Cancer and the couple: What counsellors need to know

As a relationship therapist, I’ve found myself thinking about the impact of both a cancer diagnosis and cancer treatment on couples.

Cancer and the couple

A couple should expect to face cancer 

As a nation, we are living longer. While this is a cause for celebration, those additional years bring with them the risk of health problems. The latest forecast is that one in two of us will get cancer. While the distribution is not even – in some couples, both will get cancer at some point, in others neither – on average, we should expect a long-term relationship to be impacted by cancer. While, in some cases, the interval from diagnosis to death can be tragically short, medical advances mean that cancer is not always a death sentence. Many patients will survive and live many years cancer free; others will experience periods of remission, with the possibility of the cancer’s return never quite out of sight; for some, cancer will be a long-term health condition, with a mix of treatments, involving radiotherapy, chemotherapy, surgery or some combination of the three, becoming part of life’s routine.

The couple is a system

Cancer is a physical condition. Only the patient experiences the symptoms, treatment and outcome, good or bad. But a couple is a system: what impacts one affects the other. So, the treatment regime (keeping track of medication, attending countless appointments and hospital stays, and, in the age of Covid-19, shielding) will involve both. More importantly, the psychological pain will be felt by both. If the partner with cancer dies, it is the survivor who must bear the grief. Even when there is a good outcome, few couples will be unchanged by cancer, with many having to adjust to shifts in their relationship, including their economic situation, gender roles and sexual relationship.

Towards the end of her life, the bowel cancer campaigner, Dame Deborah James, wrote a powerful tribute to her husband, Sebastien. “As cancer brings my life to an end” she wrote, “I feel this cruel realisation that I’m not fully able to be myself with the one person I have adored and needed in my life more than anyone else. I feel robbed of a body without pain to kiss with, the freedom for us to make whimsical plans for our future and retirement together.”

The emotions stirred up by cancer are intense. At times, the patient may experience fear (of treatment as well as of death), guilt (at leaving their partner too soon), anger (why me?), frustration (at the endless waiting around for callbacks or results), embarrassment or shame (is everyone in the street looking at me?). Some cancer treatments are painful, and the side effects can be brutal, but there is also the intrusion: the body is compromised by cancer and opened up to the eyes of strangers. One cancer patient said to me, “They talk about people fighting cancer, but you don’t fight cancer; the NHS fights it; your body is just the battlefield.”

Those emotions can have their parallel in the partner who doesn’t have cancer. They can also feel fear (of being left alone), guilt (for taking any time for oneself, when the partner’s needs are so much greater), frustration (at the additional load that caring brings), anger (why didn’t you take more care of yourself; why didn’t you go to the doctor sooner?) and irritation (why is everything always about cancer now?).

Couples also have to adjust to changes to the cancer patient’s body, for example, those brought by having to use a stoma (common after bowel surgery) or a penis pump (prostate surgery) or mastectomy (breast cancer surgery). Some couples embrace new ways to be intimate and others struggle.

Even positive emotions, such as the elation at getting an all-clear, or the desire to live every moment to the full in the face of a diagnosis, can be destabilising to the couple, bringing disruption to established patterns of living. Life doesn’t stop because someone has cancer: food still needs to be bought and prepared, rent and mortgages paid, and kids or grandkids picked up from school. Couples where one or both have cancer may still have to cope with the cost-of-living crisis and climate anxiety; they may already be coping with addictions or infidelities. But they will have to cope with these while also facing cancer.

The gift of time

Understandably, we fear cancer. But we must all die one day of something. A wise colleague, when speaking of their parent’s death, said, “Cancer gives you time.” While the popular fantasies of either dying quietly in our sleep or “popping our clogs” (a peculiarly British expression which I have always assumed means dying suddenly of a stroke or heart attack - with no attendant hospital stay or indeed realisation that we are dying) have undoubted attractions on an individual level, they rob the couple (and the wider family) of the time to say a proper goodbye, to put old battles to rest, to say the words that were always in our hearts, but maybe never made it onto our lips.

Our role as counsellors

Returning to Deborah James. The passage quoted above continues.

My husband is my rock... And yet I’ve wondered every day how it must have felt for him when the fairy-tale marriage he signed up for became a daily struggle to survive and fight for an extra moment of living. I’ve wondered how he’s felt knowing he is about to become a widower. I’ve wondered how he will remember me, and I’ve wondered if he will be OK.

Deborah James

I found those four “wonderings” especially poignant. Why did she have to wonder? Why didn’t she know? As counsellors, I think we can have a role here: providing a safe space where both halves of a couple can open up about the very difficult emotions cancer brings, and hear each other, without fear of judgement.

As professionals, I think we could talk more about how cancer affects the couple. If you are a couple affected by cancer or another long-term health condition and are looking for relationship therapy, email me to book a session.