Overview

Gynaecologic cancer cases account for approximately 12% of all new cancers in women; 49% of these involve the endometrium or uterus, 31% the ovary, 13% the cervix and 7% the vulva, vagina or other genital organs (Jemal et al., 2004). Advances in screening techniques, (e.g. Pap smear for cervical cancer), and therapies have led to improved survival. Since the 1970s, death rates for gynaecologic cancers have significantly declined: currently a reduction of 49% for cervical cancer, 42% for endometrial, 27% for vaginal and vulvar and 11% for ovarian. See Table 1 for additional information by disease site. For the majority, gynaecologic cancer has become a survivable disease (Ries et al., 2000). Thus, more women will survive and, necessarily, will be coping with the psychosocial morbidity associated with the disease and treatment.

Psychological reactions to diagnosis

The emotional reactions to gynaecologic cancer diagnosis are severe. In a review of studies using psychiatric (DSM-IV) criteria, Thompson and Shear (1998) reported that as many as 23% of patients might have major depressive disorder, an estimate four to five times higher than that for the general population (Spiegel, 1996). Anxiety symptoms are prevalent as well, particularly in women with poor physical functioning (Bodurka-Bevers et al., 2000). In a sample of ovarian cancer patients (n = 151), a substantial portion of patients reported moderate to severe worry (55%), nervousness (40%) and irritability (34%) (Kornblith et al., 1995).