Cancer commonly causes loss of bodily functions, damage to the body image, and threat to life itself. Fear and grief are likely consequences, and the surgical and medical treatments for cancer are often drastic and may give rise to further losses. In a psychological sense cancer invades families, for many lives are likely to be affected by this illness.
People vary greatly in the degree of confidence and flexibility with which they cope with threatening situations. Several studies show that the intensity of distress following the onset of cancer is determined by such factors and by the degree to which people feel that the losses caused by the illness have made them different from others. This, in turn, can give rise to depression, problems of sexual adjustment, and other psychological difficulties.
4–6 One indicator of adjustment, sexual functioning, gives an idea of the magnitude of the problem. Comparative studies are few, but the effect on sexuality is surprisingly similar in cancers as varied as Hodgkin’s disease and cancers of the testis
7 and those of lung and prostate.
8 In both of these studies, between a quarter and a third of respondents in each diagnostic group felt that they had become lastingly less attractive to their partners, and a similar proportion found that their sex drive was diminished.
Similar difficulties have been reported in women after mastectomy.
9–11 Many women are dissatisfied with any prosthesis that they are offered, and they may attempt to avoid facing the painful reality of their loss by refusing to look at their chest wall or allowing their partners to do so. Some go to the lengths of covering mirrors, dressing and undressing in the dark, and minimising the time that they spend bathing. These activities reflect an avoidant style of coping. It is hardly surprising that these women tend to have lasting depression and loss of interest in sexuality.
Although the psychological consequences of surgical mutilation can be severe, they need to be set against the anxiety that patients may feel if they fear that their cancer has not been completely removed. Lumpectomy has often been advocated on the grounds that it is less psychologically traumatic than mastectomy, yet in one study it was associated with a slightly higher incidence of anxiety states and depression than mastectomy.
10 Similarly, surgical treatment for carcinoma of the cervix has been shown to give rise to rather less reduction in sexual enjoyment and activity than treatment with radiotherapy.
12 On the other hand, between a quarter and a third of men who undergo surgical castration for cancer of the testis think that the operation has made them less attractive and less able to achieve sexual satisfaction,
12 whereas chemical castration for carcinoma of the prostate is associated with substantial improvement in psychological state.
6 Whether or not patients with cancer have surgical treatment, they will usually have chemotherapy and radiotherapy, with loss of hair and other physical consequences. These are a further cause for loss of self esteem, grief, and depression.
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