When a mammogram revealed a lump in Christine Amatulli's breast, her husband Dominick said he couldn't even process it. Having already lost a sister to breast cancer, he had to mentally "go to another place" to cope.
"In order to be supportive, you have to man up," said Dominick, a 54-year-old from Merrick, NY. "If you're going to pieces all the time while she's in pieces, it's makes it harder."
But despite putting up a strong front, Dominick struggled to hold it together. Friends told him he looked terrible, and even Christine worried about how he would react to any more bad news.
There's no disputing breast cancer's immense psychological impact on newly-diagnosed patients. But the subtler and often prolonged collateral damage suffered by patients' partners is raising concern among cancer clinicians.
"It's not just the person sitting in the bed, or the person sitting getting chemo that's the patient. It's the entire family -- the husband included," said Amy Sales, a clinical social worker at the Johns Hopkins Kimmel Cancer Center in Baltimore, Md.
But like Dominick, men often feel compelled to put on a strong face and might not reach out readily for support.
"The stress that's placed upon a male and the inability to release that stress in healthy environments is creating more health concerns and issues for them in the long run," Sales said.
This is emphasized by the sobering results from a study of more than 20,000 men whose partners developed breast cancer, which suggest men whose partners die from breast cancer are up to four times more likely to suffer from mood disorders like depression and panic attacks than men in the general population. The study was published online in the journal Cancer.
Over the 13-year study period, 180 of the 20,538 men were hospitalized for affective disorders such as depression. That compared with 12,185 hospitalizations among the 1,142,000 men whose female partners did not develop breast cancer.
The risk of hospitalization for affective disorders increased by more than 50 percent among men whose female partners whose breast cancer relapsed.
The results are in line with other studies showing that chronic illness, particularly cancer, exacts a heavy toll on caregivers, as well as patients, Naoki Nakaya of the Danish Cancer Society, and colleagues reported. They suggest that screening partners for depressive symptoms might be important for preventing this "devastating consequence of cancer."
Although men are bound to feel sad and worried for their loved ones who have been diagnosed with a chronic illness, serious emotional disturbances, if unchecked, can make the battle against breast cancer harder on everyone.
"I'd be concerned if they weren't exhibiting some signs of stress and emotional issues. They're on the roller coaster of their lives with their wives as they're going though this unchartered journey," said Sales.
But sleep disturbances (oversleeping or not sleeping at all), lack of appetite and feelings of despair, helplessness and hopelessness are signs that men might be suffering from depression and should get medical attention, Sales said.
Holly Prigerson, Director of the Center for Psycho-oncology and Palliative Care Research at the Dana-Farber Cancer Institute in Boston, says men are different from women in their ability to cope with the emotional stress of caring for a partner with cancer.
"Men have a lot more difficulty negotiating being a caregiver than their wives do. If the shoe were on the other foot the wives would feel more able to be emotionally available," Prigerson said. "It's taking sex differences in expression of emotion to a different level."
Prigerson stressed that, despite the stereotypes that many of them harbor, men shouldn't view talking to a mental health professional as a sign of weakness.
"This is an exceptional situation that anyone would benefit from some form of help," she said.
Depression and anxiety can be successfully treated when identified, according to Dr. Tom Smith, an oncologist and palliative care expert at Virginia Commonwealth University in Richmond, VA. Therefore, doctors should always ask patients and caregivers whether they have feelings of depression.
But restoring hope and control are also key in helping caregivers cope with their partners' illness.
"The number one issue with patients and their loved ones from the moment they hear they're diagnosed is the immense loss of control that they're feeling," said Sales. "From that moment on the goal is finding hope and putting one foot in front of the other and giving back as much control as possible."
The way to gain control, Sales said, is to get information.
"I think that men as well as women should be active participants in the meetings with the doctors, ask as many questions as they feel necessary, and really feel like they have a handle on the information being provided to them," she said.