When Illness Tests Marriage Vows
By: Judy Foreman
07/17/2001

Several years ago, Dr. Michael J. Glantz, a brain cancer specialist, was struck by what appeared to be an extraordinary number of divorces and separations among his patients, many of whom had primary brain tumors that were expected to kill them in 15 months.   Not only did there seem to be lots of breakups, but most of them seemed to occur when the women got sick. So, Glantz, who was then at Brown University and is moving this summer to the University of Arizona, began keeping track.

To the surprise of his male but not his female colleagues, Glantz found that 17 out of 183 married brain cancer patients had endured a divorce or separation within about a year of their diagnosis - an overall divorce rate of 9 percent. More importantly, he said, 14 of the 17 divorced or separated patients - 82 percent - were women.

To see whether this was tied to something particularly stressful about brain cancer, which can alter personality and cognitive function, Glantz also studied two other groups: 107 married patients with multiple sclerosis, a chronic disease that is not usually fatal, and 172 married patients with cancers that neither arose in nor had spread to the brain.

Divorces in those cases, too, he found, disproportionately occurred when it was the wife who was sick - 96 percent of the cases with MS, 78 percent of the cases of systemic cancer.

One rather unappealing interpretation is obvious: That women hang in there with sick husbands while men bail out on sick wives. But stay with this a bit longer, guys. And, ladies, don't despair. This is not heading to the all-men-are-cads conclusion you may be expecting.

For years, when researchers probed the emotional impact of cancer and other serious illnesses, they usually focused on the patient. Today, there's a growing realization that, at least in the emotional sense, it's the couple or the whole family that "has" the disease.

In fact, the well spouse sometimes feels more distress than the sick one, who at least can throw his or her efforts into survival. And, while some men do have trouble taking on the nurturing role, researchers say, many do it quite well. In fact, many couples get closer when one member has cancer, especially if the marriage was strong to start with. Beth and David Savard of Methuen can vouch for that, though things got very shaky while she was in the midst of chemotherapy for breast cancer six years ago. Both 35 now, they were 29 and the parents of a 2-year-old when Beth was diagnosed. David could deal with the factual issues about cancer, she said, but he shut down emotionally.

"He was not talking about his feelings. I was trying to talk about mine, but I couldn't talk to him because I was not getting a response."

They were about to see a divorce lawyer when they went to a We Can Weekend, an annual family retreat sponsored by the American Cancer Society. During that weekend, David began to talk and cry with other men whose wives had cancer. He began to tell Beth how helpless he felt, she recalled. He even voiced the most frightening feeling of all - that she would die and he would have to raise their child alone.

Many couples say that "when cancer came in, communication went out," Beth Savard said. But it needn't be that way. Today, Beth said, she and David are "very, very talkative. We share a lot."

Having cancer or a spouse with cancer, particularly brain cancer, has"got to be the most stressful thing in the world," said Dr. John Henson, executive director of the brain tumor center at Massachusetts General Hospital. And generally, he has found, couples are extremely supportive of each other.

But often, he said, the spouse with cancer often has some level of denial, "which is probably a healthy coping mechanism." The healthy spouse even may be more emotionally affected, something that Henson said has nothing to do with gender.

Frank McCaffrey, a clinical social worker who runs support groups at Beth Israel Deaconess Medical Center for men whose wives have advanced cancer, agreed. If the spouse who gets cancer has historically been the one who has provided most of the emotional caretaking, he said, the well spouse, regardless  of gender, "has to evolve and be able to understand that the patient, the ill spouse, can't provide the same emotional caring and support that they have been."

Not surprisingly, this is easier if the marriage is good to start with. "If the marriage was teetering before, it gets harder. They are the ones at most risk," said Dr. Jimmie Holland, chief of psychiatry and behavioral science at Memorial  Sloan-Kettering Cancer Center in New York.

Even Glantz's data, alarming as it seems at first blush, does not actually prove that the divorce rate is higher than normal among couples in which one spouse has cancer or MS.

If anything, the opposite may be true.

According to data released in May by the National Center for Health Statistics, 43 percent of first marriages end in separation or divorce within 15 years; 20 percent end within five years.

It's statistically risky to compare national divorce rates, which include many young couples, with divorce rates in couples in which one spouse gets a serious disease, in part because the latter couples are often older, and possibly more mature. But Glantz's study suggests that couples dealing with at least one serious illness, MS, have a lower than average divorce rate, just 24 percent after a median of 14 years of followup.

That doesn't surprise Steven Marcus, 58, a free-lance editor in Brookline who has been married for 25 years to Kit Crowe, 51, a librarian who was diagnosed  with MS just after their marriage. In recent years, he said, Kit has not been able to work full time, and "it's been scary for me to be the primary  wage-earner - that freaks me out sometimes."

But splitting up has never crossed is mind.

"You do the best you can," he said. "It's a question of love. Even if you're freaked out, that's not enough to make you run."

And even when a couple divorces soon after the woman gets cancer, that doesn't prove that her husband abandoned her.

Laurel Northouse, a nurse with a doctorate in research who studies the impact of cancer on couples at the University of Michigan School of Nursing, has studied couples in which the wife has breast cancer. She has found not only that the  divorce rate within the first 12 months of diagnosis is a fairly low 3 to 4 percent, but that sometimes it's the woman who decides not to spend whatever time she has left with a man she no longer loves.

A divorce soon after cancer may look "like the husband is leaving her, but she may be saying, `Enough already,' " Northouse said.

In a study of colon cancer published last year, she said, female care givers of men with cancer actually reported more distress than their husbands. One reason for that, Northouse said, is that when husbands become care givers, they are often seen as heroes doing more than society expects.

"Nobody brings casseroles to women when their husbands are sick because people assume a woman can do the caretaking, that she's a natural care giver. But women need help, too."

On the other hand, when men become care givers, they often don't ask for the support they need because they may be too stoic, said Betty Ferrell, a nurse-researcher at City of Hope National Medical Center in Duarte, Calif. Men "really do feel the financial burden. They feel they must try to keep things normal, to keep going to work."

The bottom line is that when life-threatening disease strikes, the marriage needs attention as well as the disease itself, said psychologist David Cella of Northwestern University Medical School. "It's very easy for people to put all the attention on the treatment. But some attention should be spared to focus on the couple."The American Cancer Society is enrolling volunteers in a new study of quality  of life among cancer survivors and their families. Call 1-800-ACS-2345.

Judy Foreman is a Lecturer on Medicine at Harvard Medical School. Her column appears every other week. Past columns are available on www.myhealthsense.com.

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