For some, a cancer diagnosis can make an already good relationship even stronger as people pull together in support.
However, for just as many, the announcement of cancer, or living through treatment can challenge relationships and put intense pressure on families and friends.
Cancer can be as overwhelming for loved ones as it is for the patient and can sometimes change relationships in unexpected ways, including the effect it can have on marriages and intimate relationships.
Coping with diagnosis and treatment
At diagnosis stage of course there is sadness, anxiety, often anger and despair. It's common for roles, responsibilities and priorities which had been routine previously, to alter after diagnosis and continue to change throughout treatment and recovery as the body and mind adjusts to what it's going through.
I sometimes hear from patients who say that their partner has become 'an expert' in the area of cancer they have and that it is causing strain. But it is important to acknowledge that this is just the way that some partners or family members 'cope'. They want to take control of the situation as much as they can - that may be learning about it, or being rigorous about appointments or treatment - believing that they're taking some of the pressure away.
However, this can be overwhelming for the person living with cancer.
I always recommend that couples talk about what is helpful to them and what allows for a sense of independence for the patient. At Bupa we sometimes find that some patients try to 'spare' their partner details about their diagnosis or treatment, but it's important to understand that this too can lead to a sense of isolation on both sides. However, every couple is different and patients should decide what is right for them.
Day-to-day
There can be changes too when it comes to the usual day-to-day. People who say they always vacuumed, or hung out the washing may now feel too fatigued to do that. At first they may be grateful that their partner or children volunteer to help, but sometimes that can turn to frustration or guilt as they may feel like a burden. I always suggest that patients talk openly about the limitations they may have (feeling tired after vacuuming one room for example, or taking out the bins) and openly discuss ideas about how to split household responsibilities - this can help to make both sides feel more comfortable and useful.
Intimacy can be affected
I really would say that intimacy can be one of the biggest challenges for patients when it comes to living with and beyond cancer. Often there is a reticence to discuss it openly as it may not be something you want to admit to. Such a private matter can bring embarrassment and frustration, but if possible it is important to retain levels of intimacy.
We regularly hear from patients whose appearance may have changed as a result of their cancer treatment. This could be the loss of breasts from breast cancer, hair loss from chemotherapy, or the need to wear a colostomy bag, all of which can understandably make people self-conscious and reluctant to be intimate with their loved one. Some changes are temporary - your hair may grow back - while others are not.
My advice is to talk through the issue and your concerns with your partner - acknowledge how you are feeling and understand that there are many others who are feeling the same. You may well find that these things can be worked through together or that both partners are equally nervous about having an intimate relationship once again.
Self-esteem
Many people I hear from get their self-esteem from feeling attractive, and as a consequence, from being intimate with their partner. When this area of your relationship breaks down, or the physical part of the relationship ceases to exist, how they feel about themselves is impacted. It can become a vicious cycle, but it is one which can be broken.
Saying it's good to talk may sound like a cliché, but it is true.
It takes a great deal of strength to communicate fears and concerns, but it is incredibly valuable. I do understand that it may not be something which can be said to each other at first, but there are other supportive ears.
Generally, I would advise those living with or beyond cancer to be as open and honest with those around them, as this usually helps to soothe others (and make them know where they stand) as well as help them to feel at ease and involved. However, every couple is different and this has to be the decision of the person living with cancer - only they know what is best for them and how they wish to deal with it.
What I would say though is - maintaining a relationship is a two-way thing, whether illness forms part of the relationship or not. Patients tend to have healthier, happier relationships when they communicate well with those around them. Don't let cancer get in the way of communication, and above all, be willing to share the load and let those around you who want to help, do so.