The various forms of cancer in this category consist of: breast, ovarian, uterine and cervical forms principally.

There is some controversy regarding the effects that psychi­atric/psychological factors play in the incidence and course of these and other cancers. Large epidemiologic studies found that depression was associated with double the risk of death from cancer up to 17 years post diag­nosis. However, other prospec­tive large cohort studies found no depressive symptom effects on cancer risk. In breast cancer as a protypical example, 50% of the patients experienced serious degrees of anxiety, depression and other psychiatric symptoms/illnesses during the course of their illness. Depression which may be reactionary, biologically mitigated or the result of treat­ment, can affect the course of the illness, recurrence or mortality according to some but not all studies. Issues such as adequate pain relief, adherence of recom­mended treatments/interven­tions, diminished desire to sustain life and rageful despair have all been implicated and observed in gyn and other cancer patients with co-morbid psychiatric issues.

Studies have also shown that any given patients 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 individuals abil­ity to manage the diagnosis and treatment of cancer- especially pain issues, preeminent 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, overall mental health, social support, age and stage of life, stability financially, meaning of their lives, etc., cultural and religious beliefs.

Depression in gyn and other cancers is associated with a high­er incidence than in the general population compared to other serious medical illnesses. Cancer may itself cause many symptoms associated with depression- for instance fatigue, weight loss, poor appetite, low energy, sleep disturbance and other vegetative signs of depression. Hence, there may be both an over and under diagnosis of depression as a result of overlapping symptoms.

The most serious psychiatric issue associated with gyn and other cancers is suicide. Passive suicidal thoughts are much more likely than active suicidal intent. There is still however an increased risk of suicide espe­cially with advanced disease and poor prognosis, intense pain, delirium, substance abuse, selec­tive solitude, social isolation, helpless – hopeless feelings, depression and previous suicid­ality. This serious risk must be adequately screened and profes­sionally evaluated during the course of the disease.

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 effect treatments – i.e., phobias (to needles, chemo, radiation and claustrophobics to spaces like MRI’s).

Psychosis and delirium are also possible co morbidities or can be exacerbated pre-existing issues.

In conclusion, gyn cancers present with a range of physical and psychological symptoms throughout the various stages of the disease, i.e., initial diagnosis, treatment, survival or recurrence. Multiple stressors of surgical menopause, various medications (chemotherapies, steroids, mar­cotic analgesics, etc.), pain and radiation potentials are some of the most physically demanding aspects. These all may lead to more severe psychiatric sequelae as well.

Screening for psychological distress may be useful to help identify women who would benefit from psychiatric or psy­chological care. They should be referred to a mental health professional with psycho oncol­ogy knowledge and experience. When possible, psychiatric treatment should be where they receive their oncology services. Pain, other physical discomforts, severe mood or anxiety symp­toms should be treated phar­macologically. One to one and group therapies with support are helpful. Survivors experience chronic fear of recurrence, sexual dysfunction and identity disrup­tion. Patients may also become despairing about their future. All these are best treated with individual psychiatric care with an experienced psychiatrist in oncological needs.

Ask The Doctor…

Q. What can happen really?

A. The course of treatment for gyn cancer can be very demanding physically and mentally. Significant mood dis­orders can impede the care itself, cause illnesses to progress and even lead to suicide. Treatment(s) are available but should be with knowledgeable 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 inquire and request someone with that type of experience only be utilized for treatment.

The outcomes for gyn cancers is much improved when psychi­atric issues are addressed simul­taneously.

Q. Who’s at greatest risk for trouble?

A. Those with prior psychi­atric issues – in particular, those with mood disorders and anxiety disorders are vulnerable to recurrences or significant exacerbations due to the devel­opment of gyn cancer. Treatment sooner than later can help to ameliorate these co morbid bur­dens.

No woman should struggle against these devastating diseases alone. Meaningful care is avail­able.

About The Author:

Charles Meusburger, M.D.

Please feel free to call us at 609-484-0770 or come by if we can help you with any of life’s demands.

View all articles by Charles Meusburger, M.D.

Gynecologic