Abstract

Eighty-three women, mean age 45 years, successfully treated by surgery (S) or radiotherapy (RT) for stage 1b cervical cancer were assessed a mean of 97 weeks post treatment. Forty to 50% reported persistent tiredness, lack of energy and weight gain. Sixty per cent had not resumed their full premorbid functional status. Mean scores for anxiety and depression were higher than general population means and this sample scored higher for psychological distress than published data quoted for disease free cancer patients. These women reported many concerns about cervical cancer, most commonly fear of recurrent disease (91%). More than one-third blamed themselves for the disease. There were no significant differences in functional outcome or psychological status between treatment groups or by age or time since treatment. Psychological distress scores were significantly correlated with physical complaints (P < 0.001) and functional outcomes (P < 0.02). For the 61 women who were sexually active, sexual function post-treatment was rated as significantly poorer than subjectively recalled premorbid sexual function (P < 0.005). RT treated patients were more likely to report pain on intercourse and loss of enjoyment. Psychological as well as physical problems were highly correlated with sexual outcome (P < 0.01) 44% were unable to talk adequately with their partners about their experience. The majority felt they needed more information about cervical cancer, its treatment and how to help themselves rehabilitate. Forty-nine per cent would have liked to have had counselling. Even with the same physical morbidity the functional, emotional and sexual status of these women could be improved by giving more attention to their psychological and sexual concerns.

Highlights

  • Often the psychological concerns of cancer patients go undetected and unrelieved (Maguire, 1985). It may be as difficult for cancer patients as for their doctors to open the discussion about sexual matters in a routine consultation (Auchincloss, 1989)

  • It has variously been suggested that improved information and counselling in routine care could enhance post treatment outcome (Capone et al, 1980; Auchincloss, 1989) and that for some patients psychotherapy is indicated (Bos-Branolte et al, 1987)

  • Seven RT patients reported bleeding after intercourse compared with one S patient; 11 RT patients had diarrhoea compared with three S patients; 14 RT patients had night sweats and 19 had difficulty sleeping compared respectively with six and ten S patients. These problems were not severe and there were no significant differences between treatment groups in urinary or other patient reported physical symptoms or in the total score obtained on the Rotterdam Symptom Checklist (RSCL)

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Summary

Introduction

Often the psychological concerns of cancer patients go undetected and unrelieved (Maguire, 1985). It may be as difficult for cancer patients as for their doctors to open the discussion about sexual matters in a routine consultation (Auchincloss, 1989). It has variously been suggested that improved information and counselling in routine care could enhance post treatment outcome (Capone et al, 1980; Auchincloss, 1989) and that for some patients psychotherapy is indicated (Bos-Branolte et al, 1987). Most of the work in this area has been carried out in the US and Holland. Cross cultural differences in sexual mores are important and more British research is needed

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