Cancer can have a dramatic impact on family life. As a result of changes in cancer detection and survival, a growing number of families have been touched by this illness. This article reviews some of the challenges these families face. An initial conceptual model is offered, which describes how family adjustment is influenced by medical, developmental, and family-systems factors, including phase of treatment, family structure, life-cycle tasks, personal constructions of illness, and family resources. The authors consider which families might be most vulnerable or resilient to distress and describe family interventions.
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References
1.
American Cancer Society
. (1998). Cancer facts & figures—1998. Atlanta, GA: Author.
2.
Anderson, B. L.
(1992). Psychological interventions for cancer patients to enhance the quality of life. Journal of Consulting and Clinical Psychology, 60, 552-568.
3.
Anderson, B. L
, Anderson, B., & deProsse, C. (1989a). Controlled prospective longitudinal study of women with cancer: I. Sexual functioning outcomes. Journal of Consulting and Clinical Psychology, 57, 683-691.
4.
Anderson, B. L.
, Anderson, B., & deProsse, C. (1989b). Controlled prospective longitudinal study of women with cancer: II. Psychological outcomes. Journal of Consulting and Clinical Psychology, 57, 692-697.
5.
Anderson, B. L.
, & Jochimsen, P. R. (1985). Sexual functioning among breast cancer, gynecologic cancer, and healthy women. Journal of Consulting and Clinical Psychology, 53, 25-32.
6.
Andrykowski, M. A.
, Brady, M. J., & Hunt, J. W. (1993). Positive psychosocial adjustment in potential bone marrow transplant recipients: Cancer as a psychosocial transition. Psycho-oncology, 2, 261-276.
7.
Antonovsky, A.
(1979). Health, stress and coping. San Francisco: Jossey-Bass.
8.
Balshem, M.
(1991). Cancer, control and causality: Talking about cancer in a working class community. American Ethnologist, 18, 152-172.
9.
Callahan, D.
(1991). Families as caretakers: The limits of morality. In R. P Marinelli & A. E. Dell Orto (Eds.), The psychological and social impact of disability (3rd ed., pp. 295-305). New York: Springer.
10.
Campbell, T. L.
, & Patterson, J. M. (1995). The effectiveness of family interventions in the treatment of physical illness. Journal of Marital and Family Therapy, 21, 545-583.
11.
Carver, C. S.
, Pozo, C., Harris, S., Noriega, V., Scheier, M. F., Robinson, D. S., Ketcham, A. S., Moffat, F. L. Jr., & Clark, K. C. (1993). How coping mediates the effect of optimism on distress: A study of women with early stage breast cancer. Journal of Personality and Social Psychology, 65, 375-390.
12.
Carver, C. S.
, Pozo-Kaderman, C., Harris, S. D., Noriega, V., Scheier, M. F., Robinson, D. S., Ketcham, A. S., Moffat, F. L. Jr., & Clark, K. C. (1994). Optimism versus pessimism predicts the quality of women’s adjustment to early stage breast cancer. Cancer, 73, 1213-1220.
13.
Cassileth, B.
, Volchkmar, D., & Goodman, R. L. (1980). The effect of experience on radiation therapy patients’ desire for information. International Journal of Radiation Oncology, Biology, Physics, 6, 493-496.
14.
Cella, D. R.
, & Tross, S. (1986). Psychological adjustment to survival from Hodgkin’s Disease. Journal of Consulting and Clinical Psychology, 54, 616-622.
15.
Chen, F.
, Trapido, E. J., & Davis, K. (1994). Differences in stage at presentation of breast and gynecologic cancers among Whites, Blacks, and Hispanics. Cancer, 73, 2838-2842.
16.
Christ, G.
(1991). Principles of oncology social work. In A. L. Holleb, D. J. Fink, & G. P. Murphy (Eds.), American Cancer Society textbook of clinical oncology (pp. 594-605). Atlanta, GA: American Cancer Society.
17.
Coates, R. J.
, Bransfield, D. D., Welsey, M., Hankey B., Eley, J. W., Greenberg, R. S., Flanders, D., Hunter, C. P., Edwards, B. K., Foman, M., Chen, V. W., Reynolds, P., Boyd, P., Austin, D., Muss, H., & Blacklow, R. F. (1992). Differences between Black and White women with breast cancer in time from symptom recognition to medical consultation. Journal of the National Cancer Institute, 84, 938-950.
18.
Collins, R. L.
, Taylor, S. E., & Skokan, L. A. (1990). A better world or a shattered vision? Changes in life perspectives following victimization. Social Cognition, 8, 263-285.
19.
Corney, R. H.
, Everett, H., Howells, A., & Crowther, M. E. (1992). Psychosocial adjustment following major gynecological surgery for carcinoma of the cervix and vulva. Journal of Psychosomatic Research, 36, 561-568.
20.
Curbow, B.
, Somerfield, M. R., Baker, F., Wingard J. R., & Legro, M. W. (1993). Personal changes, dispositional optimism, and psychological adjustment to bone marrow transplantation. Journal of Behavioral Medicine, 16, 423-443.
21.
Dakof, G. A.
, & Taylor, S. E. (1990). Victims’ perceptions of social support: What is helpful from whom?Journal of Personality and Social Psychology, 58, 80-89.
22.
Danoff, B.
, Kramer, N., Irwin, P., & Gottlieb, A. (1983). Assessment of quality of life in long term survivors after definitive radiotherapy. American Journal of Clinical Oncology, 6, 339-345.
23.
Duhl, F. J.
, Kantor, D., & Duhl, B. S. (1973). Learning, space and action in family therapy: A primer of sculpture. In B. A. Bloch (Ed.), Techniques of family psychotherapy. New York: Grune and Statton.
24.
Ell, K. O
, Mantell, J. E., & Hamovitch, M. B. (1988). Socioculturally sensitive intervention for patients with cancer. Journal of Psychosocial Oncology, 6, 141-155.
25.
Erwin, D. O.
, Spatz, T. S., Stotts, R. C., Hollenberg, J. A., & Deloney, L. A. (1996). Increasing mammography and breast self-examination in African American women using the witness project model. Journal of Cancer Education, 11, 2210-2215.
26.
Fawzy, F. I.
, Fawzy, N. W., Arndt, L. A., & Pasnau, R. O. (1995). Critical review of psychosocial interventions in cancer care. Archives of General Psychiatry, 52, 100-113.
27.
Fobair, P.
, Hoppe, R. T., Bloom, J. R., Cox, R., Varghese, A., & Spiegel, D. (1986). Psychosocial problems among survivors of Hodgkin’s disease. Journal of Clinical Oncology, 4, 805-814.
28.
Friedman L. C.
, Baer, P. E., Nelson, D. V., Lane, M., Smith, F. E., & Dworkin, R. J. (1988). Women with breast cancer: Perception of family functioning and adjustment to illness. Psychosomatic Medicine, 50, 529-540.
29.
Funch, D. P.
, & Mettlin, C. (1982). The role of support in relation to recovery from breast surgery. Social Science and Medicine, 16, 91-98.
30.
Gotay, C. C.
(1984). The experience of cancer during early and advanced stages: The views of patients and their mates. Social Science and Medicine, 18, 605-613.
31.
Gregg, J.
, & Curry, R. H. (1994). Explanatory models for cancer among African American women at two Atlanta neighborhood health centers: The implications for a cancer screening program. Social Science and Medicine, 39, 519-526.
32.
Hall, A.
, Fallowfield, L. J., & A’Hern, R. P. (1996). When breast cancer recurs: A 3-year prospective study of psychological morbidity. The Breast Journal, 2, 197-203.
33.
Halvorson-Boyd, G.
, & Hunter, L. K. (1995). Dancing in limbo: Making sense of life after cancer. San Francisco: Jossey-Bass.
34.
Hannum, J. W.
, Giese-Davis, J., Harding, K., & Hatfield, A. K. (1991). Effects of individual and marital variables on coping with cancer. Journal of Psychosocial Oncology, 9, 1-20.
35.
Hoskins, C. N.
(1995). Adjustment to breast cancer in couples. Psychological Reports, 77, 435-454.
36.
Hoskins, C. N.
, Baker, S., Budin, W., Ekstrom, D., Maislin, G., Sherman, D., Steelman-Bohlander, J., Bookbinder, M., & Knauer, C. (1996). Adjustment among husbands of women with breast cancer. Journal of Psychosocial Oncology, 14, 41-69.
37.
Hughson, A. V.
, Cooper, A. F., McArdle, C. S., & Smith, D. C. (1988). Psychosocial consequences of mastectomy: Levels of morbidity and associated factors. Journal of Psychosomatic Research, 32, 383-391.
38.
Ireys, H. T.
, & Burr, C. K. (1984) A part and a part: Family issues for young adults with chronic illness and disability. In M. G. Eisenberg, L. C. Sutkin, & M. A. Jansen (Eds.), Chronic illness and disability through the life span: Effects on self and family (pp. 184-206). New York: Springer.
39.
Janoff-Bulman, R.
, & Frieze, I. H. (1983). A theoretical perspective for understanding reactions to victimization. Journal of Social Issues, 39,1-17.
40.
Kerns, R. D.
(1995) Family assessment and intervention. In P. H. Nicassio & T. W. Smith (Eds.), Managing chronic illness: A biopsychosocial perspective (pp. 207-244). Washington, DC: American Psychological Association.
41.
Kivnick, H. Q.
(1991). Disability and psychosocial development in old age. In R. P. Marinelli & A. E. Dell Orto (Eds.), The psychological and social impact of disability (3rd ed., pp. 92-102). New York: Springer.
42.
Kobasa, S.
, Maddi, S., & Kahn, S. (1982). Hardiness and health: A prospective study. Journal of Personality and Social Psychology, 42, 168-177.
43.
Lalos, A.
, Jacobsson, L., & Stendahl, U. (1995). Experiences of the male partner in cervical and endometrial cancer—A prospective interview study. Journal of Psychosomatic Obstetrics and Gynaecology, 16, 153-165.
44.
Lauver, D.
(1992). Addressing infrequent cancer screening among women. Nursing Outlook, 40, 208-212.
45.
Lazarus, R.
, & Folkman, S. (1984). Coping and adaptation. In W. D. Gentry (Ed.), The handbook of behavioral medicine (pp. 282-325.) New York: Guilford.
46.
Lesko, L. M.
(1990). Surviving hematological malignancies: Stress responses and predicting psychosocial adjustment. Progress in Clinical and Biological Research, 352, 423-437.
47.
Lewis, F. M.
(1990). Strengthening family supports. Cancer, 65, 752-759.
48.
Lewis, F. M.
, Ellison, E. S., & Woods, N. F. (1985). The impact of breast cancer on the family. Seminars in Oncology Nursing, 1, 206-213.
49.
Lewis, F. M.
, Hammond, M. A., & Woods, N. F. (1993). The family’s functioning with newly diagnosed breast cancer in the mother: The development of an explanatory model. Journal of Behavioral Medicine, 16, 1-20.
50.
Lewis, F. M.
, Woods, N. F., Bensley, L. S., & Hough, E. E. (1989). The family’s functioning with chronic illness in the mother: The spouse’s perspective. Social Science and Medicine, 29, 1261-1269.
51.
Litman, T. J.
(1974). The family as a basic unit of health and medical care: A social-behavioral overview. Social Science and Medicine, 8, 495-519.
52.
Lyles, J. N.
, Burish, T. G., Krozely, M. G., & Oldham, R. K. (1982). Efficacy of relaxation training and guided imagery in reducing the aversiveness of cancer chemotherapy. Journal of Consulting and Clinical Psychology, 50, 509-524.
53.
Manaster, G. J.
, & Corsini, R. J. (1982). Individual psychology. Itaska, IL: Peacock.
54.
Manne, S. L.
, Sabbioni, M., Bovbjerg, D. H., & Jacobsen, P. (1994). Coping with chemotherapy for breast cancer. Journal of Behavioral Medicine, 17, 41-55.
55.
Massie, M. J.
, Heiligenstein, E., Lederberg, M. S., Holland, J. C. (1991). Psychiatric complications in cancer patients. In A. L. Holleb, D. J. Fink, & G. P. Murphy (Eds.), American Cancer Society textbook of clinical oncology (pp. 576-586). Atlanta, GA: American Cancer Society.
56.
Massie M. J.
, & Holland, J. C. (1987). Consultation and liaison issues in cancer care. Psychiatric Medicine, 5, 343-359.
57.
Mathews, H. R.
, Lannin, D. R., & Mitchell, J. P. (1994). Coming to terms with cancer: Black women’s narratives from eastern North Carolina. Social Science and Medicine, 38, 789-800.
58.
Merluzzi, T. V.
, & Martinez Sanchez, M. A. (1997). Assessment of self-efficacy and coping with cancer: Development and validation of the Cancer Behavior Inventory. Health Psychology, 16, 163-170.
59.
Meyer, T. J.
, & Mark, M. M. (1995). Effects of psychosocial interventions with adult cancer patients: A meta-analysis of randomized experiments. Health Psychology, 14, 101-108.
60.
Minuchin, S.
(1974). Families and family therapy. Cambridge, MA: Harvard University Press.
61.
Molassiotis, A.
, van den Akker, O. B. A., & Boughton, B. J. (1997). Perceived social support, family environment and psychosocial recovery in bone marrow transplant long-term survivors. Social Science and Medicine, 44, 317-325.
62.
Naugle, R. I.
(1991). Denial in rehabilitation. In R. P. Marinelli & A. E. Dell Orto (Eds.), The psychological and social impact of disability (3rd ed., pp. 139-151). New York: Springer.
63.
Northouse, L. L.
(1988). Social support in patients’ and husbands’ adjustment to breast cancer. Nursing Research, 37, 91-95.
64.
Northouse, L. L.
, Dorris, G., & Charron-Moore, C. (1995). Factors affecting couples’ adjustment to recurrent breast cancer. Social Science and Medicine, 41, 69-76.
65.
Oktay, J. S.
, & Walter, C. A. (1991). Breast cancer in the life course: Women’s experiences. New York: Springer.
66.
Olson, D. H.
(1989). Circumplex model and family health. In C. N. Ramsey Jr. (Ed.), Family systems in medicine (pp. 95-118). New York: Guilford.
67.
Olson, D. H.
, Russell, C. S., & Sprenkle, D. H. (1983). Circumplex model VI: Theoretical update. Family Process, 22, 69-83.
68.
Parker, S. L.
, Davis, J. D., Wingo, P. A., Ries, L. A. G., & Heath, C. W. Jr. (1998). Cancer statistics by race and ethnicity. Cancer: A Cancer Journal for Clinicians, 48, 31-48.
69.
Patterson, J. M.
(1989). A family stress model: The family adjustment and adaptation response. In C. N. Ramsey Jr. (Ed.), Family systems in medicine (pp. 95-118). New York: Guilford.
70.
Patterson, J. M.
, & Garwick, A. W. (1994). The impact of chronic illness on the family: A family systems perspective. Annals of Behavioral Medicine, 16, 131-142.
71.
Payne, S. A.
(1992). A study of quality of life in cancer patients receiving palliative chemotherapy. Social Science and Medicine, 35, 1505-1509.
72.
Penman, D. T.
, Bloom, J. R., Fotopoulos, S., Cook, M. R., Holland, J. C., Gates, C., Flamer, D., Murawski, B., Ross, R., Brandt, U., Muenz, L. R., & Pee, D. (1987). The impact of mastectomy on self-concept and social function: A combined cross-sectional and longitudinal study with comparison groups. Women and Health, 11, 101-130.
73.
Peters-Golden, H.
(1982). Breast cancer: Varied perceptions of social support in the illness experience. Social Science and Medicine, 16, 483-491.
74.
Power, P. W.
, Hershenson, D. B., & Schlossberg, N. K. (1991). Midlife transition and disability. In R. P. Marinelli & A. E. Dell Orto (Eds.), The psychological and social impact of disability (3rd ed., pp. 81-91). New York: Springer.
75.
Psychological aspects of breast cancer study group
. (1987). Psychological response to mastectomy: A prospective comparison study. Cancer, 59, 189-196.
76.
Rainey, L. C.
(1985). Effects of preparatory patient education for radiation oncology patients. Cancer, 56, 1056-1061.
77.
Ramsey, C. N., Jr.
(Ed.). (1989). Family systems medicine. New York: Guilford.
78.
Reiss, D.
, & Kaplan De-Nour, A. (1989). The family and medical team in chronic illness: A transactional and developmental perspective. In C. N. Ramsey Jr. (Ed.), Family systems in medicine (pp. 435-444). New York: Guilford.
79.
Reiss, D.
, & Oliveri, M. E. (1980). Family paradigm and family coping: A proposal for linking the family’s intrinsic adaptive capacities to its responses to stress. Family Relations, 29, 431-444.
80.
Revenson, T. A.
, & Majerovitz, S. D. (1991). The effects of chronic illness on the spouse: Social resources as stress buffers. Arthritis Care and Research, 4, 63-72.
81.
Rice, J. K.
(1994). Reconsidering research on divorce, family life cycle, and the meaning of family. Psychology of Women Quarterly, 18, 559-584.
82.
Rolland, J. S.
(1994). Families, illness, and disability: An integrative treatment model. New York: Basic Books.
83.
Rustad, R. C.
(1984). Family adjustment to chronic illness and disability in mid-life. In M. G. Eisenberg, L. C. Sutkin, & M. A. Jansen (Eds.), Chronic illness and disability through the life span: Effects on self and family (pp. 222-242). New York: Springer.
84.
Schag, C. A. C.
, Ganz, P. A., Polinsky, M. L., Fred, C., Hirji, K., & Petersen, L. (1993). Characteristics of women at risk for psychosocial distress in the year after breast cancer. Journal of Clinical Oncology, 11, 783-793.
85.
Sherman, A. C.
, & Simonton-Atchley, S. (1996). Psychological aspects of treating oncology patients. In E. M. Myers & J. Y. Suen (Eds.), Cancer of the head and neck (3rd ed., pp. 917-925). Philadelphia: W. B. Saunders.
86.
Sherman, R.
(1997). Culturally oriented techniques. The Family Journal, 5, 69-75.
87.
Simon, G. M.
(1995). A revisionist rendering of structural family therapy. Journal of Marital and Family Therapy, 21, 17-26.
88.
Simonton, S.
, & Sherman, A. C. (1998). Psychological aspects of mind-body medicine: Promises and pitfalls from research with cancer patients. Alternative Therapies in Health and Medicine, 4, 50-67.
89.
Smith, D. E.
(1993). The standard North American family: SNAF as an ideological code. Journal of Family Issues, 14, 50-65.
90.
Smith, P. E.
, (1993). Breast cancer prevention and detection update. Seminars in Oncology Nursing, 9, 150-154.
91.
Spiegel, D.
(1993). Living beyond limits: New hope and help for facing life-threatening illnesses. New York: Time Books.
92.
Spiegel, D.
, Bloom, J. R., & Gottheil, E. (1983). Family environment as a predictor of adjustment to metastatic breast carcinoma. Journal of Psychosocial Oncology, 1, 33-44.
93.
Stanton, A. L.
, & Snider, P. R. (1993). Coping with a breast cancer diagnosis: A prospective study. Health Psychology, 12, 16-23.
94.
Syrjala, K. L.
, Chapko, M. K., Vitaliano, P. P., Cummings, C., & Sullivan, K. M. (1993). Recovery after allogeneic marrow transplantation: Prospective study of predictors of long-term physical and psychosocial functioning. Bone Marrow Transplantation, 11, 319-327.
95.
Tomm, K.
(1987). Interventive interviewing: Part II. Reflexive questioning as a means to enable self-healing. Family Process, 26, 167-184.
96.
Trijsburg, R. W.
, van Knippenberg, F. C. E., & Rijpma, S. E. (1992). Effect of psychological treatment on cancer patients: A critical review. Psychosomatic Medicine, 54, 489-517.
97.
Turk, D. C.
, & Kerns, R. D. (1985). Health, illness and families: A life-span perspective. New York: Wiley Interscience.
98.
Vinokur, A. D.
, Threatt, B. A., Vinokur-Kaplan, D., & Satariano, W. A. (1990). The process of recovery from breast cancer for younger and older patients: Changes during the first year. Cancer, 65, 1242-1254.
99.
Vinokur, A. D.
, & Vinokur-Kaplan, D. (1990). In sickness and in health: Patterns of social support and undermining in older married couples. Journal of Aging and Health, 2, 215-241.
100.
Welch-McCaffrey, D.
, Hoffman, B., Leigh, S. A., Loescher, L. J., & Meyskens, F. L. Jr. (1989). Surviving adult cancers: Part 2. Psychosocial implications. Annals of Internal Medicine, 111, 517-527.
101.
Wilson, S.
, & Morse, J. M. (1991). Living with a wife undergoing chemo-therapy. Image, 23, 78-84.
102.
Zahlis, E. H.
, & Shands, M. E. (1993). The impact of breast cancer on the partner 18 months after diagnosis. Seminars in Oncology Nursing, 9, 83-87.
