title: Sexual problems, communication patterns, and depressive symptoms in couples coping with metastatic breast cancer.
abstract: BACKGROUND
  The treatment of breast cancer tends to result in physical side effects (e.g., vaginal dryness, stomatitis, and atrophy) that can cause sexual problems. Although studies of early-stage breast cancer have demonstrated that sexual problems are associated with increased depressive symptoms for both patients and their partners, comparatively little is known about these associations in metastatic breast cancer (MBC) and how patients and partners cope together with sexual problems. We examined the links between sexual problems, depressive symptoms, and two types of spousal communication patterns (mutual constructive and demand-withdraw) in 191 couples in which the patient was initiating treatment for MBC.
  
  
  METHODS
  Patients and partners separately completed paper-and-pencil surveys.
  
  
  RESULTS
  Multilevel models indicated that high levels of sexual problems were significantly associated with more depressive symptoms only for patients who reported low levels of mutual constructive communication (p < 0.01) and high levels of demand-withdraw communication (p < 0.0001). In contrast, for partners, greater sexual problems were associated with more depressive symptoms regardless of the communication pattern reported. These associations remained significant when we controlled for patients' reports of average pain and functional and physical well-being and couples' dyadic adjustment.
  
  
  CONCLUSIONS
  Sexual problems were associated with depressive symptoms for both MBC patients and their partners. The way in which patients and partners talk with one another about cancer-related problems seems to influence this association for patients. MBC patients may benefit from programs that teach couples how to minimize demand-withdraw communication and instead openly and constructively discuss sexual issues and concerns.
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1439, USA. kmilbury@mdanderson.org
authors.forename: Kathrin
authors.initials: K
authors.lastname: Milbury
authors.forename: Hoda
authors.initials: H
authors.lastname: Badr
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications / Q000523:psychology*; D003142:Communication; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008875:Middle Aged; D055361:Multilevel Analysis; D011788:Quality of Life; D012725:Sexual Behavior / Q000523:psychology*; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000523:psychology; D020018:Sexual Dysfunctions, Psychological / Q000209:etiology / Q000523:psychology; D012747:Sexual Partners; D012944:Social Support; D012959:Socioeconomic Factors; D018454:Spouses / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult