Cancer's Impact on Relationships

Meet Dr. Helen Coons- Our December Expert

Dr. Helen Coons is the President and Clinical Director of Women's Mental Health Associates, Philadelphia. She is a Clinical Psychologist who specializes in women's health and mental health. Dr. Coons is a Clinical Associate Professor of Psychiatry, Drexel University College of Medicine, and is Adjunct Faculty, Department of Psychiatry, Pennsylvania Hospital, University of Pennsylvania Health System. She received her Ph.D. in Clinical Psychology from Temple University after interning in Medical Psychology at the Duke University Medical Center. Dr. Coons' private practice specializes in improving the well-being of women facing the diagnosis and treatment of breast, gynecological, colon and other cancer diagnoses. She works with women and couples of all ages before, during and after cancer treatment(s); women with early and advanced cancer; women who are at "high risk" for cancer as well as individuals who are caring for ill family members with cancer. Dr. Coons presented at the 2002 Institute of Medicine meeting on Psychosocial Service Needs Among Women with Breast Cancer, and was the keynote speaker for the 2006 Living Beyond Breast Cancer Annual Conference for Young Women with Breast Cancer. She received the 2001 American Psychological Association Committee on Women in Psychology Emerging Leader Award, and the 2005 American Psychological Foundation Timothy B. Jeffrey Memorial Award for Outstanding Contributions to Clinical Health Psychology.

Question Five:

Should one disclose that they're a cancer patient to someone they've been dating for only 3 months? When is the best time to break the news? Thank you

Dr. Coons:

The answer to this challenging situation depends on both where you are in treatment and the relationship. If you are still undergoing chemotherapy, it may be hard not to say something to the person that you are dating. On the other hand, if you are finished chemotherapy and radiation, and actively dating, you may want to disclose your cancer history only if you are at a point where you feel the relationship is getting more serious. As the relationship grows emotionally, physically and sexually, you may find that you want to share what you have been through. Rarely is it necessary to share such personal information on a first date when you may not be interested in seeing each other again anyway. It is also important to remember that plenty of men have health concerns as well, and that other health issues (e.g., STD's and HIV/AIDS for example) need to be discussed before intimate sexual contact.

Question Four:

I was diagnosed with Stage 3 breast cancer in April 2003. I often worry about whether my cancer will recur. Should I share my persistent concerns about my cancer recurring with my family and friends?

Dr. Coons:

Fears of recurrence are understandable and common among women who have undergone treatment for breast cancer, and it is important not to be alone with your anxiety. Family and friends likely see you live your life at home and work, and may not realize that you carry the fear – whether all the time or at particular times such as when you have follow-up physician visits; a mammogram, MRI or bone scan; or experience new symptoms or pain. It is important for you to share your fears so that you have support and understanding from those who care about you the most. Also, consider telling family and friends when you are going for follow-up exams and tests and ask someone to join you. A support group may also be helpful so that you are able to talk with other women with breast cancer about how they cope with their fears of recurrence.

Question Three:

Sometimes I envy the seeming good health that my friends take for granted. What can I do to deal with these feelings when I'm with them?

Dr. Coons:

It can be difficult to be around friends who have never faced a health threat or are upset over symptoms which seem quite minor compared to the diagnosis of cancer and the wide range of surgery, chemotherapy and radiation related side effects. Sometimes it helps to remember that friends have not gone through what you have so their reference point is different. Others also tend to forget quickly what you have gone through. It is also fine to comment about your experience if you need to so that friends can support you in your efforts to enhance your health and well-being during and after cancer treatment.

Question Two:

It's been very difficult for my fiancé and I to become sexually intimate again since I had my mastectomy over 6 months ago. My fiancé is afraid to touch me and doesn't look at me with desire anymore. Furthermore,I don't know if I'll ever feel sexy again after having my body altered in such a drastic manner. How can I bring "sexy back?"

Dr. Coons:

Changes in sexual satisfaction are very common among women who have undergone treatment for breast cancer in general and especially among women who have gone in to menopause as a result of chemotherapy. You have both been through a great deal and may need to have some difficult conversations about your and his fears. Sometimes those conversations are especially difficult around the time of diagnosis and during active treatment. The best place to start is by talking with your fiancé about his feelings and your concerns. Start out slowly if you have not been intimate during treatment. For example,some couples find it helpful to give each other massages,take a shower together,dance together, and try passionate kissing. Your fiancé may need to know that he will not hurt you if he touches your breasts. You may also want to work on your own body image and take steps to (re)connect to your own sexuality – even if different than before your cancer surgery. Some couples also find it very helpful to talk with a therapist trained in psychosocial oncology and sexual issues if they continue to remain distant after treatment. Your oncologist may be able to refer you to an expert in your area.

Question One:

How common is it for friends to desert you during treatment? Should you let these people back in your life when they have let you down when you needed them?

Dr. Coons:

While most friends are very supportive during treatment, some individuals really can drop out of site when you really need them, and you may not ever know why. Some friends simply do not know what to say or do to support you, and for whatever reason, do not ask you directly how they can help. For others, cancer may bring up their own sadness, feelings of loss or anxiety. Others are just very self-focused and do not think to ask or call. If you really care about the friend, you may want to tell them that you miss them and try to talk about what is going on that they have been so distant.

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