Introduction

Initial approaches to the problem of understanding the psychosocial impact of cancer focused largely on measuring changes in individual psychological functioning and quality of life in the short-term as patients coped with their diagnosis, change in health status, and invasive medical treatments. A large literature now attests to the fact that cancer is a stressful experience that may affect multiple aspects of psychological adjustment, including emotional well-being, social well-being, body image, sexuality, and physical functioning.1-3 The majority of available research also suggests, however, that disruptions in quality of life and psychological functioning sustained by cancer patients are generally transitory and that most disease-free survivors demonstrate normative levels of psychological adjustment by a year or two following treatment.2,4-7 Thus, most cancer-related distress appears to be short- rather than long-term in nature and can be expected to abate over time.

Conceptualizations of adjustment to cancer have evolved to include the interpersonal impact of the disease, in addition to its intrapersonal effects. For instance, it is now widely recognized that cancer may affect the psychological functioning of individuals close to the cancer patient, with some data indicating that partners of cancer patients may be at least as distressed as patients themselves.6,8-11 In addition, as the field has developed, investigators have become increasingly interested in understanding the long-term implications of cancer for multiple aspects of survivor adjustment and well-being beyond the initial period of diagnosis and treatment.

The current chapter addresses relationships and interpersonal processes in cancer survivors. A broad view of cancer survivorship considers survivorship as beginning from the time of diagnosis, spanning the entire disease trajectory, and proceeding throughout the life span.12 In keeping with the goal of this volume, wherever possible we attempt to focus our discussion on cancer survivors who have completed treatment and are considered disease-free, versus those who are actively undergoing or have recently completed treatment. However, as will be shown, at present relatively little research addresses relationship processes beyond the immediate diagnostic and treatment interval. In addition, we will focus on data acquired from adult cancer survivors and on the nonsexual aspects of interpersonal relationships. We also should note that extant data are limited in that the majority of studies addressing the impact of cancer on relationships have as their focus the partner or marital relationship. With regards to terminology, we use the term marital or spouse when the sample is comprised exclusively of married people, but use the more general term partner to refer to samples that may include unmarried individuals who identify themselves as partnered and when formulating general conclusions about the data. Also, in keeping with the broader literature on marital and partnered relationships, we use the terms relationship quality, satisfaction, and adjustment interchangeably.13

In considering the impact of cancer on interpersonal relationships we address the following questions: (1) What is the impact of cancer on the quality of interpersonal relationships? (2) How does cancer affect interpersonal processes such as communication, and what is the relationship between communication patterns and adjustment to cancer? and (3) What are the predictors of relationship quality in cancer survivors? We also address methodological limitations associated with existing data, suggest directions for future research, and discuss implications for those working clinically with this population.

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