The daily impact of pain from metastatic breast cancer on spousal relationships: A dyadic electronic diary study

Women with metastatic breast cancer (MBC) experience high levels of emotional distress and pain. Although individuals often rely on their intimate partners to provide physical and emotional support when they are in pain, the daily impact of pain on the spousal relationship in the context of advanced cancer is unclear. To understand how relationships are affected by pain, 57 MBC patients and their partners completed electronic diary assessments 6 times a day for 14 days. Patients and partners rated the patient's pain, their own mood (circumplex adjectives), the provision/receipt of social support, and the degree to which cancer interfered with their relationship. Multilevel mediation models with the couple as the unit of analysis were estimated. Partners and patients reported greater relationship interference when patients experienced more pain and less aroused (i.e., more tired, less peppy, less active) mood. Greater tired mood during the day accounted for 17% and 82% of the association between patients' morning pain and their evening ratings of emotional and physical support from their partners, respectively. Partners did not directly respond to patients' pain by providing emotional or physical support; however, they were more likely to provide support when patients experienced more tired and less active mood as a consequence of their pain. Results suggest that one way that pain may wear on couples' relationships is through its adverse effects on patients' daily mood. They also suggest that partners may base their provision of support on their perception of the adverse effects of pain on patients' aroused mood.