Tubal Cancer - Psychology

Contents

What are the issues for Gynaecological Cancer patients?

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.

How Can Psychology/Psychiatry Help Patients?

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. 

What Are The Psychological Issues For Carers And Families? 

Many of the issues are similar to those for the women themselves. There may be concerns about the woman's health and the fear that she could die. Families often find it hard to talk about issues such as this, and often avoid any emotionally laden subject. It is very difficult to stand by and see someone about whom you care undergo treatment for cancer, especially when you feel helpless. There is good evidence that many family members are severely [stressed] and [anxious], or clinically [depressed], although few seek professional help. Many feel that they have to be strong to help the woman cope with treatment, and that to ask for help for themselves would be a sign of weakness. Partners are often afraid of losing emotional control, and feel particularly helpless if the woman is upset, so urge her to "think positive". This is not always helpful for the woman - in general it is better to share thoughts and feelings even if they are painful. The need for appropriate information is significant for families, and affects how they cope. As for the woman herself, the coping and relationships within the family before the diagnosis of cancer will influence adjustment during treatment.

How can Psychology and Psychiatry Help Carers and Families?

The techniques are broadly as described for woman themselves. One of the common perceptions of family members (and women themselves) is that they can "get back to normal" after the treatment, so they devote time and energy into trying to cope as before. Giving information about the common patterns of responses, and helping family members to consider that things will be different is vital. Facing the enormity of what has happened allows family members and carers to adjust - things are not necessarily worse than before, but they are different. Sometimes families say that the experience of cancer has brought them closer together and allowed them to value the things that really matter.

In cases where there have been problems in the relationships it is often useful to have some counselling sessions with the couple, or the whole family. During such sessions, there is an opportunity to explore concerns, to receive information about common concerns of families in which a member has cancer, and to discuss needs and expectations. Improving the openness of communication often means that family members feel less tense, and the chance to share even the sad feelings results in greater closeness.

Cancer of the Fallopian Tube for Professionals

The key issues for women and their families are grief and loss, the impact on body image and sexuality, and the fear and lack of control implicit in the diagnosis of any serious illness. Cancer continues to carry serious connotations within the community and the fear that the woman could die from her disease may be very pressing for some families. Concerns about body image relate not just to the anatomical changes consequent upon treatment, but to the sense that the body has been fundamentally changed, and confidence and self-esteem are often markedly affected.

Surgery 

Infertility and Menopause 

The impact of surgery varies, but the imposition of infertility is important for younger women and those who have not yet had children or completed their family. Induction of menopause may also be a source of grief especially to the younger woman who feels that she is made old before her time. The loss of the uterus may be a key concern for some women even if post-menopausal, as for some women it is seen as a vital part of femininity.

Colostomy 

The need for a stoma carries significant psychological morbidity. However there is evidence that preparation for a stoma pre-operatively improves adjustment. Access to information and emotional support improves adjustment.

Radiotherapy 

Radiotherapy is often associated with significant changes in the vaginal mucosa, and the capacity for lubrication with sexual arousal may be reduced. This has clear implications for sexual functioning. Provision of information about the specific techniques which may improve vaginal elasticity and reduce the risk of stenosis is important. 

Many women faced with a recent diagnosis of cancer feel that sexual concerns are a longer-term issue which is less pressing than the immediate treatment, and are reluctant to consider how they will feel in the future. Some women feel embarrassed about the use of dilators or lubricants. For these reasons, it is important that the woman's partner is involved in discussions where possible, that the information is repeated and the woman's understanding is checked, and that written information is provided to aid recall.

Chemotherapy 

Consideration of the need for chemotherapy may be stressful. Some women have unrealistic concerns about how they would tolerate chemotherapy, or have heard of someone who experienced major complications. The decision to undertake a treatment which potentially involves adverse physical effects when one currently feels physically very well, and for an uncertain guarantee is complex. Hair loss from chemotherapy is medically minor but may be intensely distressing to the woman. In addition, the tiredness associated with chemotherapy may persist for some time, and may have a major impact on the woman's emotional adjustment. 

Informing the woman, and encouraging her to have realistic expectations of coping, including accepting practical assistance if necessary, may be helpful.

Depression and Anxiety 

A significant number of women who have been treated for gynaecological cancer suffer depression and anxiety for which effective treatments are available. Those most at risk are those who are young, who have major family responsibilities (young children), are on their own, have a past history of mental illness such as depression, or who are facing social adversity such as unemployment or financial hardship. Women who have experienced loss or emotional trauma may be at increased risk. Advanced disease stage, functional disability and the presence of pain, and complications of treatment (such as lymphoedema) increase the risk of depression. 

A common mis-perception is that depression is a normal response to serious illness, and that nothing can be done to help. In fact, if depressed mood is sustained, there is impaired capacity for pleasure, and there is disturbance of sleep, appetite or energy, a diagnosis of depression should be considered. Emergence of suicidal ideation or lack of hope for the future mandates psychological review, these symptoms are nearly always associated with a depressive illness. A combination of pharmacological treatments and supportive psychotherapy form the basis of treatment, and most women respond well to this combination. 

There are particular emotional needs arising for those women who have advanced disease, including family concerns. Referral for emotional support will often be helpful.

There is evidence that provision of appropriate information, good communication skills, adequate preparation for surgical and other treatments, as well as the provision of emotional support by the treatment team may reduce the emotional morbidity for women and their families.

Jane Turner
MB,BS; F.R.A.N.Z.C.P.
Senior Lecturer, Department of Psychiatry, University of Queensland

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