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Single with Cancer

Posted 1/30/2013

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  First, I apologize for the late-in-the-day entry. I spent most of the day crammed into seat 12C on a flight to Phoenix. I am here for a two day board meeting of the NAPBC (National Accreditation Program for Breast Centers); I represent AOSW (Association of Oncology Social Work) on this Board, and we meet several times a year. I was not too excited about the long trip for a couple of days, but now I am ashamed of my grumbling, because it is gorgeous here. After checking into the hotel, I went out for an hour's walk and admired the flowers and the mountains and the very clean cars (no snow or muck in this city!)

  This entry is stimulated by a very nice blog piece by Dr Lidia Schapira who works at MGH. She, without naming me, credits me in the first sentence with the observation that one can't make any assumptions about support based on marital status. Like everything else, you have to observe and to ask.

  Very quickly after coming to this work, I learned this reality. The presence of a husband in the home (and I am using "husband" in the generic sense and surely also mean to include wives and partners and long term companions) may well be a wonderful asset--or it may not. One problem can be that others assume that, since there is a spouse, the basic support and practical needs are covered. It can be very embarrassing to admit to your friends that your husband is unhelpful or absent or even abusive.

  Fortunately, I have think of only three or four situations over all the years where the husband was physically abusive. That is clearly a whole other situation that must be responded to carefully and quickly. Much more often, the husband is just nasty or drinks too much or gambles or is never home or is lazy and unreliable. I remember one woman whose husband was vegan and absolutely refused to cook her meals or even touch a dish that held any animal product (including eggs or honey). Generally, she managed the kitchen tasks, and they apparently had systems that worked for them, but, during chemo, she couldn't do it. And he flatly refused to do anything related to feeding her. It was very hard for her to tell her friends, but she did, and they created a terrific system of meal delivery in containers that he was willing to handle.

  Here is Dr Schapira's excellent essay:

Single, with Cancer

Lidia Schapira, MD, Oncology, Hematology/Oncology,

I learned some years ago from a wise oncology social worker and cancer survivor, that a person's marital status

is not a reliable indicator of social support. Marriage does not necessarily translate into having a supportive

spouse during cancer treatment. And being single does not mean one is alone in the world. As more adults in

the US choose to live alone, we'll need to learn more about how people create their personal network of

supportive relationships.

I've treated young adults who chose to preserve their independence and relied on friends for rides, help with

appointments, even food and support. Their identity revolved around relationships and career and would

have been threatened or severely interrupted by moving back to the parental home. Loving relatives knew how

to maitain a respectful distance. Some were forced to return home by finances: having lost the ability to work

and often with it their health insurance, they were unable to keep up with rent payments.

Some find community among fellow church goers who provide meals, support and comfort. And for many

older single patients who are used to organizing their lives without any outside interference, cancer may be

viewed as another problem to be solved. Experience and self-reliance has taught them to chart their course

through difficult situations and cancer is certainly among top contenders! Coping with the diagnosis takes an

emotional toll. Knowing how and where to ask for support can be challenging. Learning how to choose

wisely between various treatment options and then to commit and endure what is often many months of

physically uncomfortable treatments can be quite difficult.

As for those of us who get to watch as these social structures unfold, communities take shape and

relationships emerge during a crisis: let's remember what works well and share these notes with our patients.

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