The literature on the effect of cancer diagnosis and treatment on family members is sparse.74 Of studies in this area, most have focused on the impact of cancer soon after diagnosis, during recurrence, or at the terminal phase of the disease.75-77 One study shows that partners of men with prostate cancer, generally from small convenience samples, report more distress than their sick partners, but also believe that their partners are more distressed. The only reviewed study of long-term prostate cancer survivors found that couples' health-related QOL was associated with marital satisfaction.61 Distress was inversely related to levels of family support. The men's focus of concern, on their sexual functioning (i.e., impotence), was not shared to an equal degree by their non-sick partners.78,79 The most relevant study included in our review focusing on family survivorship included families from 1 to 5 years posttreatment,80 thus making specific statements about the long-term effects of cancer diagnosis and treatment on family members difficult. The study finds that economic resources, marital status, and retirement status for cancer survivors ages 50-70 were related to higher levels of QOL.80 Contrary to expectations, physical and somatic concerns were unrelated to overall QOL. Social support was positively related to overall QOL while fear of recurrence was negatively related to QOL. The family's meaning of the illness was also related to family QOL.
Few studies have focused on the brothers and sisters of survivors who, themselves, are at higher than average risk for cancer. Most of these studies have focused on siblings at genetic risk.81-83 Family history of breast or ovarian cancer has been identified as the strongest risk factor for breast cancer. Women who have a sister or other first-degree relative with breast cancer have a 2- to 10-fold increased risk of developing breast cancer themselves.84,85 And men with a family history of prostate cancer have a 2-fold increased risk. Depending on the age of the relative and whether it is a father or a brother, the risk can be much higher.
Over the past several years, our research team has been studying the long-term reactions of survivors' family members. We have conducted studies of both men and women who have a greater than average risk of breast or prostate cancer due to a family history of the disease and have explored both their psychological and behavioral reactions to their family history of cancer. In this section we present findings from two studies, one with sisters of breast cancer survivors; and the other with the brothers and sons of prostate cancer survivors.
In the first of these studies, we interviewed the sister's of women whose breast cancer was diagnosed before age 50.86 The breast cancer survivors are part of a cohort study discussed previously.32 Our focus on survivors' sisters rather than their daughters is due to the immediacy of the experience which we thought would make this group more vulnerable and also because the interview presents a teachable moment for an
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