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Issues Facing the Single Survivor

May 10, 2001

A recent article in the journal Cancer touched on issues surrounding single women and breast cancer. Dr. Stewart Dunn and colleagues at the Royal North Shore Hospital in New South Wales, Australia interviewed women who were undergoing a breast biopsy after a suspicious finding on a mammogram. They compared 239 of these women whose biopsy proved to be cancerous with 275 women who had benign (noncancerous) breast biopsies.

They found that 4.6 percent of the women in the cancer group had experienced an extremely stressful event within the previous two years, compared to 2.9 percent of the non-cancer group. While this difference was not statistically significant, they then added in certain lifestyle factors, in particular whether the women had a close personal relationship such as a spouse.

Interestingly enough, single women had a higher "odds ratio" for breast cancer compared with their married counterparts. While the authors emphasized that stress in itself is not a risk factor for breast cancer, they said doctors should be aware that women without a close support system should be provided additional resources to help them cope through treatment and recovery.

While cancer can be an overwhelming experience for anyone, it can be especially difficult for a single adult. Family and friends will certainly be supportive, but it often can’t compare to the strength derived from a close personal relationship with a spouse or partner.

Physical and emotional changes brought on by the disease and its treatment can result in doubts about self-image, and these can be magnified with the natural uncertainty of a new relationship. If infertility has resulted, a whole new set of emotional and personal issues can arise as the relationship deepens.

Yet all of these obstacles can be overcome—with patience, understanding, and simply meeting the right person.

Some of the side effects of cancer treatment are readily visible: loss of hair from chemotherapy; physical changes in appearance; or discoloration of skin due to radiation. Because these can make you look different, they can be an initial deterrent to a new relationship.

And when cancer is involved, unfounded fears can further complicate the dating process. Questions such as, "Is cancer contagious?" can seem silly to the survivor, but may be real concerns for those not familiar with the disease. And in the back of a potential partner’s mind may linger, "Will you be alive in a few years?" People with cancer today are living longer and healthier, but that may not be understood by the new person in your life.

And then there are some side effects from cancer that can’t initially be seen: the loss of a breast or sexual organ; the need for an ostomy bag to remove body waste; the inability to achieve an erection; or even infertility.

In such cases, a whole new set of "timing" issues can arise. When do you tell your new partner about these changes—or even the fact that you had cancer? You can put it off for a period of time, but for how long?

While there are no simple answers to these questions, once a relationship starts to become serious a partner will have to be told. If it waits until the moment of sexual intimacy, it can be disastrous. Yet if it is communicated too soon, it could scare away someone who has become close. Only you will know when it would be best to confide.

For a man, fears about self-image and performance can sometimes lead to erection problems. Men who have lost their testicles may feel like "less of a man." Or if they are on hormone therapy, they may worry about becoming feminine in looks or personality.

A woman’s self-image can be greatly affected by the loss of a breast, with worries of how a partner will react when the relationship becomes intimate. Genital changes, vaginal dryness or tightness may also impact feelings of sexuality.

Your own acceptance of the physical and emotional changes that have taken place is probably the most important step you can take toward beginning a new social and sexual life. If you can’t accept your own situation, it will be impossible for a new partner to do so.

There is no single "right" way to communicate to a new partner how cancer has affected your sexuality. Your sexual desires, needs and abilities will change during the course of treatment and recovery, and some aspects of your sexuality may have been permanently altered as a result of the disease.

A new couple will need to talk openly and honestly with each other. If talking about sex is difficult, you may want to speak to a counselor who can help you to broach sensitive sexual issues.

There will always be a risk of rejection, just as in any relationship between two individuals. But if a new relationship is strong enough to overcome such a difficult emotional hurdle as cancer, think how strong it will be when faced with so many of the other life challenges that lie ahead. A few initial rejections may be a small price to pay for the perfect life partner.

SOURCES:

Cancer, March 1, 2001; 91:863-868

Cancer, February 15, 2001; 91:679-697

The National Cancer Institute (http://www.nci.nih.org)

The American Cancer Society (http://www.cancer.org)

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