Married couples where breast cancer exists are in a risk situation when the cohesion level of the family is low, according to research carried out by the psychiatrist at the Family Diagnosis and Therapy Unit at the University Hospital of Navarra, Enrique Aub? Guedea.
With the paper, ?Study of family dynamics when adapting to breast cancer?, the specialist recently defended his PhD thesis at the Faculty of Medicine at the University of Navarra. Amongst other conclusions, the work shows that those family structures that are most rigid are those that are most likely to have a negative influence on the emotional state of the breast cancer patient.
The research aimed at finding out how the functioning of the family influenced, modified or facilitated the psychological adaptation to an illness of a patient suffering from breast cancer. The study was undertaken over 6 months on 138 patients with breast cancer with a control group of 445 healthy women.
Psychological evolution of patients
To carry out the thesis, the psychiatrist monitored the patients for the first six months following the detection of the illness. Patients? assessment was carried out in three phases: at the time of diagnosis of the cancer, after two months and after 6 months. A number of psychological variables were used in the evaluation: quality of life, matrimonial satisfaction and the functioning of the family.
The results explain, on the one hand, the effect of the diagnosis of the cancer on those psychological aspects affecting the quality of life of the patients. On the other, the effects on the marriage and the influence of matrimonial and family factors on the psychological adjustment of the patient was analysed.
From the data obtained it was deduced that the psychological affectation of patients was greatest after two months; it is the moment when the patient is most altered, with greatest levels of anxiety and anxiety-depressive symptomatology.
The time pattern thrown up is significant: while at the beginning the patients are more affected psychologically, after receiving chemotherapy, the physical aspects are more to the forefront. In the last analysis, the most affected aspects are overall markers amongst which are social vitality and functioning.
More unity, less satisfaction
The study also showed how breast cancer causes a worsening of the marriage relationship. In this respect, there a drop in matrimonial satisfaction is observed: consensus is reduced although, paradoxically cohesion increases. This phenomenon is also quite common in other cancers. In general, marriages where there are cancer patients come together and are closer. At the same time, there is less satisfaction with the relationship due to the tension and worry caused by the illness, amongst other questions.
Over the 6 months studied, it was observed that this lack of satisfaction increased. It will be necessary to increase the period of research in order to see if this factor lessens. Given that the period studied in this research focused on the period immediately and shortly after the diagnosis, it has to be taken into account that, in this primary stage, the reactions produced are more intense.
Functioning of the family
As regards the functioning of the family, the study took on board two questions: on the one hand, the observation of the manner in which family cohesion is affected and, on the other, evaluation of the degree of adaptability or flexibility. These are the fundamental characteristics that influence the process of adaptation of the patient to the illness.
After the diagnosis, an increase in family cohesion was observed, a factor that remained high throughout the whole period of the study. At the same time, there was a reduction in the flexibility, the adaptability of the family, the character of which became increasingly more rigid.
The relationships between members of the family become less flexible. This is a reaction that has to be taken seriously because it is non-adaptive. It does not aid the psychological adaptation of individuals in general and of patients in particular.
Results according to adaptability and cohesion
It was observed that the more rigid the family was, the worse it functioned when a cancer was diagnosed, while families that were excessively flexible showed the worst levels of psychological adaptation and depression.
Diagnosis of breast cancer is particularly disruptive in those families that have a low level of family cohesion. In contrast, if the cohesion amongst the members of the family is high, hardly any changes in the functioning of the family are observed nor in the marriage as regards situations where there is no diagnosis of cancer.
In families with a very low level of cohesion, after diagnosis, a worsening of the matrimonial relationship is observed. Thus, families that are not close together are considered at risk when facing a diagnosis of cancer ? these marriages have a high risk of being affected negatively. This is why they are families or relationships given to preventive action, given that the cancer can rupture the matrimony.
It is important to point out that not all families have to attend family therapy in order to facilitate adaptation to a diagnosis of cancer. This research enables us to identify families and marriages that are at risk, depending on the level of prior family cohesion and adaptability.