ANAHEIM, CALIFORNIA—Ensuring that male caregivers have the necessary support may alleviate the marital distress, depression, and intimacy issues that they experience during diagnosis and treatment of their loved ones with breast cancer, two speakers said at the Oncology Nursing Society (ONS) 39th Annual Congress.
According to the American Association for Retired Persons, the proportion of male caregivers has risen from 28% to 39%, which does not even account for the last 10 years, Sarah Dihmes, PhD, AOCNP, of the Johns Hopkins Bayview Medical Center in Baltimore, Maryland, said during a podium session.
Literature on caregivers, however, has traditionally highlighted women as caregivers for their spouses with cancer, failing to show men’s prominent role in caregiving. Given the nature of breast cancer, according to Dihmes, this new role for men is particularly important.
“This is a relational cancer. It has an intimate piece that we can’t ignore,” she said. “For men especially, even more than the breast cancer patient, this marital aspect and relationship satisfaction are going to predict their psychosocial adjustment, such as how depressed they become. We need the male caregiver to be healthy so that the patient with breast cancer can get healthy.”
Prior research indicates that caring for spouses with cancer causes high levels of stress, burnout, and marital dissatisfaction, while also increasing physical, mental, and social strain on the caregiver. Dihmes and colleagues wanted to evaluate how men specifically experience these issues.
The researchers included 96 male caregivers of women with breast cancer at least 18 years old primarily using self-reported surveys. They identified primary stressors, such as activities of daily living, as well as subjective measures, including how the male caregiver perceived the illness’s psychological, social, and sexual impact on himself.
Although Dihmes and colleagues assessed prototypical depression, they also created a masculine distress scale to address the unique ways in which men may experience these problems. Questions included whether the caregiver was staying later at work, feeling irritable, consuming more alcohol, and more.
Results showed that marital distress had a considerable impact on male caregivers. The researchers also found that men whose wives had a diagnosis of invasive breast cancer versus noninvasive breast cancer experienced more sexual problems. In addition, cancer stage directly correlated with marital satisfaction and shame, with husbands of women with stage 1 cancer reporting the most distress compared with men whose wives had stages 2, 3, or 4 breast cancer.
“This is consistent with the research showing that the shock of diagnosis can be the most difficult part,” Dihmes said.
However, data indicated that men with wives who had later-stage disease reported more shame, which manifests as more internalized guilt and disappointment in men, according to Dihmes. Radiation therapy was associated with the need for more help, and mastectomy was linked to more sexual strain.
The important question is what to do with the knowledge supplied by this study, copresenter Marhalee George, PhD, MSN, MSPH, AOCNP, also from Johns Hopkins Bayview Medical Center, said. As those who provide comprehensive care ranging from administering chemotherapy to patient education, oncology nurses are “the glue that keeps patient care together.” This means they are uniquely poised to address problems experienced by male caregivers.
After all, according to George, oncology nurses often see patients’ spouses when they come for appointments. They already engage with them and ask about their well-being. By utilizing existing tools, such as surveys and psychosocial evaluations that measure risk for depression and anxiety, oncology nurses can be the ones who ensure that these male caregivers are also receiving the support that they need.
Moreover, as many nurses are trained in informatics, they can develop innovative assessment tools with their multidisciplinary teams. Brochures, new media, or even mobile phone apps could serve as ways to tackle these problems.
Future research should focus on how to address the issues experienced by male caregivers of women with breast cancer, including identifying the most acceptable support, developing culturally sensitive educational interventions, and finding the most precise instruments for detecting male distress.
“We have the perfect opportunity to intervene, make the necessary referrals, and get the information back to a multidisciplinary team so these male caregivers can have the support needed,” George said. “This way, we can provide comprehensive care and the patient can have a better quality of life.”
Dihmes S, George M. Male caregivers for women with breast cancer: Understanding the psychological impact on spouses and the role of oncology nurses. Presented at: Oncology Nursing Society (ONS) 39th Annual Congress; May 1-4, 2014; Anaheim, CA.