“The Body Gives Way, Things Happen”: Older Women Describe Breast Cancer With a Non-Supportive Intimate Partner

Abstract

Purpose

Many women identify their intimate partner as important source of support during cancer diagnosis and recovery, but little is known about how women deal with breast cancer while in a relationship self-described as difficult. The purpose of this article is to describe the aging-related experiences of older women who were diagnosed with breast cancer while in a non-supportive, difficult intimate relationship.

Method

Semi-structured qualitative interviews were conducted with a convenience sample of 16 women aged 55-84 years (mean 68.1 years) in community settings in the mid-Atlantic United States. Data were analyzed using hermeneutic phenomenological analysis.

Results

Participants self-identified as being in a difficult intimate relationship (relationship length range: 1 year- 60 years, mean 35.6 years). Reasons for relationship difficulty ranged from intimate partner abuse to terminal illness. The findings included the themes: “At my Age”: participants reflect on aging and breast cancer; breast cancer, sexuality, and aging; and silence.

Conclusions

Issues related to aging such as changes in sexual relationships, comorbidities, and partner illness complicated the women’s breast cancer experience. Despite relationship difficulties, these women coped effectively with breast cancer in various ways. Study findings will increase awareness about the unique, complex needs of older women facing breast cancer with non-supportive intimate partners. Nurses should assess older breast cancer patients keeping in mind physical functioning, comorbidities, social support network, and quality of intimate partner support.

The majority of women diagnosed with breast cancer are at least 60 years old (Ganz, Guadagnoli, & Landrum, 2003); the median age at diagnosis is 61(Carlson et al., 2008). The risk of breast cancer diagnosis increases with age, with a peak in incidence at 75-79 years old (Sweeney, Blair, Anderson, Lazovich, & Folsom, 2004). Older women, however, are underrepresented in breast cancer research (Carlson et al., 2008; Mandelblatt, 2006) and may experience breast cancer differently than younger women because they have other issues to face (Cameron & Horsburgh, 1998) and perceive cancer in a different way (Grunfeld, Hunter, Ramirez, & Richards, 2003).

Older women, the cutoff point for which is debated (Carlson et al., 2008), are unique because of differences in treatment, screening, and clinical outcomes. Functional status, life expectancy, cognitive function, mortality risk, physiologic reserve, social support, and presence of comorbidities vary for older women (Carlson et al., 2008). Partnered women rely heavily on intimate partner support while going through cancer diagnosis and treatment (Manne & Glassman, 2000). However, this is not possible for all women. Some women are in relationships self-described as “difficult” or non-supportive. The purpose of this article is to explore the lived experience of older women who dealt with breast cancer while in non-supportive intimate partner relationships. For these participants, non-supportive behaviors included intimate partner abuse (IPA), partner illness and caregiving, lack of physical or emotional support following diagnosis and treatment, and/or extramarital affairs.

Psychological Adaptation to Breast Cancer

Researchers comparing breast cancer experiences of older and younger women report varied results. Older women may be more likely to anticipate chronic illness onset, and are psychologically better equipped than younger women (Mosher & Danoff-Burg, 2006). Although quality of life for older women (>65) has been shown to be lower, mostly due to interactions between breast cancer and comorbidities, younger women tend to have a more difficult time psychologically dealing with the breast cancer diagnosis (Ganz et al., 2003). Older women are more likely to have developed optimistic coping mechanisms than younger women, either because of wider life experience (Kantor & Houldin, 1999) or because older people underreport depression and scales may not be age-adapted (Mosher & Danoff-Burg, 2006).

Aging, sexuality, and breast cancer

Sexual activity may change with aging, but it is a myth that aging eliminates the need or the desire for all older people (Rheaume & Mitty, 2008; Watters & Boyd, 2009; Kennedy, Martinez, & Garo, 2010). For some older adults, particularly women, sexual activity may become focused on emotional connection and intimacy rather than sexual activity (Watters & Boyd, 2009). Even controlled chronic health conditions including hypertension and cancer can negatively impact frequency of sexual activity in older adults (Lindau et al., 2007; Rheaume & Mitty, 2008).

Breast cancer seems to present a unique problem due to disruptions in feminine self-identity and body image, sexual function, and self-perception (Ganz, Desmond, Belin, Meyerowitz, & Rowland, 1999). Generally, older women report less body image disturbance than younger women (Kantor & Houldin, 1999), possibly treatment based. Breast cancer for postmenopausal women can create additional concerns about sexual dysfunction because of sexual issues associated with menopause (Greendale, Petersen, Zibecchi, & Ganz, 2001). Menopause does not diminish sexual desire in all women; some women become more sexually aggressive following menopause (Kennedy et al., 2010). If the woman is in a relationship, sexual activity with her partner may change.

Cancer and intimate partner support

Many patients identify their partner as their most valuable source of support during their cancer experience (Manne & Glassman, 2000), and overall relationship quality affects the way a woman adjusts to her breast cancer diagnosis (Manne & Glassman, 2000; Ballantyne, 2004). The degree of partner emotional support contributes to overall well-being for women with breast cancer (Wimberly, Carver, Laurenceau, Harris, & Antoni, 2005). Conversely, having a non-supportive partner can create harmful disease outcomes and poor adjustment to breast cancer (Ballantyne, 2004). In several studies of male and female cancer patients, Manne and colleagues found that spouses have negative responses to decreasing functional ability (Manne, Pape, Taylor, & Dougherty, 1999; Manne & Glassman, 2000; Fang & Manne, 2001; Manne & Schnoll, 2001).

Women with breast cancer tend to reach beyond their intimate partner for social support, and good quality social support has been shown to increase quality of life in cancer patients (Turner-Cobb et al., 2004). However, for many elders, social support networks are reduced by the deaths of family members and friends (Straka & Montminy, 2006), making breast cancer harder to cope with for women in non-supportive intimate relationships.

Older women experience breast cancer differently than younger women. Although there have been several studies focusing on the importance of intimate partner support for women with breast cancer, none considered non-supportive relationships and older women.

Methods

Participants in this study were older women (n=16) who self-identified as having been in a “difficult” (non-supportive) intimate relationship while being diagnosed with or treated for breast cancer. Some (n=9) of the women were in relationships that included IPA, operationalized by scores on the Women’s Experience with Battering (WEB) Scale (Smith, Earp, & DeVellis, 1995). The remaining participants experienced non-support in various other ways, such as extramarital affairs, caregiving for their intimate partner, terminal illness, and bereavement.

Recruitment Procedure

Participants were recruited over six months in a variety of ways, all approved by the University of Virginia Institutional Review Board. The principal investigator advertised in newspapers and contacted breast cancer support group leaders and cancer centers.

The primary investigator then called potential participants and verified eligibility. The eligibility criteria were 1) ability to speak English 2) either post-menopausal or minimum age of 55 at the time of the interview 3) self-described as having been in a “difficult” intimate partner relationship at the time of breast cancer diagnosis and/or treatment 4) Scoring at least 23 on the Mini-Mental Status Exam (Kurlowicz & Wallace, 1999). If participants met these criteria, they signed the consent form and completed a demographic instrument. Participants completed the Women’s Experience With Battering (WEB) Scale to determine the nature of the difficult intimate partner relationship. The WEB measures the psychological vulnerability that women experience, especially in the areas of mental health, anxiety, and depression (Smith et al., 1995; Smith, Smith, & Earp, 1999). Participant WEB scores ranged from 10 to 59 out of 60 (mean 26.8). Nine women scored above 19, indicative of emotional abuse.

Participant sample and setting

Older women were defined as women who were either post-menopausal prior to their breast cancer diagnosis or at least 55 years old, the outer limit of the average age range for menopause onset (Stoppler & Shiel, 2008). The participants ranged in age from 50 to 84 at the time of interview (mean 68.1 years). Age at diagnosis ranged from 50 to 75 (mean 60.7). Time between interview and diagnosis ranged from 1 – 31 years (mean 7.4 years). The participants were all in relationships with men that ranged from less than one year to 60 years (mean 35.6 years). Breast cancer stage ranged in this subset from Stage I – to Stage IV. Five women did not know their cancer stage. Ten of the sixteen women had a mastectomy and five women had lumpectomies as treatment. One woman was not yet undergoing treatment. Fourteen of the women were White and two were African American.

Interview

Identity of all participants was confidential. The interviews were conducted in-person or by telephone, and were digitally recorded. Either the author or a transcriptionist transcribed the interviews. The interviews lasted between one and two hours and were guided by probes and closed questions (Table 1).

Table 1.

Sample Interview Questions

LIST OF INTERVIEW QUESTIONS
[Developed from Partner Responses to Cancer Inventory (PRCI) by Manne and Schnoll (2001)]
Can you tell me a little about your partner and your relationship? Tell me about the breast cancer. How did you learn about the cancer? What kinds of treatments have you had? How did you tell your partner about the initial diagnosis? What was his/her response? How did you tell your partner about the treatments? Have you had a lot of side effects from the treatment? Do you think that the breast cancer has changed your relationship with your partner in any way? If so, how? Is there anything you wanted or needed from your partner that you did not get? How did your partner interact with you when you were not feeling well? What comments has your partner made related to the illness, if any? What was your menopausal status at the time of diagnosis? How do you describe your partner’s role in your treatment and recovery?
Describe how you dealt with your cancer.

Analysis

The investigator used a hermeneutic phenomenological strategy of inquiry for data analysis. In hermeneutic phenomenology, the researcher analyzes and interprets the narratives of those who have experienced a phenomenon first-hand in order to gain understanding of that lived experience (Creswell, 1998; Van Manen, 1990). The person interviewed is considered to be an expert on her own experience (Van Manen, 1990), and provides a thick description of her life in its multifaceted context (Steeves, Parker, & Laughon, 2009). The data were analyzed and re-analyzed in order to identify themes that characterized the experiences of the participants. First, natural meaning units were identified in the interviews. The units were then grouped into categories or and coded based on perceived similarities. This first level of coding produced categories that remained very close to the interview data. The next stage of analysis involved grouping the categories into themes that represented the experiences of the participants and addressed the specific aim. The author kept an audit trail and consulted a peer reviewer, a qualitative expert. To manage the data, NVivo 8, a computer program that assists qualitative researchers, was used.

Findings

These findings are descriptions by older women of aging while dealing with breast cancer and a non-supportive intimate relationship. The following themes emerged: “At my Age”; breast cancer, sexuality, and aging; and silence.

“At my Age”: Participants Reflect on Aging and Breast Cancer

Participants reflected on the combination of age, non-supportive intimate relationships, and breast cancer in several ways: related to treatment decision-making, the intimate relationship itself, and how age-related situations, such as partner illness, created difficulty.

Age and age-related issues seemed to affect the way participants decided on treatment more than their partner’s opinions. Most participants made treatment choices independently from their non-supportive partner. For instance, several women decided not to have reconstruction due to age. Stated one woman:

Having reconstruction at my age would be a little bit difficult for me just in terms of being 61, and having a boob job at 61 isn’t in line with how I age in other ways. But the fact is that the implants, even the best ones, are only good for about fifteen years. I’d have to make a decision at 76 (again). I don’t think so.

This woman believed that her boyfriend became emotionally and sexually unresponsive following her lumpectomy, and she broke up with him. Another woman in her 60s is not considering reconstruction because, “at this late game I don’t think I want to go through that.”

Age repeatedly entered into the participant’s reflections on breast cancer treatment. One woman stated, “At my age, I thought, ‘you know what? I don’t really need two breasts at this point in my life’, and so I said I’d just as soon have my breast removed.” Another participant, whose daughter was diagnosed with breast cancer weeks before she was, contrasted her mastectomy with her daughter’s lumpectomy, “I think she just didn’t want to be disfigured at that point in her life. To me, it didn’t make any difference; it’s just different when you’re older.”

Many participants had had other illness experiences, such as other cancer (uterine, colon, lymphoma, skin). Others had high blood pressure, chronic pain, or chronic obstructive pulmonary disease (COPD). In some cases, other medical conditions complicated breast cancer treatment. This helped the participants to put the breast cancer into perspective, and gave them a point of comparison. For instance, one woman had a post-operative blood clot. When she described her breast cancer, she said, “The cancer was not my enemy…it was not the worst thing that ever happened to me. That blood clot was.”

Some participants reflected on age related to breast cancer and relationships. For instance, one participant knew other women dealing with breast cancer and non-supportive partners, and wondered about generational differences among older women. She posited, “Women 65 and up are not as likely to leave a non-supportive spouse, whereas the slightly younger women might say, ‘I don’t have that much time left.’” She stated that she would tell friends in non-supportive relationships while going through breast cancer, “Leave now. It’s not going to get any better.” She believed that breast cancer can serve as an indicator of how your partner will respond in old age, and it only gets more difficult with age.

In several cases, intimate partner illness rendered a formerly supportive partner non-supportive. Participants with ill partners dealt with their own care as well as their husband’s care. One participant, whose diabetic husband with heart problems could no longer drive, described how she either had to take him to appointments or arrange other transportation in addition to her own. One woman poignantly described trying to juggle her diagnosis with her husband’s illness:

My husband was ill - he had been away in a facility with dementia, so I put everything on the back burner about me. It was all about him, about his illness.

Another woman, whose husband was terminally ill, knew that she needed to take better care of herself, but never figured out how. She described a doctor’s visit when they addressed this:

I told her that my husband was sick. She said, ‘you have to start thinking about yourself. You have to start thinking about yourself.’ But that’s easier said than done.

This participant performed full-time physical care for her husband’s terminal illness. She described that time:

He passed away right after I got through with radiation. The last week of my radiation I had to get someone to stay with him so I could go have my radiation. Of course hospice came in…. I was burned pretty bad with the radiation. And that was very difficult. Because I had to take care of him and myself too…

She reflected, “I just wish that I hadn’t had breast cancer so maybe I could have taken better care of him.” One woman made her treatment decision indirectly based on their partner’s health, “My husband was ill and could not drive me. So I had no choice but to do my radiation here (in a rural area).”

Age-related issues, such as caregiving, illness, or physical changes were paramount to the participants’ reflections. Non-supportive intimate partners were sometimes central to the experience, sometimes peripheral. Regardless, participant age at the time of their breast cancer was crucial to their interpretation.

Breast Cancer, Sexuality, and Aging

Aging and/or breast cancer affected most intimate relationships. Participants described how sex became increasingly complicated with age. Sex lives changed regardless of breast cancer, either due to a stagnant relationship or their husband’s health condition.

It was dwindling a little before. He had a heart attack back in September, about a year before I had this. He was on some medications that kind of took his interest away from sex. I was all right with it too. So our sexual relationship isn’t very much at all now.

Another participant acknowledged several factors:

He also had a heart condition, he was on heavy medication, so I wasn’t necessarily all to blame…. After I had the second one done, then of course there was no more breasts, and I didn’t even have feeling here. I was flat-chested and I always kept covered when we had sex because it was better to have it covered than exposed…. As time went on the physical attraction just kind of faded away to nothing.

She described her husband as a “breast man”, who told her that the breast – “never felt the same, always felt different” 20 years after the mastectomy. She said, “But I couldn’t help that…. He didn’t realize that I got pleasure out of him touching my breasts. He was only thinking about himself.” She acknowledged the aging process for both herself and her husband as factors in the discontinuation of her sexual relationship:

From 60 to 80, we didn’t do anything like that. But also, I had developed trouble in the vaginal area from lack of hormones or whatever, so it was extremely sore, so I couldn’t stand any (sexual activity).

One participant’s husband has never seen her chest since her mastectomy. They stopped sleeping in the same room to assist her recovery, and have kept this set-up. They discontinued having sex without discussion:

I feel like for me to approach him with, ‘hey, why don’t we do this any more’ would be hurtful to him. He’s never come to me and said, “Hey I’m sorry.” Because he’s never brought it up, I’ve never brought it up.

Another participant described her husband’s reaction to her mastectomy.

Very little reaction whatsoever…after that many years, you’re not involved sexually too much anyway, let’s face it.

One woman described her sexual vulnerability:

It couldn’t have happened at a worse time because if we had been younger, then we would have had time to recover, and not everybody goes into premature menopause. I felt like 50s is the worst time because it’s a double whammy…. The worst thing I can say about this cancer, assuming that it doesn’t come back, is that it stole my last three or four really good years as a passionate and vital sexy person.

Breast cancer affected intimate relationships either by how their partners viewed their bodies, or by changed sexual relationships. For several women, a negligible change in their intimate relationship coincided with their cancer diagnosis. Partner acceptance of the participant’s changed bodies sometimes altered how supported the woman felt. One woman described,

The thing that was hardest for me was that from the time I had the first biopsy, he did not want to look at me without clothes. He didn’t want to look at my breasts, and he never touched me again.

Another woman described coming home from the hospital post-mastectomy.

After I was home I asked him if he wanted to see it. He looked at it, and then covered it up. (laughs) That was about it. ….I felt that I lost a lot of his respect for me…I was no longer a perfect wife.

Echoed another woman, describing her post-operative time,

He could look at me and it looked like he was looking through me, like I was imperfect. He was afraid to touch me, he was afraid to hug me, he was afraid that he would hurt me somehow.

Another woman’s husband has never seen her chest post-mastectomy:

He hasn’t ever indicated that he wanted to see it. I don’t want to put him on the spot saying, ‘would you like to see it?’ … I know him well enough after being married for forty-eight years what he would like to do and what he wouldn’t. I don’t want for him to feel pressured into doing that.

Sexuality and aging is complex. For some, age-related changes in intimacy might have happened regardless of breast cancer. For others, breast cancer was a clear turning point in worsening relationship quality. Regardless, these women were counting on the support of their partner and did not receive it.

Silence and Shutting down

In the context of breast cancer, silence was both a manifestation of non-supportive behavior, as well as a coping mechanism for both the participant and their partner. Participants attributed their partner’s silence to age, gender, generation, and family communication patterns. One participant and her husband were unable to talk about anything related to her breast cancer, and she “cried for years” after her mastectomy. She said her husband never knew,

because he had no patience with crying. I guess that was a sign of weakness, so I didn’t cry in front of him. Of course, part of it was losing my breasts, but part of it was the distance between my husband and I. We would watch (cancer) programs on TV and I would like to have discussed it deeper with him, but just never did get around to that.

She attributed his behavior to gender and his generation, “Well, he just never talked in depth about anything, and if he got uncomfortable with something, he would just get up and leave the room. That’s what men do.” She described his supportiveness as lacking, “Emotional or personal things, no. And my husband came from that generation.”

Many participants used phrases like “withdrawn”, “very quiet” to describe their non-supportive partner’s lack of communication about their breast cancer. One woman’s husband “didn’t say anything much, just went on.” Another woman described her experience with her husband during her breast cancer as “just complete emotional detachment.” She went on,

“I just can’t seem to get through to him how I feel because he doesn’t want to talk about it. ‘Oh, you’re going to be okay, don’t worry about it, and all that stuff. Sometimes you just need more than that.”

This woman felt like her cancer diagnosis made her partner angry, like it was an inconvenient annoyance. She then deliberately eliminated him from her treatment decisions.

Several participants’ partners exhibited silence about the breast cancer diagnosis that participants attributed to fear, “But when the going gets tough or if you get sick, then he gets scared and he doesn’t communicate.” One woman’s husband, upon hearing from the doctor about his wife’s diagnosis, “was silent and he just walked out of the office. I don’t know what he did whenever he went out of the office, but he walked out of the office.” She said he “let her hang…it shocked me; whenever I needed him he wasn’t there.” The participants recognized that in these cases, silence was a coping mechanism.

It was not only the participants’ partners who did not want to discuss their breast cancer. Some of the participants did not want to talk about it either, and they were content to “deal with it and move on” from the breast cancer that was, for one participant, “just a bump on the road.” As one participant said, “No, he doesn’t like to talk about it at all. But then I don’t like to either. I don’t like to dwell on that because I feel like I’m really healthy now.” Added another participant, “ It had to be taken care of, and it was.” One woman described her feelings about her breast cancer, “I was not crawling on the ground from what I’d been through. It was just like, it’s done, we’re over it, and it’s time to move on.” Although most of the participants felt like they were changed in some way as a person as a result of having had breast cancer, one woman was adamant that breast cancer had not changed her because,

It wasn’t a disaster to me at all. Emotionally once I accepted it that hey, this is going to get taken care of and you’re going to be okay, then that was it and so then I was able to go on with my everyday life.

Dealing swiftly and efficiently with breast cancer, not dwelling on it, and moving on were coping methods used by these older women. It is not known whether or not these methods are useful because the participants are of the American Great Depression-era Silent Generation (Strauss & Howe, 1991), or simply that they are older and better-equipped to handle illness due to general life experience and expectations of later-life stages.

Discussion

These 16 older women described how they dealt with breast cancer and aging with a non-supportive intimate partner. Some of the issues they describe are similar to other studies. Like many women with breast cancer, these participants experienced changes in their intimate relationship (Barni & Mondin, 1997; Manne, Alfieri, Taylor, & Dougherty, 1999; Sormanti & Kayser, 2000). The participants generally did not seem to be distressed about their mastectomy treatment by the time of the interview, and discussed cancer in the context of their advancing age, supporting that older women deal effectively with body image following a mastectomy (Kantor & Houldin, 1999). The women in this study seemed to have made largely well-informed treatment decisions and solicited advice from friends and relatives.

What is unique about these women is their ability to navigate breast cancer without the support of their intimate partner. Although many women go through breast cancer without a partner, these women were partnered, and so to not receive intimate partner support was an unexpected hurdle. Not only were they not receiving support, they were contending with negative statements and behaviors (walking out of doctors appointments or never touching breast cancer site) or taking on additional responsibilities (such as juggling caregiving or hospice care) while dealing with their own breast cancer diagnosis. These women support previous assertions that older women cope effectively with illness, because perhaps they are already dealing with other age-related changes and have a wide breadth of life experience (Kantor & Houldin, 1999; Crooks, 2001).

The silence of both the participants and their partners seems to be related to cultural expectations of how people retell their illness stories. The repetition of phrases like “I am fine” is one example of this. According to Frank (1995), a phrase like “I am fine” is an example of a culturally acceptable restitution narrative style, expressing the cultural need both of the storyteller and the listener for the illness-sufferer’s return to a healthy, normal, disease-free baseline. Silence may also be a natural consequence of couples’ difficulties openly communicating with each other about illness (Zhang & Siminoff, 2003). Partner silence may be due to generational factors and cultural expectations for men, most of whom are from the Silent Generation (Strauss & Howe, 1991).

Partner silence and ineffective communication during a breast cancer diagnosis is not unique (Zhang & Siminoff, 2003). In one study, 65% of cancer patients and their caregivers did not communicate due to the desire to avoid distress and protect the cancer patient, and a culturally espoused belief in positive thinking (Zhang & Siminoff, 2003). The complicated social situations of the participants support previous research findings, wherein men who have partners with breast cancer may be forced into new caregiving roles and older women who have an illness may be prematurely forced to resume normal life and report that all is well (Revenson, 2003; Hodges, Humphris, & Macfarlane, 2005).

It is widely known an older female breast cancer patient is likely to present with comorbidities that complicate her treatment, and that, if she has a partner, that person is likely to have illnesses or need care (Ballantyne, 2004). These women support the assertion that older women are not exclusively focused on breast cancer, but are also concerned about their own advancing age and other comorbid health conditions (Kantor & Houldin, 1999).

Women in this study varied greatly when discussing sexuality and aging. Some, when faced with ceased sexual activity, were relieved. Other women mourned lessened levels of intimacy and/or sexual activity and blamed themselves or their breast cancer. This is consistent with Lindau et al., who present a complex picture of sexuality and aging in older American adults (2007) and Kagan et al., who indicate the complex influence of cancer on older adult sexuality (2008).

Although breast cancer certainly was very difficult and complicated, these older women seemed to assign less importance to the breast itself and the negative intimate relationship changes, and rather view breast cancer as one piece among many age-related changes happening in their lives. Although most couples experienced changed intimate relationships, the older women did not choose to leave their partners, as was the case for several of the younger women described in Sawin et al. (2009). Rather, they chose to cope by seeking outside support and sometimes distancing themselves from their intimate partner. Some researchers postulate that older women may be more skilled at looking beyond their intimate partner for support during cancer (Kantor & Houldin, 1999; Ballantyne, 2004). This was certainly true for many of the women in this study.

Caregiving, terminal illness, and comorbidities affect all people as they age, and those simultaneously facing breast cancer face additional changes in their bodies, intimate relationships, and self-perception (Kagan et al., 2008). These issues are heightened for women whose relationships with their intimate partners are strained or difficult. The breast cancer experience is increasingly complicated as women age due to complex gender, cultural, and generational issues.

Limitations

As a qualitative study there was a homogeneous, small sample size. Future studies should include an increased number of women in same-sex partnerships, minority women, and women who are frail or disabled, need caregiving themselves, or have extensive comorbidities.

Implications for Nursing

As these women illustrate, marriage is not necessarily supportive, and older women have unique needs. Many studies do not address either older couples or relationships that are non-supportive. Some interventions focus on fostering open communication in couples (Manne, Ostroff, & Winkel, 2007; Lewis et al., 2008; McLean et al., 2008), since not talking about cancer can lead to greater marital distress (Manne et al., 2006). It is not clear how effective these interventions would be for older couples that are in relationships that some would describe as non-supportive, with poor communication patterns. Many of these women described functioning working relationships, despite the many challenges they confronted with their own and their partner’s health and aging limitations. Future studies should further develop these strengths and resiliencies to develop intervention strategies.

Drawing prescriptive conclusions about clinical implications from a descriptive study is premature. However, a starting place for the health professional is awareness of the unique needs of older women with breast cancer, such as emotional support and physical needs (Crooks, 2001). Nurses should assess older breast cancer patients keeping in mind issues of physical functioning, comorbidities, social support network, and quality of intimate partner support. More research targeted toward older women with breast cancer will help clinicians understand this complex issue (Muss, 2009).

Nurses should identify personal assumptions and stereotypes about elderly women, partner support, and cultural expectations for returning to normal after treatment ends (Ballantyne, 2004; Hodges et al., 2005). Oncology nurses have excellent opportunities for identifying and strengthening patient coping strategies, and providing individualized care, extensive assessments and referrals, and patient empowerment (Ballantyne, 2004). Nurses should be aware of assistance for women dealing with issues of partner health and bereavement, including in-home nursing, respite services, and support groups.

These women illustrate the complexity of being older and having breast cancer with a non-supportive intimate partner. It is the interaction of age, breast cancer, and multifaceted intimate partner issues that makes the study of these women important and unique, because little is known about how older women in non-supportive relationships deal with age-related issues during the breast cancer experience. The participants demonstrated resilience regardless of the upheaval of facing breast cancer without the expected support of their intimate partner.