Caring for someone	Being a carer	Your feelings & emotions
Practical issues for carers	Other people's reactions	Effects on relationships
Caring for yourself	What happens afterwards?	Help & support

Effects on relationships

Friday 1 August, 2008

Taken from Caring for Someone with Cancer (793kb)

There may be times when your relationship with the person you are caring for changes. This is very natural considering all the challenges cancer and its treatment can throw at you both. For some people these changes are very positive. You feel closer and stronger together. For others the relationship weakens. You no longer feel able to communicate or support each other as well as you used to.

A lot will depend on what your relationship was like before the cancer diagnosis. Different relationships will face different challenges. If there were problems within the relationship before the cancer diagnosis then these problems are likely to become more intense now.

Caring for your partner

Caring for your partner during their cancer and treatment may be the most difficult challenge you ever face as a couple. There is likely to be a huge shift in responsibilities within the relationship. You may find yourself doing a task that you never dreamt you would have to do or could do, for example, giving an injection, mowing a lawn or doing most of the cooking. You may do these things differently from your partner, which might cause conflict within the relationship.

The person you are caring for may now be dependent on you. It is not uncommon for people in this situation to feel they have lost control of their life. Despite loving them, you may also feel resentful, angry or overwhelmed by your new responsibilities. Adjusting to these changes can take time.

There may also be times when your partner wants to do something a certain way and you are not sure you can cope with it. For example, they may want to have their treatment and care at home rather than in hospital. While you want to support them as much as you can, you may not feel comfortable with this. It can be very hard to know what you should do in these situations. You may go along with their wishes for fear of upsetting them. In the long run this may build up bad feelings between you.

Your partner may become moody and uncooperative towards you due to the symptoms and side effects of the cancer and its treatment. It can come as quite a shock when your once placid and patient partner becomes impatient and short tempered with you. This can make you feel sad, afraid and unsure about asking their opinion about certain things.

It can help to talk to each other about the changes in your roles and look for ways to cope with them. Honesty is often the best solution. It may be tempting to spare your partner the worry and make household decisions without first asking their advice. This may cause more harm than good! Working as a team and making your partner feel their input and help is still valued is very important. Let them know that you are there if necessary but let them continue with jobs that they can still do.

Intimacy within the relationship

Cancer and its treatment can affect a person's sexuality. Symptoms and side effects such as pain, sickness, tiredness and changes to the body can make someone less able or feel less confident about having sex. As their carer you may feel too tired and emotional to want sex. Or you may be reluctant to initiate sex because you are afraid of causing your partner discomfort. Some people with cancer believe that they are no longer attractive to their partner because of the changes it has caused to their body image. Fatigue is also a very common reason why people with cancer don't feel able to have sex.

Sometimes the things you have to do for your partner, such as help them on and off the toilet, clean up after they have been sick and attend to their daily hygiene needs, don't help to create a very sensual atmosphere for either of you.

‘There's nothing erotic for either person about having to help your partner change their pants because they have had an accident.' - Bill, age 64

Because of these issues you and your partner may find that your usual sexual habits change. These changes may be temporary or long lasting.

Whatever changes you both face, you can still remain close even if you don't have sex. Intimacy is more than sexual intercourse. Finding other ways to be intimate can be difficult at first. You may feel awkward or unsure. You need to be prepared to put some time and effort in to making things intimate and fun again. But it will be worth it for the rewards.

The following suggestions may help you feel closer:

Talk to your partner about your sexual needs and concerns and about how they might be feeling. This can be difficult but worthwhile.
Let your partner know that even though you may not be able to have sex you still want to be near them - cuddling, kissing and just being together!
If possible, make time each day to do something intimate together - lie on the bed and cuddle, give each other a massage, play a game, watch a movie or just sit quietly together, chat, hold hands, spend time together in the garden. Anything that will keep your spirits alive!
Reminisce about the good times you have had, when you first met, the mad things you did together and how much fun it was. This often makes couples feel alive and close again.
Sometimes people avoid intimacy for fear of it having to lead to sexual intercourse. If you or your partner has these feelings try to discuss them and set some boundaries - tell each other what you feel comfortable doing.
Remind your partner that it is not just their body that you find attractive - you love their humour, kind heart, honesty or calm nature.
If you both do feel like having sex, but penetrative sex is difficult, try oral sex, explore other parts of the body and don't be afraid to let each other know what makes you feel good.
Take your time and don't rush each other - remain open minded and allow a new intimacy to evolve. You may be surprised by what pleasures you can give each other. You can have a deep, rich and emotional time once again.
Fantasise - it can do wonders for bringing back some energy and joy!
Go away for a night together. If finances allow, find somewhere with a spa bath, have a glass of wine and enjoy some time splashing and playing together. See Help and support for information about respite and holiday programs available to cancer patients and their carers free of charge.
Acknowledge each other's losses and the changes the cancer has brought into your lives - let each other know that you may need time to adapt but you do want to make the relationship work.
Above all remember that this person is your best mate. You need to talk, talk and talk some more - you are both going through a hard time and need to give each other some extra personal attention.
Some couples may benefit from having sexual counselling. Contact the Cancer Council Helpline to find out about counsellors who deal with these issues. You can also ask your GP for a referral to a psychologist, which may allow you to have six to 12 sessions at a reduced rate.

For Cancer Council information on sexuality and cancer read Sexuality and Cancer or telephone 13 11 20. Although this information is written for people who are having cancer treatment it may also help you as a carer.

Caring for a friend, close family member or child

Caring for a good friend or close family member other than your partner can have its own difficulties. You may get on very well with the person. But for some, caring may mean having to put aside past problems so that you can support and care for the person in the best way. Knowing that they may be dependent on you for some time can cause disruption to your daily life. Juggling your work and home responsibilities along with caring for someone may be very tiring and difficult.

Children over the age of 16 can legally make their own decisions about their treatment and care, but parents caring for them may find it very difficult to accept that they may not be involved in these decisions. If you are caring for a good friend, you may find it very draining having to try to please your family and theirs. Things may not always run smoothly and you may have to deal with people getting upset with you for not doing things when and how they would have liked.

Caring for a young child with cancer can have its own unique set of problems. Giving a sick child the emotional support they need as well as attending to the needs of other children in the family can be exhausting at the very least. A young child with cancer will become even more dependent than usual on their main caregivers.

The demands on a mother and father caregiver can greatly differ. Mothers may have to deal more with the ‘hands on' care of the child as well as managing any behavioural changes the child develops as a result of the cancer and treatment. They may also be expected to plan activities for the rest of the family. Fathers may find it difficult to manage work, organise help to care for other siblings, and also support the mother. Sometimes these traditional mother/father roles are reversed and that poses more problems.

Parents who are separated may have to put aside their differences as a couple. Their main focus now must be finding the best way to support their child through their cancer and its treatment.

When your help and support is not wanted

When this happens it can be difficult to know how to cope. There may be certain tasks that the person you are caring for does not want you to help with, for example, having a bath or shower or going to the toilet. It may be very hard to step back and let them do these things for themselves, especially if you can see that they are finding the task tiring or painful. Offer your help but if they refuse and want their privacy you will need to respect their needs. If you have concerns about their safety, suggest that they have a bell nearby to ring if they need help. You may suggest that you will come back every five to 10 minutes and call out to make sure they are okay.

The person you are caring for may do something that you feel could be harmful, such as refusing medications or wound care. If this happens, try talking to them and working through things together. If this doesn't work, another family member or close friend may be able to influence them. If not, you will need to seek support and advice from the medical team, but let the person you are caring for know this is what you are going to do.

‘Mum's been grumpy and difficult all her life and I realise that now she has cancer that it won't change. Even though she doesn't want my help as her carer it won't mean that I'll stop "caring about her." ' - Thelma, age 68

Coping with changes in your relationship

Some changes may be positive. Others may put more strain on the relationship. Knowing how to cope can be very difficult.

The following suggestions may help:

Talk to the person you are caring for about your concerns. Let them know that you do care and want to sort out any difficulties between you.
Some people may find it helps to have professional counselling. This can help sort out many relationship problems, for example, about intimacy, communication, coping with your emotions and dealing with practical issues such as finance.
Learn more about the person's cancer and treatment. Being aware of what might happen and what they are going through can help you better understand their reactions and emotions. It may prevent problems and help the relationship grow. Call the Cancer Council Helpline on 13 11 20 and ask for information.
As hard as it may be, try to accept changes that you know may be permanent, such as sexual difficulties. Look for new ways to enjoy being intimate with the person rather than focusing on what isn't possible. (See ‘Intimacy within the relationship'.)
Where possible seek support from family and friends - because they are less involved they may be able to see solutions that you can't.
If you disagree on something important, try to stay calm and talk through the issues involved. Hear each other out and then make a decision together. Suggest trying both ways and see which works best. For example, ‘Why don't you try taking your pain-relieving drugs every four hours rather than only when you are in a lot of pain? If it doesn't help then we will speak with your doctor for further advice'.
Set some boundaries! This may not seem necessary at first but if your caring role continues for months or years then you both need to know what your limitations are. You can't do everything all the time. You need to care for yourself to ensure you can continue to create a happy and supportive environment for the person you are caring for.
‘Choose your battles'. Try to only focus your energy on the issues that really matter.
Remember - you can always talk to your medical team about any important treatment issues that may be causing problems, for example, if the person is refusing to take their medications. Your treatment team (for example, social worker or cancer nurse) may also be able to support you to deal with the emotional impact of caring for someone with cancer.

Read the next section, ‘Caring for yourself' for further tips on how to help with any changes in your relationship.