For many women, the diagnosis of breast cancer represents not only a major physical battle, but also the ultimate emotional challenge -- one that affects every relationship in our life.
"I do think cancer has more impact on emotions and emotional relationships than other catastrophic diseases, because with cancer, death is often the first thing people flash on. There's an immediate shock and emotional impact that few other illnesses have," says Katherine Puckett, LCSW, national director of Mind-Body Medicine at the Cancer Treatment Centers of America in Chicago.
Moreover, Puckett says that the uncertainty of the disease itself enhances that impact. "It's the not knowing aspect of breast cancer that increases the emotionality in regard to all your relationships. It heightens anxiety, but it heightens and changes everything in your life," says Puckett.
But the changes, she says, don't have to be negative.
Indeed, for some women, breast cancer can be the catalyst that turns casual friendships into deep and meaningful bonds, that brings couples closer, that helps the family unit become stronger and more cohesive.
For others, however, it can be a lonely and isolating time -- a period of life when people we counted on most seem to all but disappear.
So what is it that determines how breast cancer will affect you and the people in your life? Experts say it’s often linked to a willingness to let others share your burden, something that doesn't come easy for many women.
"Women are the caregivers. We are used to taking care of everyone else, so it can be a huge emotional struggle to give up some of that control and let people in. Even with illness, women still want to handle everything on their own," says Gloria Nelson, LSCW, senior oncology social worker at the Montefiore/Einstein Cancer Center in New York City.
Moreover, experts say, many women view asking for help as a sign of weakness, so they won't allow even those who want to help to do so.
"They think that needing help means they have no willpower or strength. But in reality, being able to share your feelings and ask for help when you need it is a sign of strength that can strengthen the relationships in your life when you need them the most," says Mauricio Murillo, MD, an onco-psychiatrist and director of Supportive Services at the NYU Cancer Center in New York City.
So where -- and how -- do you begin to do that? The best way to start, say experts, is with honest, open communication with family and friends.
Breast Cancer and Your Family Relationships
Among the most important relationships in our lives are those we forge with our partners and especially our children. And whether they’re toddlers, grade school-aged, teens, or even young adults, experts say if you want to keep the family unit strong during this challenging time, it's essential that you confide in them from the very earliest stages of your disease.
"It doesn't work to keep this important a secret from your children. Kids are remarkable in that they pick up on everything going on in their parents’ life, and they almost always know when something is wrong," says Puckett.
Moreover, Murillo cautions that when kids do sense a problem but don't know what it is, they often blame themselves.
"They begin to feel guilty, as if they are causing the situation, and they pull away. So it's very important to talk to them honestly and openly right from the start," says Murillo.
While Nelson says very few parents use the word "cancer" in their explanation -- most, she says, refer to tumors or lesions, or sometimes just say “Mommy is sick” – what trumps the list of suggestions is assuring your children that you are doing everything possible to get well.
"You can't promise your kids that you're going to be alive and that everything is OK, but you can say you are working with the best doctors you could find and that everyone is going to do their very best to help you get better," says Puckett.
And what if your child asks, "Mommy, are you going to die?" Puckett says the answer is always "I hope not."
"Tell them you are doing everything you can to stay with them, and you'll let them know if anything changes. Building a sense of trust is key to building a strong, supportive family unit during this time," she says.
Breast Cancer And Your Intimate Relationships
While crisis automatically bonds some partners in a unified front, sadly, that's not always the case. Indeed, experts say that when partners try to shield each other from the pain and worry of breast cancer, often they grow further apart -- and don't even understand why.
"This is an area that most patients have the most difficulty with -- not only the patients, but their partners -- and it occurs mainly because they are not sharing with each other, so neither knows how the other is thinking or feeling," says Murillo.
When you don't know what your partner is thinking, he says, you often assume the worst -- that they don't care, or that they don't want you. And the natural reaction is to withdraw.
"But often the real issue is that he doesn't bring things up for fear he'll make her feel worse. And she's not bringing things up because she doesn't want him to worry. So the communication stops at a time when they both really need to share these feelings," says Murillo.
But it's not just the emotional communications that can go awry. Very often the separation starts in the bedroom as breast cancer affects a couple's intimate life.
"Women connect their breasts with their sexuality and their femininity in a way that is not typical of any other cancer," says Nelson. As a result, she says, any type of breast cancer treatment has the potential to impact intimacy.
Indeed, Puckett tells WebMD, it can often leave a woman feeling that her sex life will never be the same, that her partner will be turned off, or that she herself won't ever feel like making love again. This in turn causes her to pull away from her partner at a time when sharing a physical connection can be life-affirming.
To help solve -- or prevent -- any of these problems, experts say keep the lines of communication open and be as real as possible about what you are feeling in all areas of your life.
"Any catastrophic illness, but cancer especially, forces people to look at and deal with many things they didn't pay attention to before. So take advantage of that and view it as an opportunity to make your relationship stronger," says Puckett.
She also advises talking to your doctor about any intimate problems on your mind. "Women sometimes wait for their doctor to bring it up, but doctors often don't say anything until the woman brings it up. So many miss out on the wealth of helpful medical and lifestyle information that can help with some of these problems. So don't be embarrassed or ashamed to ask about it," says Puckett.
Breast Cancer: Getting The Support You Need
While sometimes a little creative communication will be all you and your partner need to get back on track, Puckett says this isn’t always the case. Sometimes, she says, a partner is simply emotionally unable to provide you with the support you need, and no amount of communication is going to change that.
But instead of being hurt and disappointed, experts say to accept those limitations and appreciate that person for what they can give you, and then allow others into your life to fill the gaps.
"You have to be open to people. You can't expect to get everything you need from one person, even a spouse," says Nelson.
But while knowing you need help is one thing, asking for it can be quite another. What can make it easier, says Nelson, is to recognize the opportunity as a gift you give to others.
"As hard as it is for you to face your cancer, it's also hard for the people who love and care about you -- and allowing them to help you helps them to cope. So in a way, accepting their help is a little gift you give to them," says Nelson.
At the same time, Puckett says that it's also important to be as specific as possible about what you need.
"Many times people want to help but just don't know what to do," says Puckett. By being as specific as possible, she says, you'll make it easier for friends and family to give you the support you really need. Take some time to make a list of things you know you’ll need help with while you’re going through treatments, so when friends or family offer, you’re ready. For example, if you know you’ll be fatigued and sick after a chemotherapy session, ask a friend to bring over dinner or even take your kids out for a bite to eat while you rest.
Finally, experts say, don't be disappointed if not everyone in your life steps up to help, even when you ask. It doesn't mean they don't care.
"Everyone reacts to, and copes with, crisis in a different way. And very often, you don't find who can't handle things until the crisis occurs," says Puckett.
If this is the case, don't despair. Experts say the key is to recognize the role each person can play in your life. And if you need more help, don't be afraid to turn to a professional or a support group for the rest.
Says Puckett, "From counselors and social workers at your treatment center, to online communities, to chat rooms, to local support groups, to various cancer organizations, don't overlook the incredible communities of people who will open their hearts -- if you let them."