Functioning in daily living and psychological well-being of female cancer patients

Anxiety and depression in patients with advanced ovarian cancer: a prospective study

INTRODUCTION

Survival of ovarian cancer patients is still unsatisfactory despite the introduction of new diagnostic and therapeutic methods. Women with advanced ovarian cancer with long-term survival are at persistent risk of anxiety and reactive depression due to poor prognosis and risk of burdensome symptoms. The aim of the study was to assess changes in anxiety and depression during multimodality ovarian cancer treatment and to identify correlates of anxiety and depression.

METHOD

The study included 106 consecutive patients with advanced ovarian cancer. Mean age of the study group was 53.9 years (SD = 10.8, range: 23-79). The participants completed Hospital Anxiety and Depression Scale and State-Trait Anxiety Inventory four times: prior to and one week after surgery, and before the second and the fourth course of adjuvant chemotherapy. Multivariate analysis was performed to identify the independent determinants of distress at various stages of treatment.

RESULTS

The level of anxiety and the prevalence of pathological anxiety (74%) were the highest prior to surgery and gradually decreased thereafter. Irrespective of the treatment stage, the level of anxiety was higher than the corresponding level of depression. History of abortion, presence of intestinal stoma, poor general status, residual disease and time from the initial diagnosis were the main determinants of distress in ovarian cancer patients.

CONCLUSIONS

Significant changes in the level of anxiety and slight fluctuations in the depression level experienced during ovarian cancer treatment are mostly determined by clinical variables. Identification of individuals with psychological comorbidities is a vital component of patient-oriented multidisciplinary care.

Needs and priorities of women with endometrial and cervical cancer

INTRODUCTION

Rehabilitation after cancer is important, and efficient rehabilitation requires knowledge of patient's needs. This study aimed to identify short-term rehabilitation needs of women with endometrial and cervical cancer.

METHODS

Ninety-six women (82.6%) were included in an exploratory questionnaire study from Odense University Hospital from September 2011 to March 2012. Needs were assessed pre-treatment and 3 months later using the three-levels-of-needs questionnaire. Furthermore, 16 women participated in focus group interviews following the treatment. The interviews were audio-recorded, transcribed verbatim and analyzed thematically.

RESULTS

Forty-four of the included women were diagnosed with cervical cancer (median age 45 years). Of these, 22 had FIGO-stage 1 disease (50%) and 23 received radiation therapy (52.3%). The remaining 52 women (median age 66.5 years) were diagnosed with endometrial cancer. Of these, 38 had FIGO-stage 1 disease (73.1%) and 25 were treated with laparoscopic surgery (48.1%). Emotional functioning was significantly worse prior to treatment in both the cancers (p < 0.001 cervical and p = 0.002 endometrial) and worry constituted an unmet need in 70.7% of cervical and 34.7% of endometrial cancer patients. Both the patient groups experienced significant lymphedema post-treatment [endometrial cancer (p = 0.006) and cervical cancer (p = 0.002)]. Further, urological problems were more prevalent post-treatment in endometrial cancer patients (p = 0.018), while sexual problems were of specific concern for cervical cancer patients (p = 0.029). However, in both cancer groups, the mean problem intensity scores were comparable to normative data, suggesting that the majority of patients will not require extensive rehabilitation. Qualitative analysis indicated that treatment modality and marital status severely impacted on coping, suggesting that irradiated and single women are at higher risk of developing rehabilitation needs. Additionally, women younger than 55 years more often requested help dealing with sexual and psychological complications.

DISCUSSION

Women with endometrial and cervical cancer experience emotional problems prior to therapy and lymphedema, and urological and sexual problems following treatment. An awareness of these problems may facilitate early identification of women with unmet needs and enable individualized follow-up adjusted for such patient's needs. Interventions aimed at improving sexual and psychological functioning should be available.

Pelvic radiotherapy and sexual function in women

BACKGROUND

During the past decade there has been considerable progress in developing new radiation methods for cancer treatment. Pelvic radiotherapy constitutes the primary or (neo) adjuvant treatment of many pelvic cancers e.g., locally advanced cervical and rectal cancer. There is an increasing focus on late effects and an increasing awareness that patient reported outcomes (PROs) i.e., patient assessment of physical, social, psychological, and sexual functioning provides the most valid information on the effects of cancer treatment. Following cure of cancer allow survivors focus on quality of life (QOL) issues; sexual functioning has proved to be one of the most important aspects of concern in long-term survivors.

METHODS

An updated literature search in PubMed was performed on pelvic radiotherapy and female sexual functioning/dysfunction. Studies on gynaecological, urological and gastrointestinal cancers were included. The focus was on the period from 2010 to 2014, on studies using PROs, on potential randomized controlled trials (RCTs) where female sexual dysfunction (FSD) at least constituted a secondary outcome, and on studies reporting from modern radiotherapy modalities.

RESULTS

The literature search revealed a few RCTs with FSD evaluated as a PRO and being a secondary outcome measure in endometrial and in rectal cancer patients. Very limited information could be extracted regarding FSD in bladder, vulva, and anal cancer patients. The literature before and after 2010 confirms that pelvic radiotherapy, independent on modality, increases the risk significantly for FSD both compared to data from age-matched healthy control women and compared to data on patients treated by surgery only. There was only very limited data available on modern radiotherapy modalities. These are awaited during the next five years. Several newer studies confirm that health care professionals are still reluctant to discuss treatment induced sexual dysfunction with patients.

CONCLUSIONS

Pelvic radiotherapy has a persistent deteriorating effect on the vaginal mucosa impacting negatively on the sexual functioning in female cancer patients. Hopefully, modern radiotherapy modalities will cause less vaginal morbidity but results are awaited to confirm this assumption. Health care professionals are encouraged to address potential sexual dysfunction both before and after radiotherapy and to focus more on quality than on quantity.

Pilot study of radical hysterectomy versus radical trachelectomy on sexual distress

Radical trachelectomy, which leaves the uterus intact, has emerged as a desirable surgical option for eligible women with early-stage cervical cancer who wish to preserve fertility. The available data suggest excellent obstetrical outcomes with radical trachelectomy, and no differences in sexual responding between radical trachelectomy and radical hysterectomy. There is a need to examine the effect of radical hysterectomy on sexual distress given that it is distinct from sexual function. Participants were 34 women diagnosed with early-stage cervical cancer. The authors report 1-month postsurgery data for 29 women (radical hysterectomy group: n = 17, M age = 41.8 years; radical trachelectomy group: n = 12, M age = 31.8 years), and 6-month follow-up data on 26 women. Whereas both groups experienced an increase in sex-related distress immediately after surgery, distress continued to increase 6 months after surgery for the radical hysterectomy group but decreased in the radical trachelectomy group. There were no between-group differences in mood, anxiety, or general measures of health. The decrease in sex-related distress in the radical trachelectomy but not in the radical hysterectomy group suggests that the preservation of fertility may have attenuated sex-related distress. Care providers should counsel women exploring surgical options for cervical cancer about potential sex distress-related sequelae.

Ovarian cancer survivors' experiences of self-advocacy: a focus group study

PURPOSE/OBJECTIVES

To explore ovarian cancer survivors' experiences of self-advocacy in symptom management.

RESEARCH APPROACH

Descriptive, qualitative.

SETTING

A public café in an urban setting.

PARTICIPANTS

13 ovarian cancer survivors aged 26-69 years with a mean age of 51.31.

METHODOLOGIC APPROACH

Five focus groups were formed. Focus group discussions were audio recorded and transcribed verbatim. The content was analyzed using the constant comparison method with axial coding. In-depth interviews with 5 of the 13 participants occurred via telephone one to five months after each focus group meeting to clarify and expand on identified themes. Preliminary findings were shared with all participants for validation.

FINDINGS

Two major themes emerged from the data: (a) knowing who I am and keeping my psyche intact, and (b) knowing what I need and fighting for it. Exemplar quotations illustrate the diverse dimensions of self-advocacy. In addition, a working female-centric definition of self-advocacy was attained.

CONCLUSIONS

Women have varying experiences with cancer- and treatment-related symptoms, but share a common process for recognizing and meeting their needs. Self-advocacy was defined as a process of learning one's needs and priorities as a cancer survivor and negotiating with healthcare teams, social supports, and other survivors to meet these needs.

INTERPRETATION

This phenomenologic process identified key dimensions and a preliminary definition of self-advocacy that nurses can recognize and support when patients seek and receive care consistent with their own needs and preferences.

KNOWLEDGE TRANSLATION

Self-advocacy among female cancer survivors is a process of recognizing one's needs and priorities and fighting for them within their cancer care and life. Practitioners can support female cancer survivors through the process of self-advocacy by providing them with skills and resources in making informed choices for themselves.

Quality of life in cervical cancer patients treated with radiation therapy

AIMS AND OBJECTIVES

To evaluate the quality of life in hospitalised patients with cervical cancer treated by radiation therapy.

BACKGROUND

Aside from clinical variables, the quality of life should be considered in the planning and monitoring of the therapeutic process in patients with cancer. Although it is widely known that this parameter can have a considerable impact on the therapeutic outcome, it is not routinely screened in oncological patients.

DESIGN

Survey.

METHODS

The study was performed in six cancer centres in Poland between June 2004-December 2005, and included 205 women hospitalised for any stage of cervical cancer. The EORTC QLQ-C30 questionnaire (v.3) was used to evaluate the patients' quality of life. The survey was conducted three times: (1) stage 1 - before treatment, on admission, (2) stage 2 - after treatment, at discharge, and (3) stage 3 - five to six months after treatment.

RESULTS

Physical functioning was assessed the worst before the radiation treatment and increased gradually throughout further stages; all interstage differences proved to be significant. In contrast, emotional functioning was scored the highest before the initiation of the treatment and was the lowest at stage 2, a difference that proved to be significant. Role functioning was highest immediately after the treatment and the lowest prior to the treatment. Differences between stages proved to be significant. Financial problems increased their negative impact on the quality of patients' lives significantly throughout consecutive stages of this study. Age and cancer stage did not significantly influence the way participants perceived their global health, physical, cognitive, emotional and social functioning, nor their financial difficulties. Overall, the quality of life was evaluated as highest immediately after the end of radiotherapy.

CONCLUSION

Although this study revealed that patients with cervical cancer subjected to radiotherapy are satisfied with their global quality of life, attention should be paid to certain dimensions of the latter (i.e. emotional functioning and role functioning) during post-treatment period.

RELEVANCE TO CLINICAL PRACTICE

The ability to performing everyday activities independently is perceived as the most important during all stages of the cervical cancer treatment, and therefore, appropriate support in this matter is necessary on the part of the nursing personnel.

Assessment of quality of life for the patients with cervical cancer at different clinical stages

With improved overall survival of cervical cancer patients, the importance of the quality of life (QOL) is increasingly recognized. This study was conducted to compare the QOL of women with different stage cervical cancer before and after treatment to facilitate improved cervical cancer prevention and treatment. We used the generic Medical Outcomes Study Short Form-36 (MOS SF-36) to collect QOL information. Based on SF-36, we interviewed cervical cancer patients at West China Second Affiliated Hospital and Sichuan Cancer Hospital between May 2010 and January 2011. A total of 92 patients with precancerous lesions, 93 with early cancer, and 35 with advanced cancer responded to our survey. Average physical component summary (PCS) scores were significantly different between the three groups at every time point (P < 0.05). Average mental component summary (MCS) scores were significantly different between the three groups after treatment (P < 0.05). Average PCS and MCS scores increased gradually from the pretreatment to posttreatment period for patients with precancerous lesions. However, they reached the lowest at 1 month after treatment for patients with early and advanced cancers and rebounded between 1 and 6 months after treatment. Our results indicate that patients with precancerous lesions and early cervical cancer show better overall QOL than do those with advanced cervical cancer. Additionally, patients with early cancer recover more quickly than do those with advanced cancer in terms of both physical and mental functions. Thus, early detection and treatment initiatives may improve the QOL for patients with precancerous lesions and cervical cancer.

Improving care for women after gynecological cancer: the development of a sexuality clinic

The impact of a gynecological cancer diagnosis and the subsequent treatment on women is profound, both physically and psychologically, in particular with respect to sexual function and sexuality. We describe our experience creating a specialized clinic to address concerns about sexual health and rehabilitation. We used a case study approach to describe the clinic's inception and first 2 years of operation. Fifty-six survivors of gynecological cancer were seen at the clinic in the first 2 years. These patients had a significant symptom burden, many related to menopause, as well as those aftereffects of radiation therapy, chemotherapy, and surgical operation as well as psychological and emotional responses to cancer. The most common interventions were education and counseling. Patients reported high levels of satisfaction with their experience at the clinic. We hope our experience may be of assistance to others considering a similar endeavor.

Adverse outcomes after colposcopy

BACKGROUND

Colposcopy is an essential part of the National Health Service Cervical Screening Programme (NHSCSP). It is used for both diagnosis and treatment of pre-cancerous cells of the cervix. Despite colposcopy being a commonly performed and relatively invasive procedure, very little research has explored the potential long-term impacts of colposcopic examination upon patient quality of life.The aim of this study is to investigate and quantify any potential reduction in women's quality of life following a colposcopy procedure. More specifically, the degree of female sexual dysfunction and the excess risk of adverse events in those undergoing colposcopy will be explored. If such risks are identified, these can be communicated to women before undergoing colposcopy. It will also assist in identifying whether there are particular sub-groups at greater risk and if so, this may lead to a re-evaluation of current recommendations concerning colposcopically directed treatments.

METHODS/DESIGN

Cohort study using postal surveys to assess sexual function and quality of life in women who have attended for colposcopy (cases), compared with those who have not attended colposcopy (controls). The prevalence and excess risk of female sexual dysfunction will be determined. Logistic regression will identify the predictors of adverse outcomes.

DISCUSSION

There are more than 400,000 colposcopy appointments each year in England, of which 134,000 are new referrals. There is some evidence that there may be long-term implications for women treated under colposcopy with respect to adverse obstetric outcomes, persisting anxiety, increased rates of sexual dysfunction and reduced quality of life. Reliably establishing whether such adverse outcomes exist and the excess risk of adverse events will facilitate informed decision-making and patient choice.

A qualitative study examining psychosocial distress, coping, and social support across the stages and phases of epithelial ovarian cancer

Ovarian cancer patients experience high levels of anxiety and depression, yet there is little research regarding coping and support of this population. In this study we examined the experiences of women during diagnosis and treatment via 30 semistructured interviews. The interviews were analyzed qualitatively, and five main themes were evident: (1) extreme blunting; (2) having a "forgotten cancer"; (3) traumatic surprise of diagnosis; (4) highs and lows of health care; and (5) support gap experienced postdiagnosis. Currently, there is no readily accessible psychosocial/educational information source for these patients. It is likely that a telephone intervention would be the most effective solution.

"Does one size fit all?" moderators in psychosocial interventions for breast cancer patients: a meta-analysis

BACKGROUND

A variety of psychosocial interventions have been developed to promote better adjustment to breast cancer (BC) and their efficacy has been demonstrated repeatedly. However, the effect sizes (ES) vary considerably across studies.

PURPOSE

This article intends to shed light on potential moderators of intervention efficacy for BC patients, such as the intervention type (e.g., education, supportive), the composition of the sample (only BC patients or BC mixed with other cancer types), and the practitioner of the intervention (psychologist, nonpsychologist).

METHODS

Fifty-six randomized-controlled studies investigating the effectiveness of psychosocial interventions with adult BC patients were meta-analytically reviewed.

RESULTS

The overall ES of d = 0.26 was similar to previous meta-analyses and moderated by several variables. The ES varied notably based on the composition of the sample, the profession offering the intervention, and the type of intervention. Studies with samples consisting of only BC patients and studies with nonpsychologist-led interventions showed lower ES. Psychoeducation yielded the strongest ES. These moderators maintained their significance even when controlling for the nature of the control group, the format of the intervention, the timing of the intervention, or the stage of disease.

CONCLUSIONS

These results suggest that among current interventions, psychoeducation is a treatment of choice for BC patients, preferably prior to surgery and led by individuals with a medical expertise. Other psychosocial interventions appear most effective when administered individually and led by a psychologist. In addition, there is a need for improved psychosocial interventions to enhance the present ES for women with BC.

Quality of life in gynecological inpatients undergoing surgery

This study investigates the changes in the quality of life (QOL) of gynecological patients undergoing surgery, and the relationship between these changes and clinical/demographic factors. Ninety patients were examined on three occasions using the Japanese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-core30 (EORTC QLQ-C30). Although the global QOL and physical function decreased before discharge, the emotional function was lowest before surgery. There was no difference between the benign and malignancy groups in most QOL subscales. With regard to the relationship between global QOL and physical function before discharge and other demographic/clinical factors, multiple regression analysis suggested that these were explained by employment status, benign/malignancy, region of tumor, chemotherapy, postoperative complication, and psychological symptoms during hospitalization.

Chronic fatigue and its correlates in long-term survivors of cervical cancer treated with radiotherapy

OBJECTIVE

To describe the prevalence of chronic fatigue (CF) and associated variables in locoregional cervical cancer survivors (CCSs) surveyed > 5 years after radiotherapy. Demographic, clinical and psychological characteristics of the CCSs were compared with normative data.

DESIGN

Cross-sectional study.

SETTING

Department of Gynaecologic Oncology at Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway.

POPULATION

Seventy-nine CCSs aged < or = 79 years, treated between 1994 and 1999, representing 62% of those invited. Normative data were based on various population studies of Norwegian women.

METHODS

Data were collected by means of a mailed questionnaire, which included demographic variables and instruments covering fatigue, mental distress, sexual functioning, somatic impairments and quality of life (QOL).

MAIN OUTCOME MEASURES

Self-reported fatigue score and caseness of CF based on the fatigue questionnaire.

RESULTS

CCSs showed 30% CF versus 13% reported in the general population (P= 0.001). CCSs with CF had a significantly lower QOL, higher levels of anxiety and depression and more physical impairments than those without CF. In a multivariable regression model, depression was the only variable significantly associated with CF in CCSs.

CONCLUSIONS

More CCSs have CF than age-matched women in the general population. CF should be of clinical concern since these women also frequently have treatable mental and physical problems.

Factors associated with quality of life of outpatients with breast cancer and gynecologic cancers and their family caregivers: a controlled study

Background

Quality of life (QOL) issues are of interest in cancer because effective methods of treatment and detection have led to an increase in the number of long-term survivors. The objectives of the study were: to assess the subjective QOL of stable Sudanese women cancer outpatients and their family caregivers, using the WHO 26-item QOL Instrument; compare with matched general population groups, as well as diabetic and psychiatric patient groups; examine patient-caregiver concordance in ratings; and assess the variables associated with their QOL, with a view to identifying factors that can enhance quality of care.

Methods

Responses of oncology outpatients with breast cancer (117), cervical cancer (46) and ovarian cancer (18) (aged 44.6, SD 11.5) were compared with those of their family caregivers and matched general population groups. Data were analyzed by univariate and multivariate statistics.

Results

The cancer groups had similar QOL domain scores, which were significantly lower than those of their caregivers, but higher than the control group as well as those of psychiatric and diabetic patients studied previously. Patients who were married, with higher education, better employment, and with longer duration of illness had higher QOL. Patients on radiotherapy and their caregivers had higher QOL scores. Correlations between patient's ratings and caregiver impression of patient's QOL were high. Caregiver impression was a significant predictor of patient's and caregiver's QOL. Other predictors for the patient were: currently feeling sick and duration of illness; for the caregiver: feeling sick, relationship to patient, and age.

Conclusion

Cancer patients in stable condition and with psychosocial support can hope to enjoy good QOL with treatment. The findings constitute an evidence base for the country's cancer care program, to boost national health education about prognosis in cancer. Families living with women cancer patients are vulnerable and need support if the patient is recently diagnosed, less educated, single, not formally employed; and the caregiver is female, parent, younger, less educated, unemployed and feels sick. Clinicians need to invest in the education and support of family caregivers. The patient-caregiver dyad should be regarded as a unit for treatment in cancer care.

Review of the economic and quality-of-life burden of cervical human papillomavirus disease

OBJECTIVE

The purpose of this study was to conduct a systematic literature review on the economic burden and health-related quality-of-life impact of cervical human papillomavirus disease.

STUDY DESIGN

A systematic review of cost-of-illness studies and health-related quality-of-life studies was conducted. PubMed, Embase, and PsycINFO databases were searched with the use of predefined terms.

RESULTS

Nine economic and 24 quality-of-life studies were identified. The annual health care costs of human papillomavirus-related conditions in the United States range from 2.25-4.6 billion dollars (2005 US dollars). The burden of human papillomavirus is second only to human immunodeficiency virus among sexually transmitted diseases. Health-related quality-of-life areas that are impacted substantially by human papillomavirus include emotional, social, and sexual functioning.

CONCLUSION

The economic and quality-of-life burden of cervical human papillomavirus disease is significant and highlights the need for treatment and prevention options for this condition.

Emotional state and coping style among gynecologic patients undergoing surgery

The aim of the present study was to investigate changes in emotional state and the relationship between emotional state and demographic/clinical factors and coping style among gynecologic patients undergoing surgery. Using the Japanese version of the Profile of Mood States (POMS), 90 patients (benign disease: 32, malignancy: 58) were examined on three occasions: before surgery, before discharge, and 3 months after discharge. They were also examined using the Coping Inventory for Stressful Situations (CISS) on one occasion before discharge. The scores for the subscales depression, anger, and confusion were the highest after discharge while those for anxiety were the highest before surgery. The average scores of the POMS subscales for all subjects were within the normal range. With regard to the relationship between these emotional states and other factors, multiple regressions showed that the principal determinants of anxiety before surgery were religious belief, psychological symptoms during hospitalization and emotion-oriented (E) coping style; further, it was found that depression after discharge could be explained by chemotherapy, duration of hospitalization, and E coping style. The principal determinants of anger after discharge and vigor before surgery were length of education and E coping style, and severity of disease, chemotherapy, E coping style and task-oriented coping style, respectively. Those of post-discharge fatigue and confusion were length of education, psychological symptoms, and E coping style. In summary it is suggested that the following should be taken into account in patients undergoing gynecologic surgery: anxiety before surgery, depression, anger, and confusion after surgery, including coping styles.

A critical review of patient-rated quality of life studies of long-term survivors of cervical cancer

OBJECTIVES

Increasing survival rates of cervical cancer (CC) patients and the trend towards more toxic multimodal therapy have led to focus on the quality of life (QOL) of cervical cancer survivors (CCSs). The aim of this critical review was to summarize and discuss the research findings of QOL in CCSs based on self-report measures in terms of physical, psychosocial, and sexual well-being.

METHODS

Electronic databases were used to identify studies published between 1966 and August 2005. A quality assessment using methodological and treatment-related criteria was performed to distinguish between studies with good and less good methodology.

RESULTS

Twenty-three studies were included, whereof eight had a good methodology. Eight studies used at least one questionnaire that had not been validated previously, and only one of the validated questionnaires had been tested in former studies of CCSs. The studies with good methodology focused primarily on sexual and social function after treatment, and less on physical and psychological well-being. The trend is that radiotherapy is more associated with reduced QOL dimensions than surgery or chemotherapy. In earlier stages of CC and following surgery alone, there seem to be minor differences between CCSs and control groups concerning various QOL domains.

CONCLUSIONS

Reviewed studies indicate that quality of life in cervical cancer survivors is reduced compared to the general female population following radiotherapy, but less so following surgery and earlier stages of cervical cancer. Shortcomings of both methodology and content of the studies reviewed preclude definite conclusions concerning QOL for the moment.

Hysterectomy: effects on quality of life and psychological aspects

Most gynaecological disorders are not life-threatening. They may nevertheless severely affect women's quality of life. The majority of hysterectomies are performed to treat non-malignant conditions, to enhance the quality of life rather than save life. Recent research shows an enhancement in quality of life during the early years after hysterectomy. Furthermore, research shows that hysterectomy does not cause any adverse psychological outcome in otherwise psychologically healthy women, but presurgical psychopathology is predictive of postsurgical psychopathology. Research also shows that most gynaecological cancer survivors enjoy a relatively good quality of life.

Quality of life in long-term cervical cancer survivors

OBJECTIVES

To describe the quality of life (QOL) and long-term psychosocial sequelae of women of childbearing age diagnosed with cervical cancer 5-10 years earlier.

METHODS

Utilizing a cross-sectional descriptive design, 51 cervical cancer survivors and 50 age-matched controls completed a comprehensive QOL interview.

RESULTS

Participants were predominantly married, non-Hispanic White, with a mean age at diagnosis of 37 years and a mean age at interview of 45 years. This disease-free sample enjoys a good QOL, with physical, social, and emotional functioning comparable to or better than comparative norms. However, certain psychological survivorship sequelae and reproductive concerns persist. Participants reporting good QOL were less likely to report ongoing coping efforts related to having had this illness and were more likely to report greater social support, greater sexual pleasure, and less cervical cancer-specific distress. In a multiple-regression model, cancer-specific distress, spiritual well-being, maladaptive coping, and reproductive concerns accounted for 72% of the variance in QOL scores. Fifty-nine percent of respondents expressed that they would likely participate in a counseling program today to discuss psychosocial issues raised by having had cervical cancer, and 69% stated that they would have attended a support group program during the initial treatment if it had been offered.

CONCLUSIONS

This information provides insight into the complex survivorship relationships between QOL and sequelae of cervical cancer for women diagnosed during childbearing years. Therefore, it is important for health care professionals to recognize that aspects of cancer survivorship continue to require attention and possible follow-up care.

United we stand? The effects of a couple-coping intervention on adjustment to early stage breast or gynecological cancer

Cancer diagnosis affects the psychological well-being of both patients and their partners, and effective coping has been suggested to be a conjoint process of mutual support. Ninety-four married women with early stage cancer and their partners were randomly assigned to couples-based coping training (CanCOPE), individual coping training for the woman, or a medical education control. Couples' observed support communication and self-reported psychological distress, coping effort, and sexual adjustment were assessed at diagnosis, after cancer surgery, and at 6- and 12-month follow-ups. CanCOPE produced significant improvements in couples' supportive communication, reduced psychological distress and coping effort, and improved sexual adjustment. Training in couples rather than individual coping was more effective in facilitating adaptation to cancer.

Cervical cancer

Behavioral and psychosocial factors affect all aspects of cervical cancer control, from prevention to posttreatment rehabilitation. Behavioral scientists gathered at the Second International Conference on Cervical Cancer (Houston, TX, April 11-14, 2002) reviewed selected studies of behavioral factors related to cervical cancer, including women's receptivity to emerging cervical cancer screening and diagnostic technologies, factors that influence adherence to follow-up colposcopy recommendations, and cervical cancer survivors' quality of life. Researchers reported that reduced distress during examinations with new technology may improve adherence to cervical cancer screening recommendations. Until new technology becomes mainstream, research shows that distress is reduced and adherence improves when health care providers match interventions to patients' informational processing styles. Investigations of survivors' quality of life report conflicting findings, but studies indicate that survivors experience anger over reproductive loss, loss of interest in sex, and perhaps a greater vulnerability to sexual dysfunction compared with survivors of other cancers. Survivors also report a need for posttherapy support programs. Primary prevention of cervical cancer should remain a priority as research in behavioral interventions and barriers to screening, especially among vulnerable populations, moves forward.

Important aspects of health care for women with gynecologic cancer

PURPOSE/OBJECTIVES

To describe what women diagnosed with primary gynecologic cancer reported to be important during their interaction with the healthcare system.

DESIGN

Qualitative.

SETTING

A specialized gynecologic cancer care unit in central Sweden.

SAMPLE

14 women diagnosed with primary gynecologic cancer were recruited. The women had been referred to the specialized care unit for radiation or cytostatic therapy.

METHODS

Tape-recorded interviews were transcribed, coded, categorized, and analyzed.

MAIN RESEARCH VARIABLES

Primary diagnosed women with cancer and their experience with quality of care during diagnosis and treatment.

FINDINGS

Three partly overlapping categories (i.e., optimal care, good communication, and self-image and sexuality) were found to be of central importance in quality of health care. Participants stated that health care should be based on their own perceptions of the need for information and dialogue and how the disease and treatment would affect their health, self-image, and sexuality. Everyday conversations also were very important.

CONCLUSIONS

Central importance in health care for the women included both rational and human aspects. The primary need of participants was to achieve a rapid cure, which necessitated health care that was available, competent, and coordinated.

IMPLICATIONS FOR NURSING

Women with gynecologic cancer should be given individualized information and care to satisfy their individual needs and reinforce their self-image. Nurses have an important role in strengthening women's feelings of hope and supporting them in maintaining as positive a self-image as possible. Information and everyday conversation are of great significance. Sexuality should be an integral part of holistic care; to this end, inclusion of each woman's sexual partner may be helpful when discussions concerning sexuality occur.

Stress and coping strategies of patients with cancer. A Korean study

Cancer is a potential life-threatening illness that engenders considerable psychologic distress, requiring persistent coping for the treatment procedures. In this cross-sectional descriptive study stress levels and coping strategies of 257 cancer patients residing in South Korea are addressed. Lazarus and Folkman's theory of stress and coping was used as the theoretical framework. The data were collected from November 1999 to March 2000 by face-to-face interviews. Study participants were primarily male (62.6%) and married (91.4%). Cancer of the gastrointestinal system was the most prevalent type of cancer (31.3%). Women and the patients in the third-stage of cancer showed higher stress but less coping than other groups. Stress was negatively correlated with both problem-focused coping and emotion-focused coping. Korean patients with cancer used emotion-focused coping strategies more than problem-focused coping strategies.

Quality of life in patients attending a low-risk gynaecological oncology follow-up clinic

OBJECTIVES

(1) To assess the quality of life (QOL) of patients who had been treated for gynaecological malignancies and who were attending a low risk follow-up clinic. (2) To determine the accuracy of the clinic physicians' assessment of patients' QOL compared with the Functional Living Index-Cancer (FLI-C) [Schipper et al., 1984. Measuring the quality of life of cancer patients: the Functional Living Index-Cancer: development and validation. J Clin Oncol 2(5): 472-483]. (3) To examine a single subjective question about change in QOL. (4) To assess patient fear of cancer recurrence.

DESIGN

Self-administered patient questionnaire. The questionnaire contained the FLI-C, with four additional questions.

SETTING

Low risk (good prognosis) follow-up clinics in the Department of Gynaecological Oncology at King Edward Memorial Hospital (the tertiary centre for obstetrics and gynaecology for the state of Western Australia).

PATIENTS

202 consecutive attendees of the clinic. Non-English speaking patients attending without an interpreter were excluded.

RESULTS

Most patients reported a good QOL. The range of FLI-C scores was 59-154 (possible range 22-154), with a median score of 140 and a mean of 134. Younger patients were more fearful of cancer recurrence. Radiotherapy was associated with a worsening of QOL. Patients living with partners experienced deterioration in sexual functioning.

CONCLUSIONS

Patients attending the low risk follow-up clinic after gynaecological malignancy have a good overall QOL.