Site of the Month for August 2011 talks of Breast Cancer. Breast Cancer Directory features information about breast cancer including causes, symptoms, diagnosis, treatment and prevention.

There is some controversy regarding the effects that psychi­atric/psychological factors play in the incidence and course of these and other cancers. Large epidemiologic studies found that depression was associated with double the risk of death from cancer up to 17 years post diag­nosis. However, other prospec­tive large cohort studies found no depressive symptom effects on cancer risk. In breast cancer as a protypical example, 50% of the patients experienced serious degrees of anxiety, depression and other psychiatric symptoms/illnesses during the course of their illness. Depression which may be reactionary, biologically mitigated or the result of treat­ment, can affect the course of the illness, recurrence or mortality according to some but not all studies. Issues such as adequate pain relief, adherence of recom­mended treatments/interven­tions, diminished desire to sustain life and rageful despair have all been implicated and observed in gyn and other cancer patients with co-morbid psychiatric issues.

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

The most serious psychiatric issue associated with gyn and other cancers is suicide. Passive suicidal thoughts are much more likely than active suicidal intent. There is still however an increased risk of suicide espe­cially with advanced disease and poor prognosis, intense pain, delirium, substance abuse, selec­tive solitude, social isolation, helpless – hopeless feelings, depression and previous suicid­ality. This serious risk must be adequately screened and profes­sionally evaluated during the course of the disease.

In conclusion, gyn cancers present with a range of physical and psychological symptoms throughout the various stages of the disease, i.e., initial diagnosis, treatment, survival or recurrence. Multiple stressors of surgical menopause, various medications, pain and radiation potentials are some of the most physically demanding aspects. These all may lead to more severe psychiatric sequel as well. Screening for psychological distress may be useful to help identify women who would benefit from psychiatric or psy­chological care. They should be referred to a mental health professional with psycho oncol­ogy knowledge and experience. When possible, psychiatric treatment should be where they receive their oncology services.