Breast cancer stress may affect spouse's health

A recent issue of the journal Brain, Behavior and Immunity, reports that men who care for a wife with breast cancer suffer a measurable negative impact on their health up to years after their wife's cancer has been diagnosed and treatment has been completed. According to the study, men who reported the highest levels of stress, due to their wives' illness, had the highest risk for physical symptoms and weaker immune responses. The researchers decided to determine the health effects of a recurrence of breast cancer on patients' male caregivers and discovered that the level of stress the men suffered, with regard to their wives' cancer, had a greater impact on their health than the current status of their wives' disease. Leading researcher, Dr. Sharla Wells-Di Gregorio, who is assistant professor of psychiatry and psychology at Ohio State University, states that the findings suggest that clinicians who care for breast cancer patients should also take their caregiver's health into account, for instance, by screening caregivers for stress symptoms and encouraging participation in stress management, relaxation of other self-care activities. Co-author of the study, Kristen Carpenter, a postdoctoral researcher in psychology at Ohio State said: "If you care for the caregiver, your patient gets better care, too." The study involved a total of 32 men who had an average age of 58, and had been married for an average of 25 years. The majority of men were white. The wives of 16 of the men had a breast cancer recurrence eight months (average) before study commencement, and about five years after their initial cancer diagnosis, whilst the other 16 men's wives had similar cancers, yet they remained disease-free around six years after the initial diagnosis. The men were asked to complete various questionnaires that measured the levels of psychological stress, due to their wives' cancers, as well as physical stress related symptoms, and how much their level of fatigue affected their daily functioning. The researchers performed a white-blood-cell activation in response to three different antigen types or substances that activate an immune response in the body to evaluate the men's immune function. The findings demonstrated that men whose wives experienced a relapse of cancer typically reported higher stress levels, a higher impact on their daily function, due to fatigue and more physical symptoms like headaches and abdominal pain, compared to those whose wives stayed free or disease. Researchers used the Impact of Events Scale, a subjective assessment of stress that measures intrusive experiences, thoughts and avoidance attempts of people and places that serve as painful reminders on a scale of 0 to 75. In this study, the higher the score, the more stressed the men were, due to their wives' illness. Whilst scores above nine indicate a likely impact, scores between 26 and 43 suggest a powerful effect on a person's stress level, with scores above 33 indicating substantial clinical distress. The average score of all study participants was 17.59, whilst men whose wives' cancer had relapsed scored 26.25 as a group, compared with 8.94 for those whose wives were disease-free. Carpenter explained: "The scores reported here are quite high, substantially higher than we see in our cancer patient samples outside the first year. Guilt, depression, fear of loss - all of those things are stressful. And this is not an acute stressor that lasts a few weeks. It's a chronic stress that lasts for years." On average, all participants reported to have suffered from about seven stress-related physical symptoms, with men whose wives' cancer relapsed reporting to have experienced on average nine various symptoms, including headaches, nausea, coughing and gastrointestinal problems, whilst those whose wives remained free of disease reported suffering from less than five symptoms. When the researchers accounted for the men's perceived stress due to their wives' cancer, they discovered that higher stress was linked to compromised immune function. This was particularly true for those who scored the highest in the stress scale, as they had the lowest immunity responses in terms of two of the three antigens. According to earlier research, individuals whose immune response is impaired are more susceptible to infection, and may not be fully responsive to vaccines. Wells-Di Gregorio, who works in Ohio State's Center for Palliative Care explained: "Caregivers are called hidden patients because when they go in for appointments with their spouses, very few people ask how the caregiver is doing. These men are experiencing significant distress and physical complaints, but often do not seek medical care for themselves due to their focus on their wives' illness." It remains unclear, in terms of men who suffer from chronic stress, whether the immune dysregulation causes more physical symptoms, or whether the stress causes the symptoms and the impaired immune response. Wells-Di Gregorio highlighted that the level of stress may have been even more pronounced than what they observed during the study, given that women who remained free of disease were more reluctant to participate in the study. She concluded: "We found that many were not willing to participate because they said they didn't want to think about cancer again."