], and less time since the survivor's cancer diagnosis. To provide a context, all partner outcomes other than unmet needs are compared with corresponding patient survivor data.

Section snippets

Procedure

Partners were recruited via women previously diagnosed with gynaecologic cancer (“survivors”) at a large metropolitan teaching hospital in Melbourne, Australia who were participating in a study of long-term quality of life outcomes. Findings of the larger cohort of survivors including those without partners will be reported elsewhere. All partners were recruited via the survivor and not approached directly. Inclusion criteria for survivors were diagnosis of gynaecologic cancer from January 1997

Study participation

Clinical and contact details were obtained for the 670 women diagnosed from 1997 to 2006 known to have had contact with the hospital in the preceding 18 months. Amongst these patients, 12 were deceased. A further 63 women were excluded because of cognitive deficit (n = 1) or non-English speaking status (n = 62); 146 declined participation (not interested, n = 92; unwell, n = 24; did not want to participate in any research, n = 27); and 179 could not be contacted. Verbal consent was given by 270 women of

Discussion

In the context of increasing recognition of the emotional and physical impact of cancer beyond the index patient, we present novel data describing psychological morbidity, sexual outcomes, supportive care needs, positive changes, and relationship satisfaction in partners of women previously diagnosed with gynaecologic cancer. Partner data were compared with respective data from corresponding survivors.

Rates of depression (8.8%) and anxiety (10.3%) among partners were lower than among the

Conflict of interest statement

The authors have no conflict of interest to declare

Acknowledgments

This work was supported by the generous financial contribution of the Collier Charitable Foundation. The Centre for Women's Mental Health is supported by the Pratt Foundation.

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