Sushma, V (2013) A Comparative study on the Disturbances in Body Image, Psychiatric Morbidity and their Effects on Quality of Life in Post-Mastectomy and Post-Hysterectomy Cancer patients. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Cancer, described popularly as a malady ascribable to the Precipitous overgrowth of certain infinitely multiplying cells at the Expense of the surrounding tissues, has been a domain of concern for the Medical fraternity for ages. The achievements in the field of oncological Research and health care have been tremendous, nevertheless, the panacea For this dreaded disease has been eluding the human race for centuries. The graveness of the disease, although is universally recognised, one Cannot but disregard the morbidity, grievousness and disfigurements Rendered by the current treatment modalities per se. The heartrending Agonies, experienced by these unfortunate patients have been Increasingly realized and a need to acknowledge various psychological Aspects of their self-perception cannot be understated. Breasts and uterus constitute and exemplify the basic symbol of Femininity and womanhood. They are inevitable in the physical, Physiological, emotional and psychological spheres of every woman’s Life. Any deprivation of these organs, well-accepted as the principal Treatment modality in diverse breast and gynecological malignancies, can Have devastating aftermaths on the very belief of self-esteem and Muliebrity in women, apart from the more obvious physical Consequences. The profound impact of such circumstances on the Wellness of the families and society, at large, cannot merely be back Grounded as well. Malignancies of the breasts are increasingly encountered by the Medical practitioners worldwide. The incidence of these cancers in India Is 20.5/100,000.As per the epidemiological survey conducted by the Madras Metropolitan Cancer Registry the incidence of breast cancer in Urban Chennai is 31.0/100,000; the mean age of onset for breast cancer Is 45.5. The 5 year survival rate after completion of treatment is 65% , While that for partially treated and defaulted patients, it is 40%. Mastectomy and Lumpectomy with breast conservation are the two most Common surgeries performed. Gynecologic cancers form the other most common loci for Malignant disease in women, the four sites commonly involved in Descending order being endometrial, cervical, ovarian and vulvar cancers. The incidence of Endometrial cancer is 2.5/100,000 and that of cervical 23.2 in India. The incidence of endometrial cancer in urban Chennai is 4/100,000 and that of cervix is 18/100,000 ; the mean age of onset for Endometrial and cervical cancer is 50 – 54 years. The 5 year survival rate For cervical cancer is 65 years and it is even higher in endometrial cancer. Total abdominal hysterectomy with bilateral salpingo-oophorectomy is a Definitive therapy in a variety of gynecological malignancies. Importance of Psycho oncology: The field of psycho-oncology has Emerged as a sub speciality within oncology and psychiatry. It deals with The psychological, behavioral and social factors influencing the risk, Detection, treatment and prognosis of cancer. The disease and its treatment modalities evoke varied responses Among individuals based on one’s personality factors, ego-strengths, Coping strategies, adaptation skills and the support from the treating Faculty, family and the society apart from the socioeconomic and socio Cultural background. The fear of shortened life span and the approach of Death along with the have a strong impact on their psychological Behavior. Psychoneuroimmunological studies reveal the involvement of Stress and hypothalamic-pituitary axis on the initiation and progression of Psychological responses. Breast cancer has a complex impact on women. The medical, Psychological and psychosocial factors and the socio cultural background Are the major factors which influence them. Prevalence of depression in These patients is twice as that in general female population. In case of gynecological malignancies, late presentation due to Non-specific symptoms is an important cause for distress. The physical And psychological symptoms have both independent and cumulative Effects on them. The condition of cancer survivors is an important area to be Focused. They experience changes in the physical and psychological Aspects on concept of self. These along with psychological morbidity Affect the quality of living in these women. Body Image: One of the earliest definitions of body image by Schilder is a “a picture of our own body which we form in our mind, that Is to say the way in which the body appears to ourselves”. It is a dynamic Construct. The various treatment modalities affect the concept of body Image in cancer patients. Therefore it is of prime importance to address This issue while planning treatment as it affects the patients’ and their Family’s quality of living. Quality of life: WHO defines ‘quality of life’ as “Individual’s Perception in the context of their culture and value system in which they Live and in relation to their goals, expectations, standards and concerns”. Quality of life covers the following domains – physical, emotional, Social, cognitive, role and financial wellbeing. Psychiatric Morbidity: The psychiatric morbidities encountered Frequently in cancer patients who underwent a surgical procedure as a Part of the treatment regimen can be enumerated as the following: Delirium, dementia and other cognitive disorders, Adjustment Disorder, Anxiety disorders – PTSD, generalised anxiety disorders, panic Attacks, and specific phobias, Depressive disorders, suicide,Cancer Related fatigue, Bipolar disorder, Personality disorders, Schizophrenia And other psychiatric disorders, Substance use disorders ,Somatoform Disorders Pain, Sexuality, survival rate, delayed consequences of Treatment are the major concerns in cancer patients. Current treatment modalities focus on symptom removal and the Physical effects of the treatment options. Recognizing quality of life as An endpoint/goal of treatment has not been considered and due credit to This aspect has not been given till now particularly in developing Countries. Psychiatric morbidity though an obvious co-existing problem along With the primary disease is being underdiagnosed and neglected even if Diagnosed. It is essential to identify and treat psychiatric morbidities at The earliest stage possible and to bring about psychological well being Along with physical well being. This is all the more important in cases Where psychiatric morbidity is present even before the cancer diagnosis. Body image and sexuality is one sensitive area which is Slowly receiving attention at present. This is one area which is being Neglected mainly because of the social, educational and cultural Background. With the mean age of tumor patients being in a decline, This field has come into focus. But a woman’s integrity and concept of self revolves around her Body image and sexuality which in turn has a profound impact on her Psychological well being and quality of life in all spheres. This also Indirectly affects her family and society as well. In both breast and gynaecological malignancies, lot of studies have Focused on the psychiatric morbidity and quality of life issues. There are Very few studies in this part of the world focusing entirely on the context Of body image disturbances. As uterus is considered an internal organ, it Is believed that its removal does not have as much effect on these factors As its counterpart in breast and other external organs. This study mainly focuses on the body image disturbances and Psychiatric morbidity in breast and gynaecological cancers and its Influence on the various spheres of life of women.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Disturbances ; Body Image ; Psychiatric Morbidity ; Quality ; Life ; Post-Mastectomy ; Post-Hysterectomy ; Cancer patients. |
| Subjects: | MEDICAL > Psychiatry |
| Depositing User: | Subramani R |
| Date Deposited: | 19 Aug 2017 03:12 |
| Last Modified: | 19 Aug 2017 03:12 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1961 |
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