ATLANTA - The amount of support a woman receives from her husband during genetic testing can determine how much marital strain will result from the screening process, according to a study presented here at a breast cancer research meeting.
In another report, investigators determined that some breast cancer patients' fatigue from chemotherapy treatments may be related to disruption of their sleep-wake cycles, also known as circadian rhythms.
Women who learn they have a genetic abnormality that gives them a 50 percent to 85 percent risk of developing breast cancer sometime during their lifetime often experience severe anxiety and psychological distress, as well as marital strain. Those who do not have breast cancer but learn they have mutations in the BRCA1 or BRCA2 gene have the most difficulty handling the results of testing, according to Sharon Manne Ph.D., a member of the department of population science at Fox Chase Cancer Research Center in Philadelphia.
Until now, little was known about the extent to which couples talk about genetic testing and share their concerns, or the impact of test results on spouses and the marital relationship. A new study presented by Manne indicates that the amount and quality of support from spouses greatly influences whether the testing process creates marital strain and how well women adjust to the results of their testing.
Manne and her colleagues interviewed 143 women one month and six months after they had undergone genetic testing at Georgetown University Medical Center in Washington, D.C., and had learned their status. Some knew they had breast cancer in advance of the test and wanted to know whether they might pass the gene on to their children. Others had a family history of breast cancer and wished to know their own genetic status. The researchers were also able to interview 117 of the women's spouses. Manne later noted that although all the people interviewed were married, results were applicable to same-sex couples and unmarried partners.
The study concluded that husbands can lower their wives' anxiety about genetic testing with supportive behavior, such as listening to their concerns or talking about the testing process and encouraging them to go through with the tests. On the other hand, showing signs of discomfort, such as changing the subject when the wife expresses concern, can significantly heighten anxiety.
According to Manne, the spouses' response was directly related to the test results. Women who were free of cancer and did not have the genetic mutation did not report any marital stress, nor did women who already had cancer, whether or not they carried the mutation. However, those who did not have cancer but learned they carried the genetic mutation reported increased strain in the marriage.
Women whose husbands had not been supportive during the testing and who subsequently learned they did not have a BRCA mutation reported that their husbands' unsupportive behavior lifted. However, women who learned they carried a breast cancer gene mutation or received an ambiguous result said their husbands remained unsupportive, according to Manne.
Leslie Bernstein, Ph.D., professor of preventive medicine and senior associate dean at the University of Southern California School of Medicine in Los Angeles, said, ?This is a very important study which shows an area where we need interventional counseling and a supportive system for women and their spouses.?
Fatigue tied to disruption of body clock
Another study reported that about 80 percent of women who are undergoing chemotherapy to treat breast cancer experience fatigue and another one-third feel depressed. Until now, doctors have had no remedy for the fatigue except to give medication to boost red blood count and regulate hormonal imbalances.
Gary Morrow, Ph.D., professor of radiation oncology and psychiatry at the University of Rochester Cancer Center in New York, suggests that disruption of circadian rhythms, or the ?body clock,? may be the culprit. They are trying to learn more about cancer therapy fatigue by also studying jet lag among
international travelers, which is very similar to what cancer patients describe.
Morrow and his colleagues put electronic devices around the wrists of 76 cancer patients to measure their movement and assess their sleep patterns for 72 hours. Patients also filled out questionnaires about the amount of fatigue and depression they experienced. The preliminary analyses show that people who reported the most depression and fatigue after chemotherapy had the most irregular patterns of sleep and activity, which is a sign of disrupted circadian rhythms. Morrow emphasized that little is known about the phenomenon, and the relationship between cancer fatigue and jet lag is still speculation, but it does move the science closer to finding effective treatments. He noted that people often use the hormone supplement melatonin, bright-light boxes or psychostimulants to reset sleep patterns.
?The idea that circadian rhythms might have something to do with fatigue is exciting,? commented Ngina Lythcott, Ph.D., associate dean of the School of Public Health at Columbia University in New York. ?Some may consider this a New Age approach, but it is clear that time is emerging as a very important factor. A woman's menstrual cycle might influence what happens during screening, surgery or chemotherapy.?
Both of these studies were funded by the Department of Defense Breast Cancer Research Program, a congressionally mandated program partnering the military with scientists, clinicians and breast cancer survivors.
