Cancer Patients: Marital and Sexual Relationship, Psychological Adjustment and Treatment

Because of early identification techniques and promising treatments, may people who are diagnosed with cancer live long and fulfilling lives free of disease. Others may have recurrences but nonetheless maintain a high quality of life for 15-20 years. Others live with active cancers over the long term, knowing that the disease will ultimately be fatal. All of these trajectories, however, indicate that cancer is now a chronic disease, which poses long-term issues related to psychosocial adjustment. Intermittent and long-term depressions are among the most common difficulties experienced as a result of cancer.

A strong marital relationship is important in cancer because marital adjustment predicts psychological distress following cancer diagnosis. Unfortunately, disturbances in marital relationships after a diagnosis of cancer are not uncommon. Sexual functioning is particularly vulnerable. Odd image concerns and concerns about a partner's reactions represent psychosocial vulnerabilities especially when there has been disfiguring surgery, as in the case of breast cancer. Breast-conserving techniques, such as lumpectomy, lead to moderately better psychological, marital sexual and social adjustment than the more extensive mastectomy surgery.

Sexual functioning can be directly affected b treatments, such as surgery or chemotherapy, and indirectly affected by anxiety or depression, which often reduce sexual drive. Sexual functioning problems have been particularly evident in patients which gynecologic cancers and prostate cancer and underscore the fact that different types of cancers create different kinds of problems.

Adverse psychological reactions cancer can also be severe when the treatments are sever or if the patient has a poor understanding of the disease and treatment of both. Survivors of childhood leukemia, for example, sometimes show signs of post-traumatic stress disorder (PTSD), which may persist for years following treatment. Among adult patients, however, signs of PTSD appears to be relatively rare, suggesting that trying to understand the experience of cancer patients through our understanding of trauma may be misleading.

Identifying and attending to psychological distress in response to cancer in an important issue, not only for maintaining quality of life but also because psychological distress quality may itself be related to prospects for long term survival. For example, research shows that cancer survivors may show elevated cortisal and alterations in their HPA axis responses to stress subsequent to cancer treatment; this may be due to fear of recurrence, stress associated with cancer treatment and the disease, or a combination. These hormones may, in turn, exert a regulatory effect on the immune system that may influence the likelihood of a recurrence.

Reference: http://cat.inist.fr/?aModele=afficheN&cpsidt=16921897