Communication Currents

Clinicians and researchers have known for a long time that having cancer can change or threaten a person’s identity, or how they think of themself. For example, during cancer treatments, patients might not be able to fill all the roles they filled in the past. Understanding the challenges associated with cancer survivorship has become increasingly important asmoreand more people are living beyond cancer treatment. Today, an estimated 13.7 million cancer survivors are living in the United States. 

Our research builds on the knowledge of such experiences, focusing on two understudied ideas. First, instead of only looking at the patients’ experiences, our study examined both patients and their spouses. This recognizes that dealing with cancer can involve major identity changes for both members of a couple. Second, rather than focusing just on the time the patient is being treated, our study examined identity challenges throughout cancer survivorship, even after treatments have ended. Understanding cancer survivorship (beyond just the treatment period) is important because, even though cancer is out of the body, its challenges may linger long after successful treatment has been completed.

This study involved interviews of 35 cancer survivors and 25 partners. The participants were asked to describe their identity challenges throughout survivorship and their communication with their partner both during and after cancer treatment.

One particularly interesting finding was that, in addition to talking about challenges to their own identities, the participants talked about changes to their “couple identity” or the joint sense of how they saw themselves as a couple. Some couples said that coping with cancer made the relationship more central to their own identity. In other words, while they had viewed themselves as independent from one another before the cancer experience, their relationship became a crucial part of who they were after the cancer diagnosis.

One melanoma survivor described how her perception of her relationship changed dramatically: “Then I got the cancer, and I found out I had it. He, suddenly, became the entire center of my world.” Other couples described how the cancer experience played a pivotal role in relationship development and in shaping the way the partners viewed each other. For example, this partner of a cancer survivor described: “It’s sort of like wilderness camping or something. Once you go through something together it brings you closer, at least it did for us.” For these survivors, going through the cancer experience together was an important factor in defining their relationship as one that was strong, mutual, and shared.

Even when the couple had a very close relationship before the cancer, the experiences sometimes further affirmed or clarified couples’ sense of identity. For example, some couples reported that they really didn’t understand how strong their relational bond was until it was tested by cancer. One breast cancer survivor, for example, said: “Even though he said he’d love me forever, does he really mean that? And it proved to me that he really did want to stick by me through thick and thin – for better or for worse.” Other couples specifically described coping with cancer together, highlighting a clarified or new sense of their joint identity. As one participant described, “We’re going to be survivors.” He defined both himself and his wife as survivors together. They were no longer a unit in general, but they became a particular type of unit: “survivors.”

Although many participants talked about how their relational identity had become stronger or clearer, others described threats to their couple identity. Some couples, for example, reported that the cancer affected their ability to be the kind of couple they wanted to be. Other couples described shifts in the husband-wife roles that were a part of the preferred couple identity. One husband of a breast cancer survivor described his reluctance to redefine his relationship with his wife in terms of caregiving: “I don’t wanna be your doctor. I don’t wanna be your trainer, and I don’t want to be your nutritionist. It’s the challenge of being robbed of the fact that I wanted her to just be my wife versus to be a caregiver.” Many other couples reported threats relating to sexual identities, gendered identities, and future parenting.

In addition to the changes couples’ experienced relating to their joint identity, many couples continued to be challenged throughout survivorship. Although successfully completing cancer treatment is desirable, making the transition from cancer patient to cancer survivor posed some identity issues for both spouses. Some partners struggled with the changing identities associated with caregiving and specifically transitioning out of the caregiver role. They had come to see the caregiver/care-receiver definition of the relationship as highly valued; thus, after the cancer-related caregiving was no longer necessary, some partners struggled to determine their ‘new’ identity in the relationship.

One husband of a breast cancer survivor described his uncertainty about no longer being a caregiver: “So to have kind of what was now defined as you were – as your sole purpose for being just kind of go – just pulled out from underneath you, it actually was pretty – it was actually kind of traumatic…I think that was difficult to face that and be able to kind of redefine who you were again.” This husband’s experience demonstrates that the transition after active cancer treatment can pose identity challenges for couples.

Our study provides new insight into the identity challenges couples face as they cope with cancer treatment and survivorship. These insights may be useful for couples who are coping with cancer because it may help them understand their experience and make potentially confusing identity challenges seem less confusing or more normal. These findings are also important because they highlight the fact that patients and partners often do not simply resume their lives and relationships the way they were after cancer treatment is over. Understanding this may be useful for couples who experience a cancer diagnosis as well as for others who interact with them. People should not expect that everything with a couple is “back to normal” once a doctor says that cancer is out of the body; their relationship is likely changed in some ways, sometimes in positive ways and sometimes in ways that create new challenges. Couples who may be facing relationship changes or identity shifts after cancer treatment may be comforted to know that other couples experience similar challenges throughout survivorship and that “getting back to normal” may be a gradual transition.