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.
Ovarian cancer may not produce symptoms until the disease is more advanced. This may raise concerns or guilt in the woman, who wonders if her condition would be different had it been detected earlier. Sometimes there is the need for a
colostomy as part of the surgical treatment, and this represents a grief to the woman and her family. Some women may initially find it difficult to cope with the
stoma, but with time most people adjust.
If chemotherapy is required, this may be associated with
nausea and hair loss. Although hair loss is temporary, some women find that this is very distressing as it is a highly public reminder of the seriousness of her condition. Being tired following chemotherapy may pose a burden even with fairly minor domestic tasks, and often affects morale.
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.
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.
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.
Respect the woman's right to make her own choices, and allow her the chance
to talk about how she feels. Many women become frustrated when they express
concerns and their partner or other family members offer comments or
reassurance. Sometimes the woman just wants to "sound off" without
anyone offering an opinion. Asking her what she wants both from a practical
point of view, and in terms of emotional support is vital. Some women don't want
people around them to talk about the cancer, some do. Some want to be positive,
others want to be able to say they feel scared without being told to "put
on a brave face". You will only find out if you ask. Offering to attend
clinical appointments, helping her access information, and indicating your
ongoing commitment and support are important. Allowing the woman to talk about
concerns about attractiveness and sexuality is very helpful. Even if you don't
feel that the treatment makes a big difference to her appearance, it is
important for her to express how she feels about it. Telling her "it
doesn't bother me" may be an effort to reassure her, but some women feel
that such a comment trivialises their concerns.
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.
