Abstract
Ovarian cancer represents about 4% of all cancers in women and is the fifth leading cause of death in the United States each year. Ovarian cancer is associated with uncertainty, anxiety, and depression. Many women present with advanced disease at diagnosis and are faced with aggressive surgical and medical protocols to treat them. To meet the needs of women with ovarian cancer, the effects of their physical problems on psychological adjustment must be identified. Health care professionals must closely monitor women with ovarian cancer to identify those who may require ongoing psychological care or psychiatric intervention. This article presents an overview of ovarian cancer, focusing on the psychological effects, and an intervention by oncology nurse specialists to address both the physical and emotional distress that accompanies ovarian cancer. The importance of screening for psychological distress is emphasized.
Adiagnosis of cancer obviously imposes disruption and disorganization on the lives of patients. Ovarian cancer has been referred to as the silent killer because the majority of women with the disease have no symptoms for long periods of time. Although any cancer may be diagnosed with a high degree of uncertainty associated with its prognosis, certain types of cancer are associated with greater uncertainty, anxiety, and depression when diagnosed at a late stage. 1,2 Ovarian cancer is a particularly poignant example because of both the high percentage of women with advanced disease at diagnosis and the utilization of aggressive surgical and medical protocols to treat women regardless of the stage of their disease. 3,4
Within the context of advanced disease and aggressive treatment, psychiatric morbidity may be particularly significant, yet clarity regarding psychiatric phenomena requiring intervention is limited. One important reason for this incongruence is the lack of understanding as to when psychological distress, such as anxiety and depression, reaches clinical significance. Confusion also lies in the overlap of physical symptoms associated with cancer (and its treatment) with neurovegatative symptoms, such as fatigue and lack of appetite, that characterize psychiatric syndromes. 5,6 Until the psychological accompaniments of advanced cancer and aggressive treatments are clarified, detection strategies and helpful interventions will be difficult to define and apply. Patients receiving aggressive cancer treatments are among the most vulnerable populations in need of timely assessment and intervention for psychiatric morbidity.