Partners' Long-term Appraisal of Their Caregiving Experience, Marital Satisfaction, Sexual Satisfaction, and Quality of Life 2 Years After Prostate Cancer Treatment

Janet K. Harden, PhD; Martin G. Sanda, MD; John T. Wei, MD; Hossein Yarandi, PhD; Larry Hembroff, PhD; Jill Hardy, BS; Laurel L. Northouse, PhD


Cancer Nurs. 2013;36(2):104-113. 

In This Article

Theoretical Perspective and Review of Literature

The stress-coping model adopted from Lazarus and Folkman[12] served as the theoretical framework that guided the development of this study of spouse-caregivers' experiences. According to the model (Figure), selected patient disease factors and preexisting spouse personal factors may influence how spouses appraise a caregiving experience and manage the demands related to it. These factors can affect sexual satisfaction, marital satisfaction, and the QOL of the individual.


Conceptual framework of factors affecting spouses' quality of life.

Antecedent Factors

Patient disease factors include the type of treatment men receive for prostate cancer, which is related to the type of symptoms that they experience. Many studies have reported that bowel problems, bladder difficulties, and sexual dysfunction occur following treatment for prostate cancer. Incontinence, impotence, and loss of libido affect the lives of both the patient and his spouse[13,14] and, in turn, may affect each person's QOL.[15] Other research has shown that the severity of the disease at the time of diagnosis affects the appraisal of the patient and the spouse. Severity indicates how far the disease has spread within the prostate, to nearby tissue, and to other organs. The severity of disease is an important factor in selecting treatment as well as in predicting prognosis. Pretreatment cancer severity may affect a spouse's appraisal of her husband's illness. A higher cancer index score may cause appraisal of more threat related to prostate cancer.[16]

Spouse factors are preexisting characteristics of the spouse that include demographic factors: age, education, family income, comorbidities, and the spouse's own bother related to the husband's treatment effects. Younger age in couples managing an illness has been associated with higher psychological distress, whereas older age has been associated with lower psychological distress.[17] Educational level has been associated with more perceived benefit in breast cancer survivors,[18] but in prostate cancer spouses, less education has been associated with more spousal distress.[19] Lower income or changes in income resulting from treatment for prostate cancer may affect the resources available to help the couple cope with the treatment outcomes and therefore cause more perceived threat. The health status of the spouse also can affect appraisal of care giving and QOL. Physical changes associated with the development of comorbid conditions associated with aging may have a negative effect on the spouse's appraisal of caregiving.[20]

The type of treatment selected for prostate cancer is related to the type of symptoms that men experience. Changes related to the spouse's treatment adverse effects, as discussed above, can affect spouses' appraisal of the patient's illness and consequently diminish the QOL of the couple.[2,5,8,21] A decrease in the patient's energy level and an increase in urinary frequency have been associated with a worsening of QOL in the spouse.[8] Litwin et al[22] found that sexual function was significantly related to marital satisfaction in prostate cancer couples.

Appraisal Factors

Appraisal of care giving refers to the spouse's evaluation of the experience of providing care and consists of 3 components: general stress, perceived threat, and perceived benefit (Figure). Studies indicate that the degree of perceived general stress and perceived threat is directly related to negative appraisal by the person. On the other hand, higher perceived benefit is inversely related to negative appraisal of illness. Furthermore, negative appraisal has been associated with poorer QOL outcomes in cancer patients and their caregivers.[8,13,23]

General stress associated with care giving can diminish the QOL of the caregiver. Solo way et al[24] found that spouses of prostate cancer patients reported more emotional distress associated with the diagnosis than did their husbands; as the man's problems increased, there was a reciprocal decrease in QOL of the spouse. Spouses express ongoing worries about the patient's illness that disturbs their sleep and sense of well-being,[14] which may affect the spouses' appraisal of the patient's illness and in turn the spouse's QOL.

Perceived threat, harm, or loss that is anticipated, although identified less often in men treated for prostate, has been associated with mood disturbance.[25,26] Furthermore, in patients, age had an inverse relationship with threat appraisal.[27] No studies in spouses were found in which threat was a variable studied.

Although a cancer diagnosis can cause distress, there is a growing body of literature that suggests that there may also be beneficial effects associated with the illness. There is some evidence that stressful events can result in a personal growth through improved self-understanding and increased value of being with family and friends.[14,28] Some couples have expressed positive changes as a result of their experiences including development of closer relationships, more appreciation of life, recognition of positive qualities and strengths, and improved health practices.[14,29,30]

Sexual Satisfaction

Sexuality has been found to be a critical component of health related QOL in patients with prostate cancer. In a recent study of couples in the early post treatment phase, problems with sexual function were reported more often by the spouse than the patient.[31] Additional research is needed to better understand the long-term effect of living with prostate cancer on sexual satisfaction.

Marital Satisfaction

Research on women with breast cancer found that the appraisal of illness negatively affected marital adjustment, which in turn affected marital satisfaction and family life.[32] Research in prostate cancer spouses on the effect appraisal of care giving has on spouses' marital satisfaction is not well understood.

Quality of Life Quality of life is defined as an overall experience of physical, functional, psychological, and social well-being.[33] Research has shown that cancer, in general, affects the QOL of the family,[8] but that prostate cancer in particular so strongly affects the spouse as well as the patient it has been referred to as a ''relationship disease.''[34] Spouses take on the role of maintaining emotional balance, internalizing their feelings, and trying to maintain a positive outlook for their husbands.[2,4,35] because the spouse is a major source of support for the patient with prostate cancer, the spouses' response to treatment outcomes can potentially affect the quality of patients' lives as well as their own.[1,31,36]

In summary, most psychosocial studies cited were conducted shortly after treatment. Consequently, the persistence of treatment effects on sexual or marital satisfaction and QOL in long term survival is not well understood. Prior research in prostate cancer seldom addresses the QOL of spouses, even though research has shown that the QOL of one member of the dyad affects the QOL of the other. This study attempts to examine these long-term effects for the spouse.