The Heroes' Journey: A Young Couple's Experience with Choriocarcinoma

Introduction Shifts in self perception and social posturing begin the moment a cancer diagnosis is made (Lindholm, Rehnsfeld, Arman, & Hamrin, 2002). Much of the stress associated with the psychosocial and somatic challenges of a cancer diagnosis can either be alleviated or exacerbated by perceptions of spousal and familial understanding and support (Lewis & Deal, 1995). However, no amount of societal or familial support can compensate for lackluster support from a patient's significant other (Giese-Davis, Hemanson, Koopman, Weibel, & Spiegel, 2000; Walsh, Manuel, & Avis, 2005). In fact, couples who reported higher levels of marital satisfaction prior to a cancer diagnosis exhibited better adjustment post-diagnosis (Fang, Manne, & Pape, 2001). The mediating factor in terms of this adjustment seems to be the patient's ability to express their own fears and concerns pertaining to the disease and death (Lindholm et al., 2002). Manne, Ostroff, Sherman, Heyman, Ross, and Fox (2004b) noted that another component of adjustment is the ability for a patient to maintain some assemblance of normalcy in the face of such a life-changing event. If a partner exhibits mental distress in dealing with the diagnosis, a patient's ability to adjust in a beneficial way has been found to be hindered, as well (Sergin, Badger, Sieger, Paula, & Lopez, 2006). For example, in 2005, Walsh et al. found that 12% out of 117 participating couples separated after a breast cancer diagnosis. The patient had initiated the breakup in half of those separations. Patients who had initiated the dissolution felt that they were not receiving emotional support from their partner, and that the diagnosis had brought to light their partner's unsupportive nature. This study lends credence to the idea that perceived support is also a core component of a patient's adjustment to a cancer diagnosis. However, support received and given by couples may look different at points in time across the lifecycle (Lynch, 1998). The majority of researchers who have focused on cancer and married women employed samples whose collective age ranges were 29-80 years (M = 54.5; e.g., Fang et al., 2001; Giese-Davis et al., 2000; Kuijer, Buunk, Ybema, & Woods, 2002; Lindholm et al., 2002; Manne et al., 2004b; Manne Ostroff, Rini, Fox, Goldstein, & Grana, 2004b). Studies on young couples (one or both partners under age 35) are minimal. Issues for young couples often involve the relative newness and fragility of their relationship, presence of fewer resources and social supports, as well as, limited abilities of their young children to help aid in the ill parent's care (Fitch, Bunston, & Elliot, 1999; Helseth & Ulsaet, 2005). Connell, Patterson, and Newman (2006) and Guinee, Olsson, Moller, Hess, Taylor, Fahey, et al. (1994) found that the majority of couples under age 35 who are parenting young children still think about future pregnancies. While many of the concerns and issues across predominately female cancers (i.e., breast cancer) may parallel those faced by couples of any age; a greater look into young couples' experiences with gynecological cancers is a distinct and understudied area of research. Researchers have provided a general understanding of issues surrounding communication, marital satisfaction, reciprocal dyadic interactions, parenting, etc. (Giese-Davis et al., 2000; Helseth & Ulsaet, 2005; Kuijer et al., 2002; Manne et al., 2004a, 2004b; Swenson & Fuller, 1992); however, while quite expansive, their research still lacks in description both the depth and complexity of a couple's experience with cancers, gynecological cancers in particular. Existing research can be expanded on and enhanced by the utilization of qualitative research methodologies with attentiveness to detail and breadth of datum (Yin, 1989). The current study was designed to contribute to the knowledge base of how one type of gynecological and gestational cancer, choriocarcinoma, influences one couple's interactions, elucidating how both medical and mental health care providers can intervene to expand the unit of care from the patient to the couple dyad. …