Partners’ Perspectives on the Impact of Cancer on Romantic Relationships and Marriage in Adolescent and Young Adult Cancer Survivors

Abstract

Purpose:

This study aims to explore the impact of cancer on romantic relationships and marriage from the perspective of partners of adolescent and young adult (AYA) cancer survivors.

Methods:

Semistructured interviews were conducted with 10 partners, of any gender and cancer type, who entered into a relationship or decided to marry after the AYA’s cancer diagnosis.

Results:

Three key themes emerged regarding the impact of cancer on romantic relationships and marriage: no change or impact, positive impact, and anxiety. Negative impacts were rarely reported, although some participants suggested that, had the illness been more severe or active at the time they met, they might have hesitated to commit or marry. Positive impact included respect for cancer survivors and a sense of fulfillment from having overcome the disease together.

Conclusion:

Partners of AYAs generally accepted the disclosure of the survivor’s cancer history without distress and demonstrated supportive attitudes. There were few negative effects on relationships or marriage, and no differences in impact were found based on cancer type. Cultural differences were noted in attitudes toward having children, in contrast to findings from studies conducted in Western countries.

Introduction

The incidence of cancer diagnosed at a young age is rising.^1,2 Adolescent and young adult (AYA) cancer survivors must abruptly alter many aspects of their lives, including education, employment, marriage, and parenthood, while facing challenges unique to their age group.³ Compared with older cancer survivors, younger individuals experience increased anxiety—not only about the illness itself but also concerning their future, financial stability, and personal relationships.^3,4

Having a partner during and after cancer treatment offers numerous benefits for survivors in such a vulnerable state. For example, male cancer survivors with a partner report higher self-esteem, better mental health, and greater satisfaction with social support compared with those without a partner.⁵ In female survivors, a partner’s acceptance of their cancer experience and the resulting physical changes helps them to better cope with these changes and the uncertainties of the future.⁶

In contrast, cancer survivors without a partner face unique challenges. Research on AYA cancer survivors without a partner shows they often struggle with issues that emerged after their diagnosis, such as difficulty in disclosing their cancer history, fertility concerns, physical changes like scarring, and anxiety about rejection due to the stigma surrounding cancer.^7–11

A study of unmarried breast cancer survivors in Canada found that most partners accepted cancer without issue and were less concerned about scars than the survivors themselves.⁶ In contrast, research on childhood cancer survivors revealed that some partners reacted indifferently, avoided the topic, or changed the subject.¹² Survivors often feared discussing cancer would feel burdensome to their (potential) partners.

As discussed, most studies on romantic relationships after a cancer diagnosis focus on survivors’ perspectives, but some also examine their partners’ views. An Australian study found that male partners’ reactions to breast cancer diagnoses ranged from shock to acceptance, with many feeling that supporting their partners strengthened their bond.¹³ Similarly, a study in the United States found that men who became partners postdiagnosis of women with breast cancer responded positively, despite concerns about recurrence and fertility, valuing their connection, and admiring the survivors’ resilience. However, breast cancer impacted the couple’s physical intimacy and caused emotional stress.¹⁴

Romantic relationships and marriage involve close interpersonal bonds, making the partner’s perspective crucial. However, research on partners of cancer survivors is limited, especially for those who began a relationship or married after diagnosis. Most studies focus on male partners of breast cancer survivors, with little attention to other cancer types or non-Western contexts. Since cultural factors heavily influence relationships and marriage,¹⁵ it is important to explore these dynamics beyond Western countries. In collectivist cultures, such as many Asian societies, parental influence on mate selection is stronger than in Western individualistic cultures, where families play a lesser role in romantic relationships and marriage.^16,17 In the cancer context, these cultural norms can heighten survivors’ concerns. For instance, Korean childhood cancer survivors worry about rejection by a partner’s parents, as marriage is seen as a family issue in Korea.¹⁸ Similarly, a study on AYA cancer survivors in Japan¹¹ highlighted fears of rejection by a partner’s family and parenthood-related anxieties, such as fertility challenges affecting family lineage. These concerns reflect the enduring impact of traditional family expectations in East Asian societies.

Based on the above, this study aims to explore the impact of cancer on romantic relationships and marriage in Japan from the perspective of the partners of AYA cancer survivors, regardless of gender or cancer type.

Methods

Participants and procedures

We conducted semistructured interviews with the partners of AYA cancer survivors, diagnosed between the ages of 15 and 39 years, with no restrictions on cancer type. The selection criteria for partners included spouses, fiancés, or partners who entered the relationship or got married after the AYA survivor’s cancer diagnosis. This study was approved by the Research Ethics Committee of the Faculty of Human Sciences at the University of Tsukuba (Approval No. Tokyo 29-1). Participants were recruited using snowball sampling, facilitated by AYA cancer survivors connected through a cancer awareness organization and a cancer patient group. The first author explained the study’s purpose, procedures, and privacy protection measures to potential participants. After obtaining written consent, the first author, trained in qualitative research, conducted face-to-face interviews. The author had no prior acquaintance with any of the participants. As compensation, participants received $6.5 gift card.

The interview questions were based on a previous study on romantic relationships and marriage among AYA cancer survivors.¹¹ The questions used in the interviews are as follows: 1.

How did you feel and respond when your partner (the cancer survivor) told you about their cancer?

After hearing about your partner’s (the cancer survivor’s) cancer, did your feelings toward them or your relationship change?

What are your thoughts on having children? Do you have any concerns about starting a family, and would you consider adoption?

Have you sought advice from anyone regarding your partner’s (the cancer survivor’s) cancer and your romantic relationship or marriage? What kind of support or resources do you think would be helpful?

Data analysis

The interviews were recorded using a digital voice recorder. After transcribing all interviews verbatim, secondary materials were created, excluding any personally identifiable information. We then conducted an inductive thematic analysis¹⁹ to identify themes and categories. First, the first and second authors independently reviewed the secondary materials and extracted codes for each interview question. Relevant codes were grouped into categories, and categories with commonalities were combined into themes. Categories unrelated to others were treated as standalone themes. We then ensured that the data within each theme formed consistent patterns. Any disagreements between the authors were resolved through discussion until consensus was reached.

Saturation, at which no new information or themes emerge from the data, is a widely accepted benchmark for determining sample adequacy in qualitative research.²⁰ Consistent with this standard, we observed no new categories after interviewing 10 participants and concluded that theoretical saturation had been reached, leading us to cease further recruitment. Additionally, our study targeted a specific and hard to reach population—partners of cancer survivors who formed relationships or committed to marriage postdiagnosis. Similar qualitative studies investigating the experiences of these partners postdiagnosis have often employed small sample sizes.^13,14 Therefore, we determined that our sample size was adequate to capture the range of experiences and perspectives relevant to our study’s objectives.

Results

Participants

The characteristics of the participants are shown in Table 1. The group consisted of eight men and two women, with an average age of 39.1 years at the time of the interview. Eight participants were spouses of the AYA cancer survivors, while two were in romantic relationships. All participants were in heterosexual relationships. The interviews lasted an average of 55 minutes.

Table 1.

Participant Characteristics

Partner					AYA cancer survivor
ID	Sex	Age at interview	Relationship status at interview	How long with the AYA cancer survivor (years)	Sex	Age at diagnosis	Cancer type	Treatment status when met or decided to marry partner
01	Male	38	Married	4	Female	22	Acute myeloid leukemia	Completed
02	Male	34	Married	6	Female	23	Gastric cancer	Completed
03	Male	33	Married	6	Female	23	Acute lymphocytic leukemia	Completed
04	Male	39	Married	4	Female	33	Breast cancer	Under treatment
05	Male	30	Married	6	Female	27	Cervical cancer	Completed
06	Female	48	Married	23	Male	26	Testicular cancer	Under treatment
07	Female	48	Dating	5	Male	29	Gastric cancer	Completed
08	Male	36	Married	4	Female	32	Breast cancer	Completed
09	Male	56	Married	10	Female	25	Sarcoma	Completed
10	Male	29	Dating	3	Female	28	Gastric cancer	Under treatment

AYA, adolescent and young adult.

The themes, categories, and key statements of all sections of the results are presented in Table 2.

Table 2.

Themes, Categories, and Key Statements

Theme	Category		Key statements
1. Reactions upon hearing about cancer diagnosis
No distress (5)	• Had prior knowledge, no distress (2)		“I had already studied cancer and knew a fair bit about it, so I wasn’t like ‘oh wow’ or anything. It was more like, ‘she went through something tough, but I’m glad she’s healthy now.’” (Participant 02)
No distress (5)	• No prior knowledge, but no distress (3)		“Honestly, I hadn’t heard any personal stories or anything like that, so I didn’t really have a sense of how tough it must have been. It was more like, ‘oh, there are people who go through something like that,’ but I didn’t treat it as something special.” (Participant 02)
Things might have been different if the cancer had been more serious (4)			“I think if she had been undergoing treatment when we started dating, the situation would have been quite different. It’s not like I would have turned her down as a friend, but deciding whether to date her or not would probably have taken a bit more time.” (Participant 05)
Want to stay together (3)			“I decided the moment he was diagnosed with cancer that I would marry him.” (Participant 06)
Distress (1)			“When she was diagnosed with cancer, I wasn’t sure what to do. (...) I had seen my mother-in-law go through the same cancer, and the way she weakened was just unbelievable.” (Participant 04)
Acceptance of fertility issues (1)			“Sure, the thought of not having kids is a little sad—I can’t say it’s not at all—but I already know that we can enjoy life together just the two of us, so I thought, well, that’s fine too.” (Participant 01)
2. Impact of cancer on romantic relationship or marriage
No change or impact (6)	• No change or impact (4)		“Cancer has had no effect on my relationships or marriage.” (Participant 01)
No change or impact (6)	• Commonality of illness (2)		“At some point, everyone experiences something in their life. It just so happened that his was cancer, but that didn’t really affect relationships or marriage.” (Participant 08)
Positive impact(5)	• Awareness of the importance of time (1)		“Hearing her cancer history made me realize even more that I need to cherish each moment. It brought that awareness to me.” (Participant 08)
	• Respect for overcoming a serious illness (1)		“I haven’t experienced any serious illness myself, so the fact that she’s overcome all of that just makes me think, simply, ‘Wow, that’s amazing,’ or ‘I really respect her,’ and ‘She’s so strong.’” (Participant 08)
	• Consideration for partner’s health (1)		“I definitely paid close attention to the small details. She gets tired easily, so I was concerned about whether it would affect her work.” (Participant 01)
	• Positive impact on the partner themselves (2)		“The depression I had been dealing with for so long completely cleared up. I felt like I had been given a purpose, and all the indecision I had before disappeared. I thought, ‘I’m going to give everything I’ve got to help him get better.’” (Participant 06)
Anxiety (1)			“I do have this fear that she might not be around anymore. To put it bluntly, I think it’s a source of stress.” (Participant 10)
3. Thoughts on having children
3.1 Desire for children
Does not strongly desire children (3)	• Simply meeting the partner is enough (1)		“Her mother once said to me directly, ‘I’m sorry she can’t have children,’ so I told her, ‘No, I don’t care about that at all. Just meeting her is enough for me.’”(Participant 01)
	• Never really wanted children (1)		“To be honest, I’ve never really had a desire for children. I’m not great with kids... If she said she wanted one, of course I’d support her, but it’s not something I personally want.” (Participant 03)
	• Anxiety (1)		“I’m honestly scared of having kids. If something like a recurrence happened, I wonder if I’d be able to raise them on my own.” (Participant 04)
Desires children (3)	• Wants to show great-grandchild (1)		“I do want to have children. I’d like to show her grandparents their great-grandchild while they’re still alive.” (Participant 02)
Desires children (3)	• Trying/tried to conceive (2)		“We’re currently trying to conceive.” (Participant 08)
3.2 Adoption
Will not adopt (1)			“With adoption, since it’s not like I naturally have the child myself, the more I look into it, the more issues seem to come up, so right now I’m thinking it’s not for us. Honestly, I feel like adoption might be pretty tough... I’m worried about whether I could really love the child, and that’s my biggest concern.” (Participant 03)
Has not considered adoption (1)			“We haven’t really considered adoption yet at this point.” (Participant 01)
Adoption is an option (1)			“I’m open to adoption. I don’t think it has to be my biological child.” (Participant 05)
4. Support resources regarding romantic relationships or marriage with cancer survivors
4.1 Support received
Consultation about marriage (1)		“When I told my boss, who had been a great help to me, our mutual friends, and my parents, ‘I’m thinking of marrying him, even though his prognosis might not be good,’ not one of them said no.” (Participant 06)
Someone to talk to (1)		“My boss was involved in an NPO related to illness, so I thought I could talk to him about it. (...) After that, I also talked to my coworker. I was feeling pretty overwhelmed myself and wanted to talk to someone, so when I was alone with a colleague, I said I wanted to talk and shared what was going on.” (Participant 10)
4.2 Desired support
Illness explanation tools/pamphlets (1)		“If there were a well-organized resource that explained, ‘My illness comes with these risks, but as long as I get regular check-ups, it’ll be okay,’ along with other preventive measures, then an AYA survivor could explain their cancer to a partner openly, without having to hold back.” (Participant 01) “It would be nice if there were some kind of booklet or resource offering support on sexual matters, like how to be considerate in such situations.” (Participant 01)
Someone in the similar situation (1)		“If there were people in a similar situation, it would be easier to consult or talk with them. Partners or spouses of people with an illness might be in a relatively similar situation, so it could be easier to have those conversations.” (Participant 10)

The numbers in parentheses indicate the number of participants who made each statement.

Reactions upon hearing about cancer diagnosis

The most common reaction was “no distress,” with most partners accepting the cancer disclosure without surprise, regardless of prior knowledge of cancer. In contrast, a partner who had lost a close relative to cancer showed signs of distress.

The second most common reaction was, “things might have been different if the cancer had been more serious.” Some partners said they might have made different choices if the cancer had been advanced, though none rejected their partner based on the diagnosis.

One male participant, who said he might not have married his partner if her condition had been more serious, explained:

“If the cancer had spread, it’s not that I’d stop liking her, but marriage and a lifelong commitment might not have been in the picture. If she had only a few years left, I might have approached it differently—maybe just been a close confidant rather than getting married.” (Participant 02)

In contrast, some partners committed to the relationship by learning about the diagnosis. One man, whose partner disclosed her condition via a document on her computer, recalled:

“I confessed, like, ‘My feelings haven’t changed even after hearing about your cancer,’ and I felt relieved to realize that my feelings for her were still the same.” (Participant 10)

Impact of cancer on romantic relationship or marriage

The most frequent response was “no change or impact.” For most participants, cancer did not significantly disrupt or alter their romantic relationships or their decision to marry an AYA survivor. Some partners simply expressed that the diagnosis did not affect their connection, while others highlighted the “commonality of illness,” viewing cancer as one of many life challenges that can arise for anyone.

“It’s not just cancer—getting sick can happen to anyone, so I never felt anxious just because she had cancer.” (Participant 07)

In addition to seeing illness as a natural part of life, several partners conveyed a sense of gratitude for the experience, noting that their appreciation of time and admiration for the survivor’s resilience had deepened. They felt that witnessing their partner’s struggle and strength brought new perspective and, in some cases, positively shaped their relationship. One partner, whose partner’s cancer recurred after marriage, said:

“It was only 10 years from when we met until she passed away, but those years were intense and the brightest time of my life. It’s been a truly valuable experience.” (Participant 09)

“It was only 10 years from when we met until she passed away, but those years were intense and the brightest time of my life. It was truly a valuable experience.”

Conversely, only one participant voiced significant anxiety related to the possibility of losing his partner to cancer. This individual’s partner was actively undergoing treatment at the time of the interview, and his reflections underscored the stress and uncertainty that active illness can introduce to a relationship.

Thoughts on having children

Among the participants, three (two males and one female) expressed a desire for children. Though the male partners’ desire was mild, they suggested they hoped for children to continue the family or to please their families. One participant, whose partner was rendered infertile due to cancer treatments, reflected on familial expectations:

“I’m the eldest son, so of course I’ve thought about having kids (to carry on the family lineage).” (Participant 01)

Another shared,

“I’d like to show her grandparents their great-grandchild while they’re still alive.” (Participant 02)

These statements suggest that the male partners hoped to continue the family line or meet familial expectations, demonstrating a sense of duty and respect for family wishes rather than an intrinsic drive to parent.

In contrast, another male participant expressed deep reservations about having children, rooted in his fear of his partner’s cancer recurrence. This concern was unshared with his partner, as he wanted to avoid causing her distress:

“She wants kids, so I avoid mentioning anything about the possibility of death. I don’t want to tell her I’m thinking about the worst-case scenario (recurrence, death), and I just want her to hold onto hope.” (Participant 04)

When it came to alternative paths to parenthood, perspectives varied. One participant, who considered adoption when his partner’s infertility treatments was unsuccessful, was unsure if he could truly love an adopted child. Conversely, another participant expressed a more open attitude, simply saying: “I am open to adoption” (Participant 05).

Support resources regarding romantic relationships or marriage with cancer survivors

Few participants sought or used support. However, two participants, both committed to a seriously ill AYA cancer survivor, sought advice from others—one consulted coworkers and family about marriage, while the other confided in colleagues about emotional challenges of being in a relationship with a cancer survivor.

Few participants expressed a desire for support, but one highlighted the need for informational tools about cancer and sexuality. As the partner of a survivor unable to have children due to cancer treatment, he said:

“When thinking about kids, it’s tough to explain the situation to family. Even if a couple is fine without children, family involvement can complicate things. Pamphlets or smartphone apps about things like adoption and fertility issues resulting from cancer could help couples start conversations with their families about kids, adoption, and related topics.” (Participant 01)

Another participant, whose partner was still in treatment, mentioned wanting to connect with others in similar situations.

Discussion

In this study, we explored the impact of cancer on romantic relationships and marriage from the perspective of partners of AYA cancer survivors. This investigation focused on their reactions to the diagnosis, changes in their feelings or relationships, thoughts on having children, and the support they utilized or desired.

The partners of AYA cancer survivors generally accepted the cancer diagnosis without distress and were supportive, with few negative effects on their romantic relationships or marriages. There were no notable differences in the impact on relationships based on the type of cancer. Cultural differences, compared with previous studies in Western societies, were mainly observed in attitudes toward having children.

Reactions to cancer diagnosis

Most partners in this study accepted the AYA cancer diagnosis with minimal distress, showing understanding and support. Unlike previous studies^12,13 that observed indifferent reactions—such as partners avoiding questions or engaging less—none of the partners here exhibited such detachment. It is important to note that the previous studies were conducted from the perspective of cancer survivors, focusing on potential partners rather than those already in a committed relationship or marriage. In contrast, the present study directly explored the experiences of established partners, which may explain the absence of negative reactions. Some participants expressed that, had the survivor’s condition been more serious or if treatment were ongoing, they might have initially hesitated to pursue the relationship. However, this hesitation did not suggest they would have rejected their partner due to the cancer diagnosis. This finding highlights the nuanced responses partners may have, shaped by the current health status.

Impact of cancer on romantic relationship or marriage

The minimal negative impact of cancer in this study is likely because many partners met AYA survivors after treatment, meaning they did not share the illness experience. Additionally, choosing to pursue a relationship with a survivor led partners to view the cancer experience positively. As a result, negative effects were rare, and positive influences such as respect and admiration were observed, consistent with studies on breast cancer partners.¹⁴ Partners also viewed cancer as a common illness, echoing previous research on male partners of breast cancer survivors.¹³

In a study on romantic relationship or marriage among unmarried AYA cancer survivors,¹¹ many participants—both men and women—cited physical changes, such as hair loss or scarring, as affecting the formation of relationships. However, in this study, no partners mentioned physical changes impacting their relationship or marriage. This result is consistent with findings from male partners of breast cancer survivors, who similarly expressed no concern about physical changes.¹³

Thoughts on having children

The findings of this study reveal a spectrum of considerations around family planning among partners, shaped by personal, familial, and health-related factors. While some were motivated by family expectations, one participant struggled with apprehensions about the future, underscoring the layered and sensitive nature of discussions on parenthood in these relationships.

In a study on AYA cancer survivors,¹¹ many cited the inability to have children as affecting their relationships, expressing personal pain, and guilt toward partners and their families. However, partners in this study did not strongly desire children or feel guilt toward their families. Similarly, concerns about having children and passing on cancer, noted in a study of male partners of breast cancer survivors,¹⁴ were absent among partners in this study.

While none of the partners strongly desired children, some male participants expressed a desire to continue the family line or present a grandchild, reflecting Japanese cultural expectations. This aligns with Japanese AYA cancer survivors’ concerns about fertility and producing an heir,¹¹ rooted in a value system prioritizing family continuity. Such awareness of family lineage has not been observed in Western studies, highlighting the influence of East Asia’s sociocultural context.

Support resources for romantic relationships or marriage with cancer survivors

This study explored the specific support needed by partners of cancer survivors, addressing a gap in prior research that has typically overlooked the perspectives of partners. One partner suggested the development of tools for survivors to communicate their illness to partners in a clear and reassuring way, which could promote understanding and alleviate uncertainty. For example, one survivor in this study even prepared a document to disclose her condition to a potential partner, reflecting a need for structured approaches to share complex information.

As previous studies indicate, survivors often struggle with how and when to disclose their cancer history.^11,21 This challenge involves not only revealing their medical background but also sharing treatment details, current health status, potential fertility issues, and physical changes. While tools exist to facilitate communication between survivors and health care providers,²² few resources support explaining these sensitive topics to nonmedical individuals, including partners. Developing resources to help cancer survivors convey their situation in an accessible and straightforward way would provide essential support to both survivors and their partners.

Conclusion

While some partners mentioned possible hesitation due to the severity of cancer, most accepted the AYA survivor’s diagnosis with little to no negative impact on their relationship. Partners expressed admiration for the survivor and felt fulfilled by facing cancer together. No differences were noted based on cancer type, but cultural differences, especially in attitudes toward having children, were observed compared with Western studies.

Limitations and future research

This study has two main limitations. First, 8 of the 10 participants were males. Given that cancer incidence is higher among women than men in AYA populations,²³ it is more common for partners to be male. The underrepresentation of female partners may have limited the exploration of gender-specific nuances particularly in fertility and parenthood themes. While none of the participants expressed a strong desire for children, the inclusion of more female partners could introduce different perspectives, as women may have a stronger intrinsic desire for parenthood, independent of external expectations. Female partners might emphasize the emotional aspects of parenting or have unique concerns about fertility preservation. Future studies with a more balanced gender representation would provide a deeper understanding of these dynamics in the context of AYA cancer survivorship.

Second, many participants met the survivors after treatment. Since the experiences of post-treatment partners may differ from those who shared the treatment period with the survivor, future research should focus on including partners present during that phase.

Despite these limitations, this study extends previous research on the impact of cancer on romantic relationships and marriage from the perspectives of partners, which has mostly focused on male partners of breast cancer survivors in Western contexts. By examining other cancer types and including female partners in Japan, it broadens our understanding of these dynamics. For AYA cancer survivors without a partner, insights into partners’ perspectives on relationships, marriage, and having children could help them navigate future relationships.

Footnotes

Acknowledgment

The authors extend their gratitude to all the AYA partners who generously shared their experiences for this study.

Authors’ Contributions

Y.K. and M.Y. developed the study concept and design. Y.K. carried out the material preparation, data collection, and analysis. Y.K. and M.Y. collaboratively reviewed the generated codes and themes. Y.K. drafted the initial article, with M.Y. providing overall supervision. All authors contributed to article revisions, reviewed, and approved the final version.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

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