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Psychiatric Aspects of Gynecologic Cancers
The various forms of cancer in this category mainly consist of: breast, ovarian, uterine and cervical forms.
There is some controversy about the effects that psychiatric/psychological factors play in the incidence and course of these and other cancers. Large epidemiological studies found that depression was associated with double the risk of death from cancer up to 17 years after diagnosis.
However, other prospective large cohort studies found no depressive symptom effects on cancer risk. In breast cancer as a protypical example, 50% of patients experienced severe degrees of anxiety, depression and other psychiatric symptoms/illnesses during the course of their illness.
Depression that can be reactionary, reduced biologically as a result of treatment, can affect the course of the disease, recurrence or mortality according to some but not all studies. Issues such as adequate pain relief, adherence to recommended treatments/interventions, reduced desire to preserve life and raging despair are all involved and observed in gyn and other cancer patients with comorbid psychiatric problems.
Studies have also shown that any given patient’s psychiatric/psychological response to a diagnosis and course of cancer is influenced by many factors. These may include: the specific aspects of the type and stage of cancer itself, an individual’s ability to manage the diagnosis and treatment of cancer – especially pain problems, prominent factors of medical, social and psychological stability, the type and effects of various treatment modalities and their complications, pre-existing traumatic experiences and coping styles/skills, personality strengths or limitations, general mental health, social support, age and stage of life, financial stability, meaning of their life, etc., cultural and religious beliefs .
Depression in gynecology and other cancers is associated with a higher incidence than in the general population compared to other serious medical illnesses. Cancer itself can cause many symptoms associated with depression – for example, fatigue, weight loss, poor appetite, low energy, sleep disturbance and other vegetative signs of depression. Consequently, there may be both an over- and under-diagnosis of depression as a result of overlapping symptoms.
The most serious psychiatric problem associated with gyn and other cancers is suicide. Passive suicidal thoughts are much more likely than active suicidal intent. However, there is still an increased risk of suicide, especially with advanced disease and poor prognosis, intense pain, delirium, substance abuse, selective loneliness, social isolation, helpless – hopeless feelings, depression and previous suicidality. This serious risk must be adequately investigated and professionally evaluated during the course of the illness.
Anxiety is a very common disorder associated with early diagnosis, treatment decisions, fears of recurrence or progression, post-traumatic stress reactions and specific pre-existing syndromes that may affect treatments – ie, phobias (to needles, chemo, radiation and claustrophobic to spaces such as MRIs).
Psychosis and delirium are also possible co-morbidities or pre-existing problems may be exacerbated.
In conclusion, gynecological cancers present with a variety of physical and psychological symptoms in the different stages of the disease, that is to say, initial diagnosis, treatment, survival or recurrence. Multiple stressors of surgical menopause, various drugs (chemotherapy, steroids, marcotic analgesics, etc.), pain and radiation potentials are some of the most physically demanding aspects. All this can also lead to worse psychiatric sequelae.
Screening for psychological distress may be useful in identifying women who would benefit from psychiatric or psychological care. They should be referred to a mental health professional with knowledge and experience of psycho-oncology. If possible, psychiatric treatment should be where they receive their oncology services.
Pain, other physical discomfort, bad mood or anxiety symptoms should be treated pharmacologically. One on one and group therapies with support are helpful. Survivors experience chronic fear of recurrence, sexual dysfunction and identity disruption. Patients may also despair about their future. All of these are best treated with individual psychiatric care with an experienced psychiatrist in oncological needs.
Ask the doctor…
Q. What can really happen?
IN. The course of treatment for breast cancer can be physically and mentally very demanding. Major mood disorders can interfere with self-care, cause illness and even lead to suicide. Treatment (s) are available, but must be with experienced mental health professionals with oncology experience. Medication is often helpful and should be prescribed by a well-trained psychiatrist also with oncology experience. It is strongly recommended that the patient and or family specifically ask and request that someone with that type of experience only be used for treatment.
Outcomes for gynecological cancers are much improved when psychiatric problems are addressed at the same time.
Q. Who is most at risk for problems?
IN. Those with prior psychiatric problems – particularly those with mood disorders and anxiety disorders are vulnerable to recurrences or significant exacerbations due to the development of gynecological cancer. Treatment sooner rather than later can help improve these co-morbid burdens.
No woman should have to fight these devastating diseases alone. Sinful care is available.
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