Psychiatry is an area of medical specialty which is concerned with an understanding of the emotional and social experiences which shape behaviour and coping, as well as the assessment and treatment of illnesses such as
depression and
anxiety. In settings such as medical or surgery units, a sub-specialty of psychiatry (known as consultation-liaison psychiatry) offers expertise in assisting patients adjusting to illness or disability, including emotional support for family members where necessary. Psychiatrists are medically qualified doctors, so are able to recognise the medical aspects of care which affect emotional responses.
Health care is becoming increasingly focused on the "whole person", rather than just particular aspects of disease or disability. There is growing evidence that emotional issues affect the ways in which people cope with serious illness, and also that there are effective ways to reduce distress, and improve coping. Consultation-liaison psychiatry offers expert advice about the ways in which the personal background of an individual person may influence their coping or behaviour, and practical ways all members of the treatment team may help the patient and her family. A key issue to which consultation-liaison psychiatry can contribute is in communication between health professionals and patients, as there is growing evidence about the best ways to give information to help patients make informed decisions, and to reduce distress when the news is difficult.
Depression is a common complication of any serious illness, and consultation-liaison psychiatry can offer treatments which are usually highly effective.
The diagnosis of cancer is often a devastating blow. The diagnosis may have been quite unexpected, and there is shock and disbelief, and apprehension about what this means. All women diagnosed with cancer do wonder, even if only briefly, if they might die.
Treatment for gynaecological cancer usually involves surgery and often chemotherapy and
radiotherapy. All of these treatments affect the woman emotionally as well as physically. Many women are very conscious that a very private part of their body is affected, and are concerned about their femininity and how this will affect their sex life. Having a
hysterectomy is a concern for many women even if they consider their family complete, as they see their
uterus as defining their status as a woman. Becoming
menopausal following treatment may be associated with
distress about aging, and concerns about sex drive.
Even following successful treatment, many women find that they remain somewhat anxious. They are concerned that the cancer could return, and their confidence has often been affected. It may take some time for the woman to feel that she is "on top of things" again. Some women may become
depressed following diagnosis and treatment for cancer. Women may be reluctant to seek help, feeling that being "down" is normal after such an experience. Women may also feel reluctant to concern their doctors about these feelings, as they feel that this is selfish or a sign of weakness. Increasingly we are seeing that treating the whole person is important and women should feel confident about expressing concerns about how they are coping emotionally.
Depending on the exact location of the cancer, a woman may need to have
part of her vagina
removed. This clearly may have a large impact on sexual adjustment. Many
women are unaware that the normal vagina expands during sexual arousal,
and that removal of a portion of the vagina may not make a large
difference to their ability to have sex. Many women have fears about being
able to have sex after treatment, but find this a difficult issue to
discuss with their treating team.
If the woman becomes depressed,
there are very effective treatments available. The usual treatment would
be supportive counselling. Sometimes medication is also required.
In general the techniques involve efforts to enhance the woman's sense of control over a stressful situation. Provision of information is crucial. Not only does this allow the woman to participate in making an informed decision about treatment, but also allows her to consider the issues which may arise for her family in the future. The woman may have false perceptions about her condition, and addressing these is important in improving her emotional adjustment. Providing an opportunity for the woman to express her emotional concerns, and offering ongoing support is usually helpful. A key aspect is acknowledging the grief and loss inherent in the diagnosis of cancer.
For some women, there is guilt about not having sought treatment earlier, and many women are very distressed and concerned about their family. Talking about these concerns, and exploring how realistic these ideas are, is generally helpful. Every woman is different, and it is vital that her unique strengths and concerns are treated with respect. In order to assist each woman it is usually necessary to build a picture of the type of person she is, including the experiences shaping her personality and view of the world. In addition, consideration of her social relationships and responsibilities provides an insight into the practical issues she is facing in addition to the cancer. It is vital to give the woman a sense of confidence that her concerns are understood, and to instil a sense of hope about her ability to cope.
All psychological treatments are aimed at the particular woman and her special concerns. Although there may be similarities in the emotional concerns for some women because of the type of cancer for which they have been treated, there are unique qualities of each woman which make it difficult to generalise. It is a case of this particular woman who has this cancer, rather than the particular cancer the woman has.
The following web site has useful information on the emotional aspects of gynaecological cancer::
http://oncolink.upenn.edu/
In addition, the Journal "Psycho-oncology" published by Wiley includes publications about the emotional aspects of many cancers.
The Queensland Cancer Fund (QCF) has information booklets about the various cancers.
They also have a publication titled "Understanding emotions" There are specific publications available from QCF written by Lesley Schover about the sexual aspects of cancer.
