title: Double-Edged Sword: Women with Breast Cancer Caring for a Spouse with Cancer.
abstract: Experiences in caregiving may affect further coping with illness. The aim of this study was to assess mortality risk among women diagnosed with breast cancer while caring for a male spouse who had been diagnosed with cancer before or at the time of their own diagnosis.
  
  
  
  We used a historical prospective study of a nationally representative cohort that was assessed by the Israeli Central Bureau of Statistics 1995 census and followed until 2011. The study population was divided into 2 × 2 groups (according to a positive/negative cancer history of the male spouse before the time of breast cancer diagnosis of the women X spouse alive/dead). The analyses were adjusted for age, ethnicity, breast cancer staging, and time of diagnosis.
  
  
  
  A total of 14,429 cases of breast cancer and 3,400 deaths were reported during the study period. Mortality was not mediated by the spouse's survival at the time of breast cancer diagnosis of the women. However, decreased risk of death was seen in women with a positive spouse history of cancer when the spouse was alive at the time of diagnosis in women who were diagnosed with breast cancer stages II and III (hazard ratio = 0.76, 95% CI: 0.59-0.98).
  
  
  
  Among a subset of women diagnosed with breast cancer, there is evidence of a significant protective association between a history of caregiving for cancer of a spouse who is alive at the time of self-diagnosis and subsequent survival. Our findings support hypotheses concerning a positive experience of caregiving and emphasize the need to define the patient and the caregiver as an integrative "unit of care."
authors.affiliation: 1 Sharett Oncology Institute, Hadassah University Hospital , Jerusalem, Israel .
authors.forename: Yakir
authors.initials: Y
authors.lastname: Rottenberg
authors.affiliation: 2 Assuta Medical Center, Oncology Institute , Tel-Aviv, Israel .
authors.forename: Lea
authors.initials: L
authors.lastname: Baider
authors.affiliation: 3 Geriatrics and Geriatric Rehabilitation Department, Hadassah University Hospital , Jerusalem, Israel .
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Jacobs
authors.affiliation: 1 Sharett Oncology Institute, Hadassah University Hospital , Jerusalem, Israel .
authors.forename: Tamar
authors.initials: T
authors.lastname: Peretz
authors.affiliation: 4 School of Behavioral Sciences, Tel-Aviv-Yaffo Academic College , Tel-Aviv, Israel .
authors.forename: Gil
authors.initials: G
authors.lastname: Goldzweig
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006801:Humans; D007557:Israel; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018454:Spouses; D013315:Stress, Psychological
keywords: breast health; cancer; epidemiology