A diagnosis of cancer is trying for any marriage

Cancer can be very tough on a marriage -- just ask Sandro Segalini, 64, of Falmouth.

His first wife died of breast cancer 14 years ago. His second wife, Marcia Woltjer, 59, left him earlier this year, three years after her own diagnosis with breast cancer.

Segalini, a retired businessman, had been totally willing to take control of things and help Woltjer the way he had helped his first wife -- to be, as he put it, ''chief cook, bottle washer, bandage changer, and jester."

But Woltjer, a registered nurse who has since moved to Michigan, wanted someone who didn't feel he had to be in charge all the time.

Obviously, when cancer strikes, there's no easy role in any marriage, whether you're the patient or the spouse. What makes some marriages fall apart under the strain of cancer and others get stronger? That's a tough one, but researchers are finding some clues.

When it's the man who has the cancer, the sheer fact of having a partner -- regardless of the quality of the relationship -- is linked to better survival and quality of life, according to a recent study of men with prostate cancer, by Dr. Mark Litwin, a professor of urology and public health at the Jonsson Cancer Center at UCLA.

But when it's the woman who has cancer -- and that's the scenario most frequently studied -- the quality of the relationship may matter more, perhaps because of the challenges to traditional gender and care-taking roles, said Laurel Northouse , a professor of nursing at the University of Michigan School of Nursing.

What many women -- both with and without cancer -- want, Northouse said, is not so much for the husband to be in charge, but for him to understand her feelings and to talk about his own.

For many couples, this means that when the wife gets cancer, both partners have to adapt, said Northouse. Men may have to listen, and express, feelings more, and women may have to turn to friends and supporters when the husband is maxed out on listening.

Researchers who studied 73 Israeli couples in which the wife had breast cancer found that if husbands were emotionally or behaviorally disengaged or unable to express their feelings in a constructive way, the wives were more distressed.

Other studies published in the 1990s also show that venting feelings in an uncontrolled way does not help, nor does criticizing each other's emotional styles or withdrawing emotionally. Empathizing with each other's feelings does help.

It's also important, when the woman is the patient, for men to give up the desire to ''fix" things, said Marc Silver, an editor at US News & World Report and author of the 2004 book ''Breast Cancer Husband," which he described as a ''guide for clueless guys."

''Every guy I interviewed said he had an urge to 'fix it,' " said Silver, whose wife had breast cancer. Guys have ''an inability to sit there with things not fixed. They want to get in there and make it better. But what guys really need to do is shut up and listen."

Marc Heyison, founder of a Maryland-based group called Men Against Breast Cancer, which has a $1.1 million grant from the federal Centers of Disease Control and Prevention to help African-American, Latino, and Native American men support their wives with breast cancer, put it even more bluntly: ''Be honest, men. You have to give up the remote control."

Giving up control can be hard, especially when there's disagreement about treatment. Silver recalled one wife with breast cancer who wanted holistic treatment. Her husband was appalled. But instead of taking charge, he just gently asked if there was any evidence for the holistic methods. Together they found a mainstream oncologist who was open to complementary medicine and addressed both of their concerns.

Yielding control is also hard when the couple visits the doctor. ''Some guys want to take over and run the doctor's office like a meeting at work," said Silver. Don't. You can help your wife remember her questions and even ask a few yourself, but ''she's the boss. It's her body and her disease."

Sometimes, marriage counseling can help with communication, though it's not clear whether this translates into a medical benefit.

Karen Kayser, a professor of social work at the Boston College Graduate School of Social Work, has studied couples in which the wife had breast cancer. She compared those who were randomly assigned to get couples counseling and those who weren't. The results were mixed: Counseling helped partners communicate better, but overall quality of life was no different in the two groups. Counseling did appear to be more helpful for couples in the early stages of marriage.

A number of other small studies have shown that couples counseling can reduce emotional distress for both patients and partners, but, again, how much this translates into overall satisfaction with life is unclear.

There is one other thing that can help many couples and that is the fact, as Northouse of Michigan put it, that ''cancer makes people grow up.

''A lot of people are pretty materialistic, they're trying to achieve, achieve, achieve. You get evened out when cancer comes along. It's letting some of that go. I actually think cancer brings maturity to people."

And that maturity can be the best thing that ever happens to a marriage.

Judy Foreman is a freelance columnist who can be reached at foreman@globe.com.