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7 Reasons Mental Health Counseling Should Be Part of Every Woman's Treatment for Reproductive Cancers

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While any cancer diagnosis and the subsequent treatment process is incredibly stressful, the specific difficulties of women undergoing treatment for reproductive cancers are often overlooked. A 2017 study published in the International Review of Psychiatry showed that 45 percent of individuals with gynecological cancers experience post traumatic stress disorder (PTSD), exacerbated by the fact that many women blame themselves for their illnesses due to use of birth control or smoking early in life. According to the National Cancer Institute, nearly 41 percent of survivors of breast cancer – which is also considered a reproductive cancer because many who have the BRCA gene also develop ovarian or uterine cancers – have a sub-clinical presentation of PTSD; this means that while they don’t meet all the criteria for a full diagnosis, they still suffer from the intense fear and helplessness associated with PTSD.

• What is PTSD?

Despite these alarming statistics, mental health counseling is not part of most cancer treatment programs. And while many women do get emotional support from their spouses, families and other cancer survivors, that is very different from having the services of a trained mental health professional.

Stress and anxiety related to reproductive cancer treatment often leads women to skip treatments and blood draws. This can lead them to be perceived as “difficult” by their doctors, but their non-compliance is usually an avoidance behavior to cope with the stress associated with the treatment. And if an oncologist recognizes this problem in one of his or her patients, the protocol is to send the patient to their primary care physician for anti-anxiety or anti-depressive medications. This only adds another doctor’s appointment the patient often does not want to attend, and more medication they do not want to take.

“I see a significant need for counselors to be trained in how to work with people with cancer, especially women with reproductive cancers, because they have very unique needs,” says Linda Waters, a Licensed Professional Clinical Counselor Supervisor. “People with cancer are living a lot longer, and they must deal with physical and mental health issues throughout their lives.”

Waters is pursuing her doctorate in counselor education at the University of Toledo. As part of her research, she is studying the impact of female reproductive cancers on mental health.

Here are seven specific reasons women with female reproductive cancers develop mental health issues that could be positively addressed by a professional mental health counselor:

1. Loss of fertility and sex drive.
Young women with reproductive cancers who still want to have children can often be put into early menopause by cancer treatments, which also can greatly reduce sex drive, both of which may cause angst in relationships. To boot, reproductive cancer survivors are often not eligible for hormone replacement therapies to alleviate the symptoms of early menopause. “For many women, hormone replacement drugs are not indicated for estrogen-positive cancers,” Waters explains. “Even an estrogen cream that would help with lubrication could fuel cancer recurrence.”

2. Body-image issues.

As a result of treatment for female reproductive cancers, women can have scarring from mastectomies and other surgeries, internal scarring from radioactive seeds, intense burns or changes in skin texture and appearance from radiation or drugs, and swelling of limbs due to the removal of lymph nodes that necessitates the wearing of compression bandages. Mental health counseling can help women learn to love and accept their new bodies, and view their scars as signs of strength.

3. Loss of role.

Many women are not used to being the center of attention in their family unit. They are typically the caregiver, not the focus of caregiving. Women often withhold their emotional experience with cancer because they don’t want their spouses to worry about them. Waters also says that the general push to maintain optimism will prevent women from sharing their experience with people outside the family unit. “People often say, in a simplistic way, ‘Just be positive.’ So if I share that I’m struggling or that I’m afraid of dying, and you want me to maintain optimism, that shuts down the conversation,” she says.

4. Financial strain.

In many cases, women also manage family finances. Gynecological cancers, which are among the most expensive cancers to treat, drain bank accounts and cause financial uncertainty and additional stress. According to NPR, in 2013, 25 percent of cancer patients chose not to fill a prescription due to cost, and one in eight cancer patients rejected a treatment for financial reasons. Additionally, mental health counselling can be viewed as a luxury expense, and therefore is not often considered.

5. Facing mortality.

Research says that women’s main concerns during cancer treatment are how their family is being affected and how their family may be affected when they are gone. “My research shows that even women with earlier-stage cancers that are still curable and treatable are facing their own mortality in ways they never have before,” Waters says. And while hospice counselors are available for those with late-stage cancers and can help attend to the needs of children, women with earlier-stage cancers are left to manage the process on their own. For that reason, the risk of suicide for those who experience cancer is twice that of the general population.

6. Cancer-related pain, fatigue and sleep-disturbance.

“If I get a bump or bruise soreness in my hip, I think, ‘Gosh, what did I hit?,’” says Waters. “But if you’ve had cancer, you think, ‘Oh my gosh, is it coming back?’” Cancer survivors can struggle with pain, that if left uncontrolled, can contribute to depression and substance-abuse disorders. Fear of cancer recurrence (FCR) can cause cancer-related fatigue and sleep-disturbance, which can make women feel disconnected from their families and friends. Also, cancer-related fatigue is not often a result of lack of sleep, and is more often cured with light exercise over rest. Only a mental health counselor trained to work with cancer patients would have all the information needed to truly help.

7. Support groups aren’t for everyone.

Support groups can be wonderful, but they often create additional mental health stressors for participants. “If you have supportive friends and family, and you go to a group where people talk about how their friends and family have let them down, it can be distressing,” Waters explains. “In addition, as the illnesses of members of the group progress, you can experience grief from the loss of those who were supportive to you, and you can experience survivor’s guilt.” To the contrary, if a woman with cancer were seeing her own therapist, the sessions would be focused on addressing the issues and problems specific to her.

Waters’ long-term goal is to develop a non-profit cancer counseling fund so those with cancer can receive counseling at no cost. Because those with cancer report that their mental health needs are often unaddressed during their treatment, she also hopes to train mental health counselors specifically to work with people with cancer and oncology providers to consider the mental health aspects of cancer.

In the meantime, however, if you believe you or your loved one with cancer may need professional assistance navigating the mental health challenges of cancer, reach out to a trained counselor. A counselor can help each individual draw on personal strengths and support systems and can give life perspective to guide you or your family. Your primary care provider can provide a referral to a private counselor or community mental health agency for counseling tailored to your needs.

How have you managed your mental health during or after a cancer diagnosis? Let us know in the comments below.

Originally published: August 21, 2020
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