A diagnosis of breast cancer impacts the entire family
system. With the importance of treating breast cancer in the family context increasingly recognized, this present review seeks to identify the impacted relational
aspects and the unmet psychosocial needs of patients and families, as well as systemic
family interventions that may best serve this population. There has been a
considerable amount of research conducted on affected couple dyads indicating
that partners are significantly affected, younger couples face greater
adversity, and that compromised communication, emotional support, and sexual
relations are sources of concern that compromise coping and resilience factors.
Research shows that adolescents are at particularly high risk for distress. Although
family and couples therapy interventions have proven to be beneficial in
improving quality of life and decreasing familial distress, implementation of
medical family therapy programs emphasizing biopsychosocial frameworks and a
culturally sensitive lens may hold the best promise in complementing the medical
treatment of breast cancer.

The Effects of Breast Cancer on the Family: The Essentiality
of Medical Family Therapy Interventions

The National Cancer Institute estimated that in 2006 approximately 2.5 women with a history of breast cancer were living (American Cancer Society, 2009). While in
2009, an estimated 254,650 new cases of breast cancer was diagnosed among women
and about 1,910 cases were expected to occur among men according to the
American Cancer Society. Increased survivorship has changed the disease to a
chronic condition with biopsychosocial aftereffects with multiple challenges
beyond the acute phase of medical treatment (Naaman, Radwan, & Johnson, 2009).
Although morbidity rates for breast cancer have declined and the majority of
women treated for the disease survive, more women are also being diagnosed and
treated for breast cancer (Figueiredo, Fries, & Ingram, 2004). A diagnosis
of breast cancer not only affects the life of the woman, but also the lives of
those closest to the patient, including partners and children (Campbell, 2003;
Faulkner & Davey, 2002; Heiny, Hermann, Bruss, & Fincannon, 2001;
Northouse, Kershaw, Mood, & Schaefnacker, 2005; Manne & Badr, 2008;
Wagner, Bigatti, & Storniolo, 2006). Breast cancer diagnoses and
experiences present considerable challenges such as altering family roles,
future plans, changing physical appearance, coping with treatment side effects
and psychological distress (Figueiredo, et al., 2004; Manne, Ostroff, Sherman,
Heyman, Ross, & Fox, 2004; Petersen, Kruczek, & Shaffer, 2003; Scott,
Halford, & Ward, 2004). Cancer impacts all families, even those with good
coping skills and adaptation abilities (Faulkner & Davey, 2002).

The purpose of this review is to identify the affected relational aspects and the
unmet psychosocial needs of the patients and families, as well as some family
interventions that have been studied for coping with breast cancer. With
females being 99% of those affected by breast cancer, this review will focus on
this population.

Some of the most common psychosocial concerns reported by women with breast cancer are: fear of recurrence, physical symptoms, body image, sexual dysfunction, treatment-related anxieties, intrusive thoughts, marital or partner communication, feelings of vulnerability and existential concerns (Hewitt, Herdman, & Simone, 2004).
Such concerns and psychological distress extend beyond the patient and can
negatively impact the quality of life of the family and caregivers as well
(Feldman & Broussard, 2006; Kershaw, Northouse, Kritpracha, Schafenacker
& Mood, 2004; Northouse, et al., 2005; Wagner, et al., 2006). Breast cancer
has been described as a “family affair” and as a “biopsychosocial problem that
occurs in the context of an intense personal relationship that affects, and is
affected by, the disease process in a circular reciprocity,” (Naaman, et al.,
2009), thus family support is crucial for patients’ well-being (Shields &
Rousseau, 2004). While over the last 20 years, researchers and oncology
clinicians have recognized the importance of treating breast cancer in the
family context and Medical Family Therapy growing as a valuable specialty in
the field, the literature suggests there is still a great need for
collaborative oncology teams consisting of a family therapist and
implementation of psychosocial family programs within oncology departments
(Anllo, 2000; Campbell, 2003; Faulkner & Davey, 2002; Manne & Badr,

Impact of Breast Cancer on Marital and Intimate Relationships 

It has been well documented that the martial relationship is the most important source of support for patients during breast cancer diagnosis and treatment,
(Figueiredo, et al., 2004; Manne, et al., 2004), as well as the most
influential family relationship on health (Campbell, 2003). Research shows that
both partners affect the others’ coping styles and that distress by both
partners was linked to their coping efforts (Feldman & Broussard, 2006). In
a qualitative study examining the core concerns of couples facing breast cancer
who were seeking psychosocial support it was found that the core concerns were
tension in the relationship, not knowing how to respond to her, wanting him to
understand, needing to know what it is like to be touched, needing to be
together and without the children, tired of listening to worries, wondering
about the children, and managing the threat of breast cancer and fearing
reoccurrence (Shands, Lewis, Sinsheimer, & Cochrane, 2006). Marriage is
definitely stressed by breast cancer (Dorval, et al., 2005), and couples have
reported ineffective communication as their biggest concern (Hodgson, Shields,
& Rousseau, 2003). Several studies have examined and studied communication
and engagement in couples coping with breast cancer and it has been supported
that open disclosure and relationship talk is related to relational
satisfaction, feelings of intimacy and greater emotional well-being, and
avoidant coping is associated with partner distress (Badr & Acitelli, 2005;
Figueiredo, et al., 2004; Hodgson, et al., 2003; Manne, et al., 2004; Manne,
Ostroff, Rini, Fox, Goldstein, & Grana, 2004; Manne, Ostroff, Winkel, Grana
& Fox, 2005). A study was conducted on couples who reported breast cancer
brought them closer and it was found that the spouse accompanied the patient to
treatments, they reported they were confidants, and the patient gave advice to
the spouse on how to cope with her breast cancer, which also supports the
benefits of open disclosure and may suggest that the couple relationship is not
fundamentally threatened by breast cancer (Dorval, et al., 2005). Studies
conducted on the effectiveness of couple-interventions in coping with breast
cancer have proved to be effective in reducing psychological distress and
improving relationship functioning, however many have been pilot studies or
have been conducted with the use of focus groups (Baucom, et al., 2009;
Northouse, et al., 2005; Scott, et al., 2004; Shields & Rousseau, 2004). It
is proposed that Emotion-Focused therapy may benefit couples following
treatment for breast cancer to focus on reducing avoidance and may enhance open
communication and self-disclosure (Manne, Ostroff, Norton, Fox, Goldstein &
Grana, 2006; Naaman, et al., 2009)

Impact of Breast Cancer on Partners 

The literature also shows that husbands or intimate partners are often the primary
caregivers for their spouses during breast cancer treatments (Feldman &
Broussard, 2006; Northouse, et al., 2005; Wagner, et al., 2006). Male partners
are assuming fundamental roles in the patient and family care; however,
literature suggests that they are in a high-risk group because they tend to be
disregarded or neglected while health care professionals focus on the patients’
concerns (Feldman & Broussard, 2006; Wagner, et al., 2006). A breast cancer
diagnosis in a partner is associated with considerable psychological distress
for husbands, typically shown as anxiety and depression (Wagner, et al., 2006)
which affects other aspects of their lives such as sleep, work, aspects of
their relationship, sex lives, and relationships with others (Feldman &
Broussard, 2006). In a study on men’s adjustment to their partners’ breast
cancer it was found that patients’ physical well-being was negatively
associated to men’s negative coping. However, longer relationship length was
correlated with less illness intrusiveness, lowered occurrence of depression
and higher levels of their partner’s physical well-being (Feldman &
Broussard, 2006). Being such an important figure and at high-risk, partners
should be included in psychosocial interventions for the patient, including
couples-coping techniques to assist with dyadic coping skills.

Impact of Breast Cancer on Sexual Relations   

There is a growing body of evidence to suggest that changes in body image after
breast cancer and its treatments may have direct effects on sexuality, sexual
response, sexual roles and intimate relationships (Anllo, 2000; Pelusi, 2006).
However, responses to changes or importance placed on these issues may vary
culturally, because one study found that Asian American women did not place
value on their body image, they opted for a mastectomy more often so they would
not be away too long from family duties (Kagawa-Singer & Wellisch,
2003).Traditional health care providers do not typically address these issues.
The effects on cancer and its treatment on sexuality are not usually included
in the assessments or plans of care for the patients (Anllo, 2000).
Psychotherapy interventions have been suggested to help with understanding the
potential impact on sexuality, help with sexual dysfunctions and enhance body
image or self-esteem, specifically with Medical Family Therapists who may be
more comfortable handling sex and relational issues regarding breast cancer
(Anllo, 2000; Pelusi, 2006).

Impact of Couples’ Age on Diagnosis

In astudy examining the role of reconstructive surgery, younger age was found to be
more of an important risk factor for distress and sexual dysfunction than the
type of surgery received (Rowland, Desmond, Meyerowitz, Belin, Wyatt, &
Ganz, 2000). 68% of young women reported feeling self-conscious and had sexual
problems since their treatments (Walsh, Manuel, & Avis, 2005). Breast
cancer in young women usually means these women have small children to care for
while battling a life-threatening disease. While for younger women who have not
yet had their children, the diagnosis and treatment of breast cancer can lead
to possibilities of death, infertility, toxicities, or premature menopause, all
which contribute to the risk of greater psychological distress in young women
and their young husbands (Hewitt, et al., 2004). Also the study on men’s
adjustment to their partners’ breast cancer found that the impact can be more
severe for young couples in the childrearing years and also because they have
not had the opportunity to grow and develop their relationship over time, which
was found to be a source of strength for partners (Feldman & Broussard,

Impact of Mothers’ Breast Cancer on Children and Adolescents

Literature on the impact of breast cancer on children and adolescents is sparse and not as extensive as that on the couple dyad; therefore little is known on the effects
of their psychosocial development (Faulkner & Davey, 2002). However, some
child-related themes are present in the literature including role shifts,
emotional distress, increased closeness and the importance of the child’s
development stage (Faulkner & Davey, 2002; Heiny, et al., 2001; Petersen,
et al., 2003; Walsh, et al., 2005). From a family systems perspective, the
stress of parental illness affects the balance of the system (Faulkner &
Davey, 2002; Petersen, et al., 2003) and concerns about the effects on the
children were present in the qualitative study by Shands, Lewis, Sinsheimer
& Cochrane (2006).
Breast cancer can cause mothers to be inaccessible due to treatment demands, suffer
depression and be emotionally unavailable, to have marital tension, all which
can affect the children in the household (Faulkner & Davey, 2002). In a
study evaluating the impact on young women’s relationships with partners and
children, it was found that women felt a huge loss in quality time with their
child and their maternal role. The shift in family dynamics presented
challenges and 61% of mothers reported negative effects on their relationships
with their children, while 39% did report a positive impact and increased
closeness (Walsh, et al., 2005).
A mother’s breast cancer impacts children differently depending upon the child’s
age and developmental stage and should be considered when deciding how to
discuss the disease with the child (Heiny, et al., 2001), when behavioral
changes related to the breast cancer need to be distinguished from normal
developmental changes (Shands, et al., 2006) and when determining how to best
clinically intervene (Faulkner & Davey, 2002). Literature suggests that
young children do not understand the concept if cancer due to their concrete
mode of thinking, but their emotional responses are mainly fear, loneliness,
anger and uncertainty. Older school-age children are aware that they have more
household responsibilities and chores, but they are more concerned with their
own interests and activities, which is appropriate for their egocentric
perspective (Faulkner & Davey, 2002; Petersen, et al., 2003). Adolescents
however are at greater risk for emotional distress. They report that their
lives are complicated by their mothers diagnosis, and they feel torn with
struggling for independence and forming a separate identity but they know they
are needed at home emotionally and physically (Faulkner & Davey, 2002).
They tend to take on more roles and responsibilities which may hinder their
progress towards autonomy during their developmental stage (Davey, Gulish,
Askew, Godette, & Childs, 2005; Faulkner & Davey, 2002; Petersen, et
al., 2003). They are of age to comprehend the life-threatening disease and thus
are more vulnerable to emotional distress (Faulkner & Davey, 2002). There
are gender differences in the way adolescents cope with their mothers’
diagnosis (Davey, et al., 2005; Faulkner & Davey, 2002; Petersen, et al.,
2003). Daughters are more affected because they want to support their mother
but may be resentful of taking on their tasks due to their socialized gender
role in the family, as well as fearful of inheriting the disease which may
cause them to withdrawal (Faulkner & Davey, 2002; Petersen, et al., 2003),
whereas adolescent sons may just avoid communication about the illness and
situation (Faulkner & Davey, 2002).
While studies on family interventions with children are lacking in relation to breast
cancer, it has been suggested that they would be beneficial and that family
therapists can provide emotional and social support to the family, helping them
find ways to tell their children, navigate the stresses of coping with cancer,
promote shared family understanding and open communication (Davey, et al.,
2005; Faulkner & Davey, 2002; Heiny, et al., 2001).


In aggregate, the literature supports the importance of viewing breast cancer in a family context, noting the negative impact that breast cancer has not only on the
patient, but on the couple dyad, and the psychological well-being of the
partners and children of women facing breast cancer. Implications suggest that
despite the current advances in medical family therapy, interventions are
essential in the medical treatment of breast cancer. Family interventions are
needed, emphasizing services for partners and caretakers for coping strategies,
and working with couples to optimize communication and emotional support, and
to help alleviate sexual dysfunction. Research findings suggest that resources
targeting younger couples, children and adolescents are in particularly high
demand. There is also a growing need to provide therapy for survivors and that adjuvant models of care should be developed beyond core treatment.

Directions for Future Research

While the literary base regarding female patients of breast cancer is extensive, more research should explore the effects of male patients with breast cancer to examine if
there are gender differences on the impact for them and their caregivers. As
the literature was predominantly representative of heterogeneous couples; more
research should be conducted to examine a variety of dyadic relationships and the
unique relational distresses they may experience while facing breast cancer. Diverse
cultural populations should also be further examined to increase the generalizability of these findings outside of the American, middle class Caucasian population.

Clearly, more research should be conducted to examine the effectiveness of different
family therapy interventions for breast cancer patients and their families.


American Cancer Society (2009). Breast Cancer Facts and
Figures 2009-2010. Atlanta, GA: American Cancer Society, Inc.

Anllo, L.M. (2000). Sexual life after breast cancer. Journal
of Sex & Marital Therapy, 26, 241-248.

Badr, H., & Acitelli, L. (2005). Dyadic adjustment in chronic illness: Does relationship talk matter? Journal of Family Psychology, 19(3), 465-469. doi: 10.1037/0893-3200.19.3

Baucom, D.H., Porter, L.S., Kirby, J.S., Gremore, T.M., Wiesenthal, N., Aldridge, W., & Keefe, F.J. (2009). A couple-based intervention for female breast cancer. Psycho-Oncology, 18, 276-283.  doi:10.1002/pon.1395

Campbell, T.L. (2003). The effectiveness of family inventions for physical disorders. Journal of Marital and Family Therapy, 29(2), 263-281.

Davey, M., Gulish, L., Askew, J., Godette, K., Childs, N. (2005). Adolescents coping with mom’s breast cancer: developing family intervention programs. Journal of Marital and Family Therapy, 31(2), 247-258.

Dorval, M., Guay, S., Mondor, M., Masse, B., Falardeau, M., Robidoux, A., &  Maunsell, E. (2005). Couples who get closer after breast cancer: Frequency and predictors in prospective investigation. Journal of Clinical Oncology, 23(15), 3588-3596. doi: 10.1200/JCO.2005.01.628

Faulkner, R.A., & Davey, M. (2002). Children and adolescents of cancer patients: The impact of cancer on the family. The American Journal of Family Therapy, 30, 63-72.

Feldman, B.N, & Broussard, C.A. (2006). Men’s adjustment to their partners’ breast cancer: A dyadic coping perspective. Health & Social Work, 31(2), 117-127.

Figueiredo, M.I., Fries, E., & Ingram, K.M. (2004). The role of disclosure patterns and unsupportive social interactions in the well-being of breast cancer patients. Psycho-Oncology, 13, 96-105. doi: 10.1002/pon.717

Heiny, S.P., Hermann, J.F., Bruss, K.V., Fincannon, J.L. (2001). Cancer in the Family: Helping Children Cope with a Parent’s Illness. Atlanta, GA: American Cancer Society, Inc.

Hewitt, M., Herdman, Simone (2004). Meeting Psychosocial Needs of Women with Breast Cancer. Washington, DC: The National Academies Press.

Hodgson, J.H., Shields, C.G., & Rousseau, S.L. (2003). Disengaging communication in later-life couples coping with breast cancer. Families, Systems & Health, 21(2), 145-163.

Kagawa-Singer, M., & Wellisch, D.K. (2003). Breast cancer patients’ perceptions of their husbands’ support in a cross-cultural context. Psycho-Oncology, 12, 24-37. doi: 10.1002/pon.619

Kerhsaw, T., Northouse, L., Kritpracha, C., Schafenacker, A., & Mood, D. (2004). Coping strategies and quality of life in women with advanced breast cancer and their family caregivers. Psychology and Health, 19(2), 139-155. doi: 10.1080/08870440310001652687

Manne, S., & Badr, H. (2008). Intimacy and relationship processed in couples’ psychosocial adaptation to cancer. Cancer Supplement, 112(11), 2541-2555. doi: 10.1002/cncr.23450

Manne, S.L., Ostroff, J.S., Norton, T.R., Fox, K., Goldstein, L., & Grana, G. (2006). Cancer-related relationship communication in couples coping with early stage breast cancer. Psycho-Oncology, 15, 234-247. doi: 10.1002/pon.941

Manne, S., Ostroff, J., Rini, C., Fox, K., Goldstein, L., & Grana, G. (2004). The interpersonal process model of intimacy: The role of self-disclosure, partner disclosure, and partner responsiveness in interactions between breast cancer patients and their partners. Journal of Family Psychology, 18(4), 589-599. doi: 10.1037/0893-3200.18.4.589

Manne, S.L., Ostroff, J., Winkel, G., & Grana, G. (2005). Partner unsupportive responses, avoidant coping, and distress among woman with early stage breast cancer: Patient and partner perspectives. Health Psychology, 24(6), 635-641. doi: 10.1037/0278-6133.24.6.635

Naaman, S., Radwan, K., & Johnson, S. (2009). Coping with early breast cancer: Couple adjustment processes and couple-based intervention. Psychiatry, 72(4), 321-345. Retrieved from Psychology and Behavioral Sciences Collection Database

Northouse, L., Kershaw, T., Mood, D., & Schafenacker, A. (2005). Effects of a family intervention on the quality of life of women with recurrent breast cancer and their family caregivers. Psycho-Oncology, 14, 478-491. doi: 10.1002/pon.871

Pelusi, J. (2006). Sexuality and body image: Research on breast cancer survivors documents altered body image and sexuality. Cancer Nursing, 106(3), 32-38.

Petersen, L., Kruczek, T., & Shaffner, A. (2003). Gender roles and the family life cycle: The case of women with cancer. Journal of Feminist Family Therapy, 15(2), 99-119. doi:  10.1300/J086v15n02_06

Rowland, J.H., Desmond, K.A., Meyerowitz, B.E., Belin, T.R., Wyatt, G.E., & Ganz, P.A. (2000). Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. Journal of the National Cancer Institute, 92(17), 1422-1429.

Scott, J.L., Halford, W.K., & Ward, B.G. (2004). United we stand? The effects of a couple-coping intervention on adjustment to early stage breast or gynecological cancer. Journal of Consulting and Clinical Psychology, 72(6), 1122-1135. doi: 10.1037/0022-006X.72.6.1122

Shands, M.E., Lewis, F.M., Sinsheimer, J., & Cochrane, B.B. (2006). Core concerns of couples living with early stage breast cancer. Psycho Oncology, 15, 1055-1064. doi: 10.1002/pon.1036

Shields, C.G., & Roisseau, S.J. (2004). A pilot study of an intervention for breast cancer survivors and their spouses. Family Process, 43(1), 95-107.

agner, C.D., Bigatti, S.M., & Storniolo, A.M. (2006). Quality of life of husbands of women with breast cancer. Psycho-Oncology, 15, 109-120. doi: 10.1002/pon.928

Walsh, S.R., Manuel, J.C., & Avis, N.E. (2005). The impact of breast cancer on younger women’s relationships with their partners and children. Families, Systems, & Health, 23(1), 80-93. doi: 10.1037/1091-7527.23.1.80


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