Men are from Mars, women are from Venus . . . women are better communicators . . . men compartmentalize their lives. During stressful times, women want to talk about it; men would rather not.
These statements are stereotypes or are they common knowledge? Could these descriptions of gender-specific communication styles help explain how men and women cope with a cancer diagnosis? Many who interact with cancer patients believe they do.
"Sharing feelings is a very feminine perspective," said Matthew Loscalzo, director of patient and family services and co-director of the Center for Cancer Pain Research at the Johns Hopkins Oncology Center, Baltimore.
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Gender-related ways of coping, Loscalzo said, have "profound differences, with important implications in how you engage women and men in the disease process."
Because most social work professionals are women, said Loscalzo, it is often easy for them to find ways to communicate with women who have cancer, but "they get frustrated when they try that same [communication style] with men. With men you have to identify a problem and see it as external to the person, and you have to come up with a plan of action."
"The Same Tape"
Loscalzo doesn't see the differences as cultural. "If it was just cultural, it would be different in different countries," he said. "I've seen cancer patients in China, the United States, Saudi Arabia, South America . . . and wherever I go, it's like somebody playing the same tape just the languages are different."
Women generally cope better than men, he said, both as cancer patients and as caregivers. However, women also tend to have social support networks that men don't have.
"If you ask a man, Who is your best friend?' it's going to be his wife. If you ask a woman, it's much less likely to be her husband," he said. "Most men report that they do not have another man to talk to about emotional issues."
Jimmie Holland, M.D., chair of the department of psychology and behavioral sciences at the Memorial Sloan-Kettering Cancer Center in New York, agreed.
"Women tend to have a lot of friends and resources men tend to have very few people on whom they might call," she said. But men's unwillingness to express what is troubling them does not mean that they don't need support.
"If you said that everyone in a support group must be having trouble well, that's women," Holland said. "Men are unwilling to enter a support group. By nature they are more apt to keep things to themselves. The idea of sharing with other people is not a part of their way of coping."
Different Flavor
"Support" groups for men do exist, but have a different flavor than female-centered groups. Research has found that men and women in Internet-based, "virtual" support groups have different priorities and concerns.
Paula Klemm, D.N.Sc., an associate professor at the University of Delaware, and colleagues looked at three different Internet support groups: a prostate cancer group of 117 men, a breast cancer group of 126 women, and a group of 92 patients of both genders with any type of cancer.
"In the mixed group, both men and women were more likely to give and seek information, but when they were separate, there were distinct differences between the two," Klemm said. "[In the gender-specific groups,] most comments from women were about what they were going through. Men asked about the disease, asked about chemotherapy, or told other men about it."
Other research has also found that men are more likely to use support groups as an educational outlet, while women tend to share personal experiences and encourage other women.
How men and women deal with a cancer diagnosis may also affect how active they are in seeking treatment. Jeff Sloan, Ph.D., senior associate consultant at the Mayo Cancer Center, Rochester, Minn., and colleagues developed a tool to examine the role that cancer patients wanted to play in the decision-making process. In a 1992 study of Canadian cancer patients, the group found that women with breast cancer were the most assertive, while men with prostate cancer were the least assertive.
"Prostate cancer, especially in 1992, had not had anywhere near as much attention [as breast cancer]," Sloan said, "nor do men generally discuss such issues quite as readily." Also, he said, at puberty, women begin speaking with health care providers about issues related to the reproductive system, and thus may be more comfortable when a problem arises.
Long-term studies of the psychological effects of cancer on both genders are few, but Holland and colleagues have looked at coping in survivors of Hodgkin's disease. Seven years after diagnosis, "the men were more depressed," she said, "but these were the men with more physical problems, those less likely to work and those with lower income."
Holland believes that gender-based "stereotypes" of coping with the psychological stresses of cancer are lessening, but that the profession must deal with the "double stigma" of having cancer and having a psychological or psychiatric problem.
Too Busy
Also, she said, "A lot of doctors are so busy they don't have time to ask the right questions, and people often will not mention they're having anxiety or feeling depressed. A good third of the patients in waiting rooms are stressed enough to need help, but less than 10% of them actually will get it."
Psychological aspects of dealing with cancer have focused mainly on newly diagnosed breast cancer cases, Loscalzo said, while "most people who get cancer are over 65 and are men . . . really, we know almost nothing about how men and women cope. I think we really only know about the first 30 days [after diagnosis], and that's mostly crisis intervention rather than psychological adjustment."
As for the future, Loscalzo said, "The whole psychosocial area is virtually ignored. People have avoided this area; I think it's left over from views of mental health. We need to understand how women and men integrate stress and cope with it, and then we need to learn how they interact and how we can help them to do so more effectively."
Research in this area may also be hampered by inadequacies in getting at patients' true feelings, which may not fit into prescribed categories on a questionnaire.
"There are different responses and mechanisms of coping," said Suzanne L. Dibble, D.N.Sc., a researcher at the Institute for Health and Aging at the University of California, San Francisco. "The problem is that we continue to use instruments that have been established in only one gender."
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"I question whether we can use the same instrument in both sexes depression means different things to men than it does to women," she said. "As long as we use the same instruments that measure depression, for example, maybe women always look worse, but maybe [women are] just responding differently to the questions."
Dibble and others published a study last year that found gender differences in the concept of cancer-related quality of life. In women, psychosocial well being and physical competence were considered most important for good quality of life, while men indicated that vitality and personal resources were most important.
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