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Psychiatric Aspects of Gynecologic Cancers

The various forms of cancer in this category consist primarily of forms of the breast, ovary, uterus, and cervix.

There is some controversy regarding the effects that psychiatric / psychological factors play on the incidence and course of these and other cancers. Large epidemiological studies found that depression was associated with twice the risk of death from cancer up to 17 years after diagnosis.

However, other large cohort prospective studies found no effects of depressive symptoms on cancer risk. In breast cancer as a typical example, 50% of patients experienced severe degrees of anxiety, depression, and other psychiatric symptoms / illnesses during the course of their illness.

Depression, which can be reactionary, biologically mitigated, or the result of treatment, can affect disease course, recurrence, or mortality according to some but not all studies. Issues such as adequate pain relief, adherence to recommended treatments / interventions, decreased desire to sustain life, and raging despair have been implicated and observed in gynecologists and other cancer patients with comorbid psychiatric problems.

Studies have also shown that the psychiatric / psychological response of any patient to a diagnosis and course of cancer is influenced by many factors. These may include: the specifics of the type and stage of the cancer itself, the individual’s ability to manage the diagnosis and treatment of cancer, especially pain problems, the preeminent factors of medical, social and psychological stability, the type and the effects of various treatment modalities. and their complications, pre-existing traumatic experiences and coping styles / skills, personality strengths or limitations, general mental health, social support, age and stage of life, financial stability, meaning of their lives, etc., cultural and religious beliefs .

Depression in gynecological and other cancers is associated with a higher incidence than in the general population compared to other serious medical illnesses. Cancer itself can cause many symptoms associated with depression, for example, fatigue, weight loss, poor appetite, lack of energy, sleep disturbances, and other vegetative signs of depression. Therefore, there may be an over or under diagnosis of depression as a result of overlapping symptoms.

The most serious psychiatric problem associated with gynecologist and other cancers is suicide. Passive suicidal thoughts are much more likely than active suicidal intention. However, there is still an increased risk of suicide, especially with advanced disease and poor prognosis, severe pain, delirium, substance abuse, selective loneliness, social isolation, feelings of helplessness, depression, and previous suicidal tendencies. This serious risk must be properly examined 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 can affect treatments, i.e. phobias (of needles, chemotherapy, radiation and claustrophobic to spaces like MRIs). ).

Psychosis and delirium are also possible comorbidities or may be exacerbated pre-existing problems.

In conclusion, gynecological cancers present with a variety of physical and psychological symptoms throughout the various stages of the disease, that is, initial diagnosis, treatment, survival, or recurrence. Multiple stressors of surgical menopause, various medications (chemotherapies, steroids, marcotic pain relievers, etc.), pain, and radiation potentials are some of the most physically demanding aspects. All of these can also lead to more serious psychiatric sequelae.

Screening for psychological distress can be helpful in helping to identify women who would benefit from psychiatric or psychological care. They should be referred to a mental health professional with knowledge and experience in psycho-oncology. When possible, psychiatric treatment should be the place where you receive your oncology services.

Pain, other physical ailments, high mood, or anxiety symptoms should be treated pharmacologically. Supported group and individual therapies are helpful. Survivors experience a chronic fear of recurrence, sexual dysfunction, and identity alteration. Patients can also despair about their future. All of these are best managed with individual psychiatric care with a psychiatrist experienced in cancer needs.

Ask the doctor …

Q. What can really happen?

FOR. The course of treatment for gynecologic cancer can be very physically and mentally demanding. Major mood disorders can impede attention itself, cause the disease to progress, and even lead to suicide. Treatments are available, but they must be done by mental health professionals with knowledge and experience in oncology. Medications are often helpful and should be prescribed by a well-trained psychiatrist with experience in oncology. It is strongly recommended that the patient or family specifically ask and request someone with that type of experience who is only used for treatment.

Outcomes for gynecologic cancers are greatly improved when psychiatric issues are addressed simultaneously.

Q. Who is most at risk for problems?

FOR. Those with previous psychiatric problems, in particular, those with mood disorders and anxiety disorders are vulnerable to recurrences or significant exacerbations due to the development of gynecological cancer. Treatment sooner rather than later can help alleviate these comorbid burdens.

No woman should fight these devastating diseases alone. There is significant care available.

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