When cancer endangers the health of a marriage

Earlier this year, Marcia Woltjer, a registered nurse who had been battling breast cancer for three years, decided to end her marriage -- cancer or no cancer.

Her husband, Sandro Segalini, 64, a retired businessman who lives in Falmouth, Mass., had been willing to take control of their daily lives and help Woltjer the way he had helped his first wife fight breast cancer unsuccessfully 14 years ago. He was, as he put it, “chief cook, bottle washer, bandage changer and jester.”

But Woltjer, 59, didn’t want someone who felt he had to be in charge all the time.

Obviously, when cancer strikes, there’s no easy role in any marriage, whether you’re the patient or the spouse. And cancer does strike often -- 9.8 million Americans have or have had cancer and about 1.4 million more will be diagnosed this year.

But what makes some marriages fall apart under the strain of cancer and others get stronger? Researchers are finding some clues.

When a man has cancer, the sheer fact of having a partner -- regardless of the quality of the relationship -- is linked to better survival and quality of life, according to a recent study of men with prostate cancer by Dr. Mark Litwin, a professor of urology and public health at the Jonsson Cancer Center at UCLA.

But when a woman has cancer -- the scenario most frequently studied -- the quality of the relationship may matter more, perhaps because of the challenges to traditional gender and caretaking roles, said Laurel Northouse, a professor of nursing at the University of Michigan School of Nursing.

What many women -- with and without cancer -- want, Northouse said, is not for the husband to be in charge but for him to understand her feelings and to talk about his own.

For many couples, this means that when the wife gets cancer, both partners have to adapt, Northouse said. Men may have to listen, and express, feelings more often, and women may have to turn to friends and supporters when the husband is maxed out on listening.

When the woman is the patient, it’s also important for men to give up the desire to “fix” the problem, said Marc Silver, an editor at U.S. News & World Report and author of “Breast Cancer Husband,” which he described as a “guide for clueless guys.”

“Every guy I interviewed said he had an urge to ‘fix it,’ ” said Silver, whose wife had breast cancer. Guys have “an inability to sit there with things not fixed. They want to get in there and make it better. But what guys really need to do is shut up and listen.”

Marc Heyison, founder of a Maryland-based group called Men Against Breast Cancer, which has a $1.1-million grant from the federal Centers of Disease Control and Prevention to help African American, Latino and Native American men support their wives with breast cancer, put it even more bluntly: “Be honest, men. You have to give up the remote control.”

Ceding control can be hard, especially when there’s disagreement about treatment. Silver recalled one wife with breast cancer who wanted holistic treatment. Her husband was appalled. But instead of taking charge, he gently asked if there was any evidence for the holistic methods. Together they found a mainstream oncologist who was open to complementary medicine and who addressed both of their concerns.

Yielding control is also hard when the couple visits the doctor. “Some guys want to take over and run the doctor’s office like a meeting at work,” Silver said. Don’t. You can help your wife remember her questions and even ask a few yourself, but “she’s the boss. It’s her body and her disease.”

Sometimes, marriage counseling can help with communication, though it’s not clear whether this translates into a medical benefit.

Karen Kayser, a professor of social work at the Boston College Graduate School of Social Work, has studied couples in which the wife had breast cancer. She compared those who were randomly assigned to get couples counseling and those who weren’t. The results were mixed: Counseling helped partners communicate better, but overall quality of life was no different in the two groups. Counseling did appear to be more helpful for couples in the early stages of marriage.

A number of other small studies have shown that couples counseling can reduce emotional distress for both patients and partners, but, again, how much this translates into overall satisfaction with life is unclear.

There are no rules for how to respond to a spouse with cancer. But Israeli researchers who studied 73 couples in which the wife had breast cancer found that if husbands were emotionally or behaviorally disengaged or unable to express their feelings in a constructive way, the wives were more distressed.

Empathizing with each other’s feelings does help.

There is one other thing that can help many couples, and that is the fact, as Northouse of Michigan put it, that cancer makes people grow up.

“I actually think cancer brings maturity to people,” she said.

And that maturity can be the best thing that ever happens to a marriage.