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As if we didn't know:


by Heather Lindsey
[ 8/24/00]

Men with prostate cancer often choose not to talk about their disease, even with their spouse, and are uncomfortable with the idea of needing emotional support, according to new research.

This tendency may cause tension between spouses and prevent men from receiving the support they need, researchers said.

"This study reveals the dilemma that men with prostate cancer and their partners are facing," said the study's lead author Ross E. Gray, Ph.D., of the psychosocial and behavioral research unit at Toronto-Sunnybrook Regional Cancer Center in Toronto, Canada. Men often don't want to talk about the disease with others, even though it can have a deep emotional impact, while spouses usually like to discuss the illness, he said.

Not talking about the disease can "lead to some isolation for people," he added.

"It's not obvious that people who disclose [their condition] are more psychologically healthy than people who do not disclose," cautioned Sarah Auchincloss, M.D., assistant attending psychiatrist at the New York Presbyterian Hospital in New York. "They are both valid ways to deal with a diagnosis."

On three separate occasions, Gray and his colleagues interviewed 34 men who underwent prostate cancer surgery and their wives. The average age of the men was 60; the average age of the women was 57. The study appeared in the July/August [2000] issue of Psycho-Oncology.

Why Men May Not Talk

Even though they may have a need for support, most of the men said they preferred to avoid talking about prostate cancer with anyone other than their spouse. Couples often decided not to talk about the disease so their lives would remain as normal as possible.

"This used to be common, but it's less prevalent now," said Christopher J. Logothetis, M.D., chairman of the department of genitourinary medical oncology at the M.D. Anderson Cancer Center in Houston. "My sense is it's more a measure of the confidence people have in their relationships rather than primarily a personal trait of the patient." For example, if the relationship with a family member or friend is good, the patient is more likely to talk to him or her about the illness, he noted.

There can be understandable reasons patients may not want to talk about their cancer, explained Logothetis. For example, they are sometimes concerned about the strain it might place on a relationship. Many men worry that their friends or family may treat them differently once they learn about the disease, he added. Men in the study also were concerned about burdening or worrying others.

Social stigmas surrounding impotence and incontinence, which are common of prostate cancer treatment, play a large role in men not wanting to talk about their disease, said Gray. Even though the topic of the vulnerabilities of male sexuality is becoming more common in the media and among the public, especially with the marketing of Viagra, "on an individual level, most men aren't comfortable with that discussion taking place," he said.

Fortunately, the number of men who may be embarrassed by the stigma of the disease is becoming smaller and smaller, said Logothetis. In recent years, many public figures, including New York Mayor Rudolph Giuliani, Yankees coach Joe Torre and author Michael Korda, have all talked openly about their prostate cancer.

Silence Can Cause Tension With Spouses

Not talking about cancer can cause tension between husbands and wives, noted Gray. Women often want to discuss the illness and its emotional impact with friends and family, he said. Sometimes spouses in the study were successful in encouraging their husbands to disclose more than they originally wanted to. Some men were grateful for this encouragement, while others refused to be persuaded by their spouse's view.

Another source of tension is "men becoming dependent and needing more from women [emotionally] and not liking having that degree of need," said Gray. Overall, men in the study did not like the idea of needing emotional support, especially from their spouses.

Logothetis, however, finds that spouses tend to play a supportive role for the patients in his practice and that conflict between husbands and wives is not a big problem.

If a man chooses to talk about his illness, he often does so to make his loved ones feel better, noted Gray. For example, the patient may see that his daughter wants to talk about the illness, he said. "The man is kind of uncomfortable about that but may go along with it so his daughter feels better," he explained.

Some men in the study gained emotional support from friends and family after talking about their disease, but even then the information they shared was not detailed, said Gray. "One man said he felt really supported by his friends, but all they knew was that he was struggling [with prostate cancer]," said Gray. These friends made a point of treating the patient in a normal way, he added.

Finding the Right Kind of Support

One way health care professionals can help provide support to patients and spouses is to understand that a couple's decision not to talk about the emotional issues surrounding cancer is a coping mechanism, noted Gray. However, health care providers should also be willing to look beyond this way of coping to see how the patient and his spouse are actually feeling, he added.

"How to structure a program of help is very challenging," said Auchincloss, adding that too much "support" can overwhelm a patient.

Men may also find support by seeking out other patients with prostate cancer, Gray noted, adding that the Internet also provides online discussion groups and support.

However, "support groups are not for everybody, in the sense that there are a significant number of people who don't feel comfortable about public discussions about their illness," said Logothetis.


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