Helping Women and Their Families Cope
With the Impact of Gynecologic Cancer
Deitra Lowdermilk, RNC, PhD, FAAN,
Barbara B. Germino, RN, PhD, FAAN
=The impact of gynecologic cancer on the
woman and her family depends on psychosocial fac-
tors and cancer-specific factors. Family assessments
determine how the family is adapting to the woman’s
illness. Nursing interventions that families say are
helpful include providing physical care, providing in-
formation, and giving support. Strategies used by
families to cope with the stress and emotional strain
of caregiving include taking time for themselves,
maintaining a sense of humor, and focusing on the
present. /OGNN, 29, 653-660; 2000.
Keywords: Caregiver-Coping strategies-
Family assessment-Gynecologic cancer
Accepted: February 2000
The estimate of the number of women who
will receive a diagnosis of cancer in 2000 in the
United States is 600,400 (American Cancer Soci-
ety [ACS], 2000). Carcinoma of the uterine corpus
(endometrial cancer) and ovarian cancer are the
fourth and fifth most common sites of cancer in
American women (ACS). The news about repro-
ductive cancer trends in this country is mixed. The
incidence of invasive cervical cancer has decreased
70% during the last 30 years, whereas preinvasive
cancers are increasing. Improved screening tech-
niques and earlier detection have made the differ-
ence. However, endometrial carcinoma has de-
creased only very slightly since 1975, and its
incidence remains consistently around 20 per
100,000 women. Ovarian cancer rates have
changed little since 1973, and it kills more women
each year in this country than all other gyneco-
logic cancers combined (ACS, 2000).
November/Decernber 2000
There are ethnic differences and familial ten-
dencies for some gynecologic cancers. In the
United States, both the incidence and mortality as-
sociated with cancer are highest among African-
American women for most gynecologic cancers,
particularly cervical cancer. Caucasian women
have a higher incidence of endometrial and ovar-
ian cancers. Women who have had breast cancer
or have a family history of ovarian cancer are at
increased risk for ovarian cancer; a family history
of breast or ovarian cancer increases the risk for
endometrial cancer (ACS, 2000).
It is important to note these differences are
not fully understood. Some studies indicate ethnic
differences are really socioeconomic ones-poor
people have higher overall cancer rates. It has
been suggested that access to care is limited for the
poor and that they have disease diagnosed at a
later stage and may have fewer treatment options
if they are uninsured or underinsured. Transporta-
tion to care may be an issue, as may safety of the
environment. There also are cultural beliefs that
may influence health-seeking behavior. Fatalism
about cancer may be an issue for some older
African-American women, whereas some Latino
women may not get needed cancer screening be-
cause they do not seek care when they feel well
(Lannin et al., 1998; Mishel, Germino, & Braden,
1999).
For years, women with gynecologic cancer
and their families have dealt with the experiences
of their illness and treatments on their own be-
tween any necessary hospitalizations and outpa-
tient visits for diagnosis, treatments, and follow-
up monitoring. More recently, these women and
JOGNN 653
their families face even more of a challenge because
health care systems in which cancer is diagnosed and
treated have responded to a national mandate for cost
containment by limiting hospital admissions, shortening
hospital stays, and discharging people with cancer ear-
lier than ever before. Women who have been hospital-
ized for surgery or other treatment of their gynecologic
cancer or for complications will be discharged so
quickly they still require a great deal of direct and indi-
rect care, including teaching, support of various kinds,
monitoring, and help managing the sequelae and side ef-
fects of treatment and symptoms of their cancer. Man-
aged care has profoundly affected cancer care. Home
care agencies and other community agencies have not
been able to keep pace with the demands imposed by
changes in the health care system, so families continue
to carry the largest part of the burden of care for
women with gynecologic cancer. In the United States,
family members provide as much as 80% of home care
for patients with cancer. The spouse usually gives care
to the middle-aged woman. Although spouses are caring
for some older women as they age, many are widowed,
and their adult children, siblings, other family members
and friends may be involved in the care.
H o m e care agencies and other
community agencies have not been able to
keep pace with the demands imposed by
changes in the health care system, so families
continue to carry the largest part of the burden
of care for women with gynecologic cancer.
A Framework for Examining the Impact of
Cancer on Women and Their Families
The impact of gynecologic cancer on families is
shaped by a number of factors, including the specific
type of cancer and the implications of the diagnosis for
the woman and her family; the meaning of the cancer ex-
perience to them; the social impact of physical changes;
the timing of the cancer in the woman’s and the family’s
lives; and the costs of the cancer to her family.
Impact of Diagnosis
There is limited nursing research on the impact of a
diagnosis of gynecologic cancer on women and their fam-
ilies. The impact of the illness can be extremely stressful.
Women often play a central role in the day-to-day man-
654 JOGNN
agement of family life, the nurturing of children, and the
care of extended family members. When a woman learns
she has gynecologic cancer, her ability to perform these
important roles can be limited, resulting in a negative im-
pact for the whole family system (Yates, 1999). However,
depending on the type of cancer, its stage, and the initial
treatment, many women can perform their usual family
roles within 6 months of diagnosis.
Several studies have identified situations that
evoke stress for family members who may be caregivers.
Many of the situations listed are most acute after the
first hospitalization and particularly after surgery
(Allen, Goldscheider, & Ciambrone, 1999; Northouse,
1995; Steele & Fitch, 1996a, 199613; Yates, 1999):
the need to be available 24 hours a day, 7 days a
week;
the fear of leaving the woman alone at home;
disruption of household routines and changing
plans at the last minute;
balancing work outside the home with care;
maintaining or returning to the usual work pattern;
strained relationships with other family members,
especially if they are not caregivers, and resent-
ment that this has happened;
having to manage the woman’s physical care and
treatment, including lack of knowledge in man-
agement of her physical symptoms or lack of con-
fidence that they have done the care correctly
(such as changing dressings);
having to provide emotional support to the
woman (one of the most difficult tasks identified
is lack of knowledge about psychologic needs);
the lack of time to develop or maintain supportive
social relationships for themselves and the feeling
of isolation; and
concerns about their own health and how they are
going to manage all of the demands on them.
Shifting roles from the ill woman to the well part-
ner or other family member can be overwhelming. The
mental health of the family caregiver can be affected.
Anger and depression have been reported in husbands as
stress of the caregiver’s role increases, particularly when
the role involves helping the woman with her activities of
daily living (Allen et al., 1999). The impact of a mother’s
cancer on children may vary, depending on the age and
developmental stage of the child. For example, young
children may be concerned about the family’s safety and
the ability of their family to stay together. Older school-
aged children may be worried about the added chores
they have to assume and the disruptions caused by the ill-
ness. Adolescents may want to be supportive and help
Volume 29, Number 6
care for the woman, or they may not want to be involved
at all and resent having to help. Older adolescent daugh-
ters may be concerned about heredity and whether or not
this could happen to them. Children of all ages may have
adjustment problems (Gates & Lackey, 1998). Concerns
about roles and relationship issues are common for adult
children whose parents are dealing with cancer (Germino
& Funk, 1993).
Improvements in diagnostic techniques and treat-
ments for gynecologic cancers have resulted in in-
creased survival rates. As more women survive the
acute phases of gynecologic cancer, they are faced with
sometimes devastating chronic problems, such as
changes in body image and function (Zacharias, Gilg,
& Foxall, 1994). Women who have recurrence or nu-
merous symptoms related to cancer or the treatment re-
port significantly more problems in performing family
and domestic roles than do women with new diagnoses
(Northouse, 1995; Steele & Fitch, 1996a, 1996b; Steg-
inga & Dunn, 1997). Thus, as a woman’s disease pro-
gresses, she may be less capable of performing her roles
and will need a healthy partner (or other family mem-
ber) to assume additional family roles.
As a woman’s disease progresses, she may
be less capable of performing her roles and
will need a healthy partner (or other family
member) to assume additional family roles.
Women with gynecologic cancer have described a
number of specific psychosocial and physical difficul-
ties associated with diagnosis and treatment. They have
reported anxiety, depression, and fear of dying. They
have described physical side effects that have changed
their physical abilities and functioning and altered their
social relationships. Some of the physical side effects of
treatment include fatigue, pain, bladder dysfunction,
and vaginal stenosis.
Women voice fears and concerns about the spe-
cific treatments. For example, concerns about feminin-
ity and changes in sexual functioning have caused
women to experience a wide range of difficulties after
surgery, specifically hysterectomy, and after radiation
treatment (Wilmoth & Spinelli, 2000).
Social Impact
Gynecologic cancer may have a significant impact
on the social aspects of life for the woman and her fam-
ily. It may alter the nature of or isolate women from the
NovemberlDecember 2000
social relationships that provide them with the energy,
support, and encouragement that may be needed more
during their experiences with cancer than under everyday
circumstances. Social support is a key factor in psycho-
logical adjustment to cancer for clients (Dunkel-Schetter,
Feinstein, Taylor, & Falke, 1992), and it is logical to as-
sume that loss of or change in social relationships that are
important to the family may have negative consequences.
Often physical changes, particularly changes in
appearance and physical functioning, and fatigue may
have a social impact. The woman whose appearance
has, in her view, changed for the worse may not be will-
ing to go out to social occasions, to church, or to her
usual activities, and her family may curtail their activi-
ties both with her and as individuals. Fatigue may limit
the woman’s ability and willingness to see friends and
neighbors and demand the immediate family’s time and
energy, having social impact on all of them.
Finding Meaning in the Cancer Experience
The personal meaning of the cancer experience for
woman with cancer and her family is their perception of
the potential significance of the cancer for themselves
and for their plan of responding to it. Meaning may
change with time and may be negative or positive or
somewhere in between (Germino & O’Rourke, 1996).
The meaning of cancer to the family and to individual
members is an important factor in adjustment. For the
woman, the meaning she makes of her situation may
provide some indication of her ability to adjust to the
stresses with which she is living (Lewis, 1992; Lewis &
Hammond, 1992; Lewis, Hammond, & Woods, 1993).
The many changes imposed by gynecologic cancer must
somehow be integrated by the woman and her family
members, and this may involve major shifts in the way
they view their family, their life, their values and rela-
tionships, and how they address fears and concerns
(Germino, Fife, & Funk, 1995).
Women with gynecologic cancer and their families,
in the process of making some meaning out of potentially
frightening and difficult experiences, must sort through
the events and relate them to their past experiences with
illness and loss and their encounters with the health care
system. They also must deal with changes from the can-
cer and the fears and concerns generated. Finding some
understanding of the significance of the cancer for their
lives, thinking about the consequences of the cancer,
looking at their attitudes toward themselves and others
and toward life, learning to live with the cancer, and find-
ing sources of hope are issues involved in finding mean-
ing (O’Connor, Wicker, & Germino, 1990).
The importance of understanding this process and
of some ongoing assessment of where women and their
family members are in the process is related to their ad-
justment. When individuals and their families view their
JOGNN 655
illness experiences very negatively and see the future with
great anxiety and little hope, they may need some help in
reframing meaning to integrate the cancer experiences in
a way that allows them optimal quality of life. Family
members may have their own struggles and needs for as-
sistance in this process. In addition, if adjustment is to be
achieved by the family as a unit, some communication
about the struggle to find meaning is important for each
person in the family to respect and understand their dif-
ferences and support each other (Germino et al., 1995).
Timing
When the gynecologic cancer occurs is an impor-
tant factor to be considered. The stresses associated with
gynecologic cancer are added to and complicate the nor-
mal demands of family life; those demands vary with the
family life cycle. For example, when gynecologic cancer
occurs in a young woman, family members may be cop-
ing with starting careers, less-than-optimal finances, and
caring for young children. These demands are difficult
enough on a day-to-day basis, but when a woman in the
family has gynecologic cancer, the diagnosis superim-
poses added worries of a life-threatening illness, possibly
body-changing surgery, threats to sexuality and the sex-
ual relationship, and the side effects of treatment. Young,
newly married couples trying to create their own families
and separate from their families of origin may experience
conflicts if the cancer diagnosis pushes them back to inti-
macy with their parents and siblings, rather than with
each other (Rait & Lederberg, 1990).
Disruption appears to occur in families with all
ages of children, and at the time of diagnosis, there are
no reported differences by children’s age in the level of
disruption. However, by 6 months after diagnosis, fam-
ilies with older (adolescent) children report less role
strain and role conflict than do families with preschool
and school-aged children (Gates & Lackey, 1998). Role
and relationship concerns may be a major issue for
adult children when a mother has cancer (Germino &
Funk, 1993). For instance, adult children may have un-
resolved relationship issues with their parents. Taking
on the new role of support person to a mother with gy-
necologic cancer is a challenge to young adults. Balanc-
ing the demands of a mother’s illness with the pressures
of their own work and family lives exemplifies the im-
pact of cancer for middle-aged children, sometimes
known as “the sandwich generation” because they are
in the middle of two demanding situations.
During periods of life transitions such as child-
birth, career changes, and retirement, where demands
for adjustment are extraordinary, there can be a more
intense response to a gynecologic cancer diagnosis. In
today’s families, where traditional developmental
phases are no longer necessarily the norm, changes and
their resulting demands may occur at many different
656 JOGNN
times as people marry and have children later, divorce,
remarry, and reconstitute families containing children of
a broad range of ages. Family changes, losses, and tran-
sitions are ongoing. Some of these are normative; others
are highly disruptive and stressful. Family stress theory
suggests that an accumulation of stressors eventually
can affect even the most resilient of families and make
it difficult for them to continue to function effectively
(McCubbin, Sussman, & Patterson, 1983).
costs
Cancer’s economic impact on the family can be sub-
stantial, especially for families who are uninsured or un-
derinsured. But many families with seemingly adequate
insurance coverage may experience the cost of cancer
through gaps in coverage for medical expenses; loss of or
gaps in employment and accompanying earnings; addi-
tional out-of-pocket expenses, such as transportation,
overnight stays, and child care; and quality-of-life factors
(Berkman & Sampson, 1993; Given, Given, & Stommel,
1994). Unfortunately, there have been, until recently, few
studies that define costs beyond those associated with
medical expenses and loss of employment (Given et al.).
The costs of caring at home for a family member with
cancer have been described only recently. When family
labor is included in cost calculation, home care by family
members during a 3-month period was only slightly less
than the costs of nursing home care (Stommel, Given, &
Given, 1993). A number of factors influence the costs of
caring for a family member at home, including the extent
of impairment of the family member’s functioning espe-
cially in activities of daily living, family living arrange-
ments, and survival status (Given et al.). Quality-of-life
costs, including reduced work effort, decreased produc-
tivity in the home, loss of promotion opportunities at
work, and others, have not been well studied.
Management of Care
Assessment of Needs of Caregivers
In clinical practice settings, family-based assess-
ments are needed to determine how families are adapt-
ing to the woman’s illness. Identifying what families see
as their greatest need provides important information
for designing interventions that best use the family’s re-
sources and external resources. It also is important to
reassess needs at various intervals, especially during
transition times, such as after hospitalization, at the be-
ginning of a new treatment, at recurrence, and when
palliative or terminal care needs to be considered.
In acute care settings and in office or clinic settings,
nurses do not always have time to do a comprehensive
assessment during one encounter. A few directed ques-
tions can determine how the family is adjusting. Table 1
lists questions that can be asked to collect essential infor-
Volume 29, Number 6

Identifying what families see as their greatest
need provides important information for
designing interventions that best use the
family's resources and external resources.
mation for planning care. If a more in-depth assessment,
such as the one described in the following section, is
needed, the information can be gathered during several
encounters with the woman and her family.
A comprehensive family assessment begins with
history taking to determine family functioning. Family
member ages, geographic location, socioeconomic status,
ethnic background, roles, relationship to client, develop-
mental level, major stressors, alliances, and frictions arc
identified. Questions address the following areas.
Structure. What is the family composition-house-
hold members, divisioddistribution of household activ-
ities, members not living at home, young children in the
home, caregiver's role in family? This information can
be used to assist the family to redefine roles and redis-
tribute household tasks. These issues may be more com-
plex for nuclear families with no extended family living
close, lesbian couples, and single/divorced/widowed
women.
Pattern of authority. Who is the decision maker?
Identifying the persons of authority can facilitate care.
Level of Family Development. What is the
level-older adult, mid-adult, young adult? Young cou-
ples may be establishing a household and family. Un-
derstanding the developmental level of the family can
-
TABLE 1
Quick Family Assessmerit
Key starting questions
1. Who does this woman consider to be her family,
and are these the people most involved with her ill-
ness right now?
2. What is the most pressinglupsettingldistressing issue
for the family right now? Is it the same for all im-
mediate family members, or does it differ from per-
son to person? What are they doing right now to
deal with the issue? With their distress? Are their
strategies working?
3. Does this family have or know about the resources
it needs to deal with this issue and others? Do they
know how to access the resources, and are there
any barriers to doing this?
NovemberlDecember 2 000
facilitate identification of alternative acceptable goals
for their lives.
Values. How do cultural values relate to family
roles and function and the family's beliefs about health
promotion? What family activities are most important?
Optimal functioning of the woman can be promoted by
incorporating cultural and family values. For example,
if having dinner together is a priority, nursing interven-
tions can be directed at helping the woman and her fam-
ily meet that goal, perhaps by helping the woman use
assistive devices to get to the dinner table.
Behavior. Which family members work together?
Does the family do things together? Look for cohesive-
ness among family members.
Coping Ability. What does the family see as the
strengths of the family and its individual members?
What is the meaning of the cancer event to the family?
How vulnerable is the family to crisis? Can family mem-
bers modify their roles and change their personal ex-
pectations and goals. For example, a mother's cancer
may interfere with an adolescent daughter's autonomy
and peer relations, especially if she has to be a caregiver.
She may become resentful or unwilling. The nurse can
assist members to identify measures to change the expe-
rience and cope more effectively.
Health and Functional Status. What is the health
and functional status of the primary caregiver? He or
she needs to be in good health for 24-hour care. Is the
caregiver physically able to perform the necessary tasks
or procedures, such as lifting or moving the patient?
Stressors. Are there other stressors affecting the
family, such as illness or work issues of other family
members? Families experiencing a high number of other
stressors in their lives may be at higher risk for prob-
lems (Northouse, 1995).
Support Systems. Does the family have an outside
support system? Families may be reluctant to ask for
help or may not be aware of community resources. The
nurse can help the family identify and gather support
(such as from neighbors or church members) to prevent
or diminish caregiver fatigue.
Knowledge of Illness and Health Practices. What
does the family know about the cancer and its treat-
ment? The nurse may need to provide information
about increased risk for female family members and
what diagnostic tests are appropriate (e.g., genetic test-
ing for ovarian cancer). The nurse also may have to
teach caregivers the skills necessary for care, such as
wound care.
Nursing Interventions
Most of the research on the impact of cancer on the
family has been done with families of women with breast
cancer. Other major research has been focused on family
caregivers of patients with cancer at home, without indi-
JOG" 657
cating the type of cancer. The most common phases of
cancer studied are during the initial diagnosis and in the
terminal stages. Not much is known about the treatment,
post-treatment, and rehabilitation phases. Although find-
ings of these research studies may or may not be general-
izable to the gynecologic cancer population, current prac-
tice in gynecologic oncology nursing reflects
implementation of many of the following interventions
that have been found to be beneficial in relation to pro-
viding care, information, and support (Harrington,
Lackey, & Gates, 1996; Hull, 1992; Given & Given,
1996; Steginga & Dunn, 1997; Zacharias et al., 1994):
Care. Give excellent, knowledgeable, skilled, and
personalized care to the woman in a calm, unhurried
approach. It is especially important in home care that a
nurse competent in gynecologic cancer nursing should
be assigned to provide care.
Provide the woman with emergency care if
needed.
Be available 24 hours a day (e.g., 24-hour hot
line), 7 days a week to reduce anxiety about caregiving.
Allow the woman to be as independent in self-care
as possible.
Infomation. Teach family members how to keep
the woman comfortable (e.g., pain management, posi-
tioning). Repeating information as necessary and pro-
viding demonstrations and written information are use-
ful strategies in helping families recall information and
techniques.
Answer questions honestly and willingly; convey a
nonjudgmental attitude.
Teach not only what to do but also what to ex-
pect. For example, teach about the possible side effects
of chemotherapy and suggestions for dealing with them.
Fact sheets given to the family are useful reminders.
Table 2 displays the various phases of gynecologic can-
cer and general information needed by women and their
family caregivers in each phase. Families also can be di-
rected to formal caregiver cancer education programs
that offer topics such as symptom management, finding
community resources, and improving communication
skills (Robinson et al., 1998).

-
TABLE 2
Tinting of b t fovritntiort Needed by Womert with
Gyitecologic Caiicer and their Fantilies

Phase of illness Itttimnalion needed

Diagnostic phase Explanation of procedures to be done, including
preparation if needed
When to expect test results
What emotions can be expected while awaiting diagnosis
Discuss familial risks if appropriate and available testing
if recommended
Hospital phase Explanation of type of surgery planned
When to expect pathology report
Postoperative expectationsflimitations
Treatment phase Explanation of type and length of treatment planned (e.g.,
radiation, chemotherapy)
Potential side effects and how to minimize these effects
Effects on normal activities
Infomation on support groups
Adaptation phase Timing of follow-up tests and examinations if needed
Common concerns about follow-up
Availability of support groups
Recurrent phase Explanation of type of treatment planned
Potential effects
Common feelings regarding recurrence
Ways to keep up hopes
Support group availability
Community resources

658 JOGNN Volume 29, Number 6

 Support. Accept the family’s feelings and con-
cerns; respect different religious (spiritual) beliefs. Ac-
knowledge the caregivers’ efforts and contributions to
care at every contact.
Assist the family to problem solve on a daily basis,
such as using support systems and identifying commu-
nity resources. Table 3 lists information about some
support groups and community resources for women
with gynecologic cancer and their families. In addition,
nurses need to know their local resources and how to
refer women and families. It is useful to know how ac-
cessible these may be for the family, including distance
from home, eligibility, and cost.
Promote communication among the family mem-
bers. The nurse can talk with the woman and her fam-
ily separately and together to help them initiate dialogue
about their concerns. Setting up family conferences also
can help families deal with conflicts.
Use humor-laughing, joking, teasing-to help
recharge family members both physically and psycho-
logically.
Coping Strategies
Caring for the woman with gynecologic cancer
can cause the family to experience chronic stress and
emotional strain. Research on how families cope in
these situations is limited mainly to family caregivers of
patients with terminal cancer. Coping efforts of these
family caregivers have been reported as being directed
toward trying to change the environment, changing the
meaning attributed to a situation, and selecting what
merits attention (Steele & Fitch, 1996b). Family care-
givers of women with gynecologic cancer who use these
TABLE 3
-Resources
American Cancer Society: httpJlcancer.org or
1-800-ACS-2345
Local chapters for the support groups, I Can Cope,
and We Can Weekend
Gynecologic Cancer Foundation: httpd1www.wcn.org
or 1-800-444-4441
National Cancer Institute Cancer Information Service:
http:llwww.nci.nih.govor 1-800-4-CANCER
National Cervical Cancer Coalition:
http:llwww.nccc-online.orgor 1-800-685-5531
National Ovarian Cancer Coalition:
http:llwww.ovarian.org or 1-888-682-7426
Hospices: http:llwww.hospice.org
Local agencies: check newspapers and yellow pages of
telephone books
NovemberlDecember 2000
coping strategies may find the following suggestions
helpful.
Changing the Environment. Try to keep life as
normal as possible by taking time away from the house.
Caregivers should ask a friend, neighbor, or other vol-
unteer to stay with the woman and go to the health
club, a sports event, or a movie. Encourage visits from
friends and other family members if leaving the house is
not an option. Use distraction by doing something en-
joyable, such as working in the garden, listening to
music, watching a favorite television show, or working
a puzzle.
Changing the Meaning Attributed to a Situation.
Think positively. Maintain a sense of humor. Talk the
problem over with family and friends. Ask for help.
Talk the problem over with a professional person, such
as the health care provider or clergy.
Selecting What Needs Attention. Focus on the
present, not the potential future problems. Be active in
caregiving activities. Handle things one step at a time.
Evaluation of Care
Reports on the woman’s status from family care-
givers need to be given careful consideration. Nurses
can use this evaluative data to work with the woman
and family to identify alternative methods for meeting
goals or changing goals when needed.
Implications for Nursing Research
Nurses who work with patients with gynecologic
cancer need to use the research base that exists but also
need to seek research answers for clinical practice ques-
tions when a research base is not available. Based on the
review of the literature for the current article, both
qualitative and quantitative studies are needed on the
impact of specific gynecologic cancers; the impact of gy-
necologic cancer on women of different cultural and
ethnic groups; the impact of gynecologic cancer on les-
bian women; survivors of gynecologic cancer, especially
young women who may be faced with making decisions
about becoming pregnant and starting a family; and dif-
ferences in the needs of caregivers of women in different
phases of cancer and in different settings.
Conclusion
Nursing interventions for the family of the woman
with gynecologic cancer that are based on the needs
identified by the family can foster the family’s cohesion
and strengthen interaction, communication, coopera-
tion, and emotional involvement. Meeting the needs of
the woman and family caregivers may minimize stress.
The quality of life for the woman with cancer and her
family can be enhanced.
JOG” 659
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Deitra Leonard Lowdemilk is a Clinical Professor in the
School of Nursing at the University of North Carolina at
Chapel Hill.
Barbara B. Gennino is an Associate Professor in the School of
Nursing at the University of North Carolina at Chapel Hill.
Address for correspondence: Deitra Leonard Lowdermilk,
RNC, PhD, FAAN, School of Nursing, University of North
Carolina at Chapel Hill, CB 7460 Cam‘ngton Hall, Chapel
Hill, NC 27599.
Volume 29, Number 6