Table 4.

Characteristics of included studies.

Author	Country	N of Dyads	Design	Measurement Point/Intervals	Variables	Key Results
Northouse, 1989	USA	41	Observational	At three points in time: 3 days, 30 days, and 18 months post-surgery	Mood, roles functioning and symptoms over distress as post indicators of adjustment.	At 18 months post-surgery, approximately 35% of patients and 24% of partners reported a moderate level of distress. Both patients and partners had few difficulties carrying out the role functions at work, family and social levels. No correlation between demographic factors (e.g., age, level of education, length of marriage) and adjustment was found. Furthermore, no significant differences resulted between medical factors (type of surgery, evidence of recurrence, current treatment, completion of breast reconstruction) and psychological distress or mood symptoms. As for husbands, demographic factors were related to mood disturbance. Younger men and in marriage for a shorter period of time reported a lower level of positive states. Husbands of women with recurrent cancer or women on chemotherapy reported more role problems.
Carter, 1993	USA	14	Mixed Methodology	2–3 years from the mastectomy	How the couples adapt over the term of treatment. What interactional factors characterize couples affected by BC.	No apparent psychological consequences took place over time to either the husband or the patient as a single individual. Differences did not occur between husbands and wives on individual adjustment to illness. In contrast, significant differences were found in marital interactions that define the psychology of the couple system. Marriages are characterized by extraordinarily high levels of enmeshment. Less rigidity, in terms of rules and roles, flexible interaction patterns (three components: marital domination, the punitiveness of one spouse toward the other and conflict resolution through negotiations), communication patterns that facilitate disclosure and free exchange represent crucial components of adaptability.
Antoine et al., 2013	FR	11	Qualitative	Undergoing hormone therapy	Identify the experiences of partners and young women who had breast cancer, identify the marriage functioning in BC hormone treatment.	Five main themes emerged: the disease cemented our relationship; the mirror breaks (i.e., refers to physical, psychological and emotional symptoms); the onslaught of solidarity (means the support, both instrumental and emotional one, by close and distant family and friends); a suspended future (cancer and recurrence, difficulties with long term perspectives and family planning); what the disease revealed to me.
Skerrett, 1998	USA	20	Qualitative	From 18 to 31 months post diagnosis	How a diagnosis of breast cancer affects the marital relationship. How different aspects of the relationship can help or impede couple adaptation.	High Adapters: challenging impact identifiable, united coping philosophy, selective communication patterns, positive use of multigenerational legacies (i.e., the information about their history to fashion personal theories about a method of coping that would work for them), articulated beliefs on health and illness, and beliefs regarding one’s ability to control or influence the course of illness and well-being, resilient sexuality. At-Risk Adapters: devastating impact, lack of dyadic coping, mutual isolation, strained communication, difficulty using multigenerational legacies, absent or conflictual beliefs, multiple stressors (e.g., medical complications, past losses and traumatic histories).
Ptacek et al., 1994	USA	36	Observational	Currently disease free (1.5 years from the end of radiotherapy)	The couple’s modalities of coping with treatment.	A consistent pattern of correlations among coping techniques for both spouses was reported. Respectively, it was found a strong correlation, for both husbands and wives, among the coping strategies of self-blame, wishful thinking and avoidance. However, the self-reported coping of one spouse was largely unrelated to the self-reported coping of the other spouse. In terms of well-being, for both husbands and wives, the greater relative use of seeking support and less use of avoidance was associated with better mental health. A low level of well-being was also related to the use of problem-focused coping and wishful thinking in wives and blaming oneself in husbands. Satisfaction with the marital relationship was far less strongly correlated to cancer-specific coping.
Picard et al., 2005	FR	16	Qualitative	From 10 to 12 following the initial diagnosis	Ways in which the couple as a dyad deal with the disease and associated treatments.	Four themes: dealing with the Unknown; dealing with the Threat of Loss and the Uncertainty of the Future; dealing with the Woman’s Personal Transformations in the Couple’s Sex Life; organizing a Social Support Network.
Keesing et al., 2016	AUS	8	Qualitative	Till 6 months to 5 years from completing the treatment, excluding adjuvant hormone treatment	How wives and spouses communicate with each other; the pattern used by the couples to maintain their relationship; the needs and supports required by women and their partners.	Three themes: A disconnection within the relationship (the woman survivor of breast cancer needing to prioritize her own needs, sometimes at the expense of her partner and the relationship); Reformulating the relationship (i.e., reflects the strategies used by couples to negotiate changes within the relationship); Support is needed to negotiate the future of the relationship (i.e., couples emphasized the need for additional support and resources to assist them in maintaining their relationship during early survivorship).
Chung et al., 2012	KR	7	Qualitative	From 5 to 63 months following the initial diagnosis	The aspects of couples’ going throw after BC diagnosis.	Nine themes: HITTING A WALL (when the women and their husbands initially heard about the cancer diagnosis, a feeling of shock was the most common immediate response); FACING HARDSHIPS WITH TREATMENT AND SUPPORT (after their immediate responses, couples underwent a difficult phase of facing hardships with treatment and support as summarized with “suffering with treatment” and “feeling; CONTROLLING AND PROTECTING MYSELF (women focused on themselves: controlling and protecting myself); REFORMING MY LIFE TO CARE FOR HER (husbands try to find ways to help their wives more actively, three categories of “reforming my life,” “providing care” and “keeping a positive attitude”); WORKING TO SURVIVE THE REALITY (couples agreed to deal with the situation together as categorized by “following standards,” “accepting the new reality” and “working to survive”); COMING INTO MY OWN (cancer as a turning point for women to change their attitude from being introspective or forbearing to being more assertive and expressive, BEING A CARING PERSON (changes in husbands); KNOWING THINGS’ WORTH (the couples learned lessons, involving four categories of “appreciating partners,” “thinking what this event means,” “thinking about what is important” and “asking for further support”); BEING SUSPENDED WITHOUT RESOLUTION (several issues were still challenging the couple)
Canzona et al., 2019	USA	53	Qualitative	End the treatment from 3 months to 25 years prior to recruitment	How couples attempt and experience the challenging of BC.	Five sources of uncertainty: perceptions of post treatment bodies, worry about effects on relational partners, ethical concerns about dissatisfaction with sexual relationship (partner prospective), fears about future of the relationship and apprehension about Sexual Health treatment uselessness. Four themes of communication efforts: supporting survivors’ body esteem (partner prospective), navigating potentially hurtful disclosures, responding to partners’ obstructive behavior and believing communications useless.
Dorval et al., 2005	CA	282	Qualitative	Three measurement points: at 2 weeks and 3 and 12 months after treatment start	The potential adaptation Predictors from the perspective of both couple Members.	A global agreement between the patients and their spouses about the effect of the disease on their relationships emerged. Most of the couples reported that breast cancer and associated treatments had made them closer. In terms of marital satisfaction, at twelve months, significantly higher levels were found among couples where both partners reported individually that breast cancer had made them closer. Four factor predictors were found: giving advice to the spouse about coping with breast cancer, the spouse’s accompanying the patient to surgery, and the spouse reporting the patient as a confidant. The fourth factor consisted of tenderness and affection from her spouse since diagnosis.
Morgan et al., 2005	USA	12	Qualitative	Not specified field	The pattern by which African American couples cope with BC.	Two main dimensions: merging strengths (as uniting and working together to cope with the challenges of a breast cancer diagnosis) to cope with and survive a breast cancer diagnosis. Six categories of merging strengths were reported: walking together; praying together; seeking together information and supportive network; trusting together; adjusting together; being together. Spirituality was an integral component that influenced the effectiveness of each of these major categories.
Comez et al., 2016	TR	14	Qualitative	At least 1 year prior to recruitment	The process of women with BC and their spouses from diagnosis to treatment completion.	Different themes related to the phase of treatment—When the couples received the diagnosis, two main themes emerged: perceptions of breast cancer (BC) and reactions to BC. During the treatment process, four themes emerged: symptoms experienced, fear, understanding each other’s worth and needs and counseling. Three themes characterized the stage related to coping with the disease and treatment: process body image and sexuality, religious beliefs and support systems. After the treatment period, three themes were found: changes in roles, health-promoting behaviors and living for oneself and not for others.
Hoskins, 1995	USA	128	Observational	Six measurements points: at 7–10 days, atone, 2, 3, and 6 months, and 1 year post surgery	Adjustment outcomes as an interpersonal variable.	Emotional adjustment in both patients and partners could be predicted by satisfaction of interactional and emotional needs. The effects of cancer accentuated the dynamics of a complementary pattern of interaction (partners perceived and complemented i each other’s needs) as a strategy for coping with the experience. This interaction may be enhancing the likelihood of positive emotions.
Northouse et al., 1998	USA	73	Observational	Three measurements points: at the time of diagnosis and at 60 days and 1 year post diagnosis	The concurrent stress, resources, appraisal and patterns of adjustment of couples in the benign and malignant groups, comparing the psychosocial responses of patients versus spouses.	During the first year following diagnosis, the patterns of adjustment (emotional distress and role problems) were clearly dissimilar for couples facing benign versus malignant disease. Couples in the malignant group reported significantly higher levels of emotional distress and more role problems than couples in the benign group, and these differences persisted over time. Couples in the malignant group reported greater decreases in marital satisfaction and family functioning than couples in the benign group. A significant decline of social support over time was reported by women with malignant breast cancer. Couples in the malignant group reported more uncertainty about the nature and course of the illness than couples in the benign group. The uncertainty of women with breast cancer decreased over time, but their uncertainty and that one of their husbands remained markedly higher than the level of uncertainty reported by couples in the benign group.
Meier et al., 2019	OH	70	Observational	Three measurements points at 2 weeks, at 3 months, and 1 year after cancer surgery	The effect of Common Dyadic Coping (CDC) on individuals 1 year after cancer surgery. Psychological distress in patients and their partners.	At 1 year after cancer surgery, patients and partners reported lower psychological distress when the couple showed a CDC in terms of couples’ agreement on how partners cope as a couple. Specifically, high CDC congruence was related to lower psychological distress among female patients. However, CDC may lose its importance over time when couples cope with chronic issues related to the disease.
Manne et al., 2006	USA	127	Observational	Two measurement points: during cancer treatment and at 9 months after the baseline (Time 2)	The association between types of couple’s communication strategies and couple’s ability to handle breast cancer’ stressors.	Partners who reported more constructive mutual communication had lower levels of discomfort at Time 2, while partners who reported greater avoidance of discussing problems and stressors or greater use of request-withdrawal communication experienced higher levels of suffering. Greater communication regarding stressors due to illness between patient and partner reduced the partner’s anguish levels and increased relationship satisfaction while potentially modulating the perception of the patient’s physical damage. Greater mutual constructive communication was a significant predictor of low partner distress, and greater mutual omission was a marginally significant predictor of partner suffering. Furthermore, request-withdrawal communication was not a significant predictor of the partner’s distress.
Kim et al., 2008	USA	168	Observational	Approximately 2 years from the diagnosis prior to recruitment	The dyadic effects of psychological distress on the quality of life of couples dealing with cancer.	The strongest predictor of the couple’s quality of life was the individual psychological distress, and it was strongly related to mental health. At 2 years post diagnosis, cancer survivors and their spouses displayed normal levels of psychological wellbeing and quality of life. Patients and partners caregivers reported similar levels of psychological distress and quality of life. The partner’s distress and the (dis)similarity in the levels of distress of the couple played a significant role in the individual quality of life. At the dyadic level, for men, a greater dissimilarity in psychological distress was associated with better physical health.