Reflection about the quality of life from many perspectives often shows that those factors that are largely blamed by the ‘cancer’ were in fact, in disarray before. Cancer treatment reframes the level and awareness of intimacy amongst couples. It will either strain or strengthen a relationship so honest communication is vital. However, it is not uncommon for marriages and long-term partnerships to be put under an enormous strain. For women not in relationships, it heightens the impact on fertility, and impact on finding a new partner who is accepting of her physical changes.For many though, a feeling of emotional disconnection from herself and partner is not uncommon in the first twelve months, especially if there are other factors creating pressure. It is almost as if the enormity of the diagnosis flings each into her or his space to sort them out. And in this space there is a lack of connection. It is common to suddenly be at a loss of what to say to each other; for both to feel useless and abandoned in the relationship – any attempts of ‘support’ seem futile. One of you may be focusing on the practical issues facing you while the other is in need of intensive emotional support at that time. Nothing seems to synchronize. The potential threat to life is now compounded by the potential loss of self-esteem, partnerships, relationships and an uncertainty of how the other will now accept her as a ‘new and unknown’ person.It is a common immediate reaction to focus on the physical – the healing of the body, and often because of the frustration associated with the slow progress of recovery, anger and hostility toward each other may emerge. The ‘healing’ of the emotions and mind usually comes after acceptance of the condition has commenced, although in the initial phases you may feel the need for strong emotional affirmations. For relationships that are fragile, dealing with the healing of the physical can often be too much to bear and relationships disintegrate, often permanently. For women with children, the coping during this time is usually focused on trying to maintain the relationship for the ‘children’s sake’. It is important to discuss any relationship issues you may have with your doctor, as they understand this is a normal outcome of treatment.Talking about your feelings either with each other, or in a support group, may help rebuild your life, release the tension and relearn how to be aware of and understand each other’s way of coping. Understanding during this time that life is possibly going to be out of balance makes it easier to develop realistic ways of coping. Understanding that underlying the angry outbursts and unexplained ‘new’ behaviour is often an expression of fear, a reaction that cannot be expressed in more harmonious ways. For that person, at that time, regardless of whether they are patient or carer, it is the only way she knows how to react. It is when the reaction is abnormally hostile or angry and the person is not aware of the ongoing intensity of the reaction that counseling may need to be sought.As this was the third round with a family member having cancer for my husband, he was not very communicative about it except with his brother.We’d just keep the family going for the boys benefit. He didn’t really care about changes to my physical appearance things like that. The fact that I was alive was enough. EmilyHe always seemed to be positive and in control. ‘You’re going to get better; you’re going to survive this.’ That struggle for survival was a bit above expectations sometimes. It was very evident he was more nervous about my survival especially after my first round of chemo. I was told his worry was normal. Giuliana My husband has been fairly supportive and does not get frustrated or irritated.I have always been the initiator of sex but it has changed. I read that orgasms aren’t as good after surgery but that is not the case. My sex life is O.K. Caroline*38/144/5*
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The question the reader will ask at this point is ‘Given all this epidemiological study, do we know the causes of cancer?’ Broadly the answer is ‘yes’ in many circumstances and for many cancers, and the opportunities for prevention that this understanding generates are there to be taken. We do not always know how the factors that have been identified by the epidemiological studies discussed in this chapter link up to what is being learned in the laboratories of the molecular biologists. This connection is being made rapidly and will be increasingly clear by the end of the century. Epidemiology has been very successful in discovering or confirming which features of our lives in the Western world can be now identified as causes of cancer.
Sexual activity has been extensively investigated as a factor in the cause of certain cancers, particularly cancer of the neck of uterus. Certainly, the number of sexual partners appears to be
an association. In a woman with only a single lifelong sexual partner, the number of partners that her one sexual partner has had also seems to affect her risk. How this leads to a cancer, and particularly whether the cancer is caused by transfer of a virus, is the subject of current research focusing particularly on the human papilloma virus. The transfer of infectious agents which give rise to AIDS must also be considered under this heading because people with AIDS can get unusual types of cancer.
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