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At Each Phase, Patients—and Their Oncology Nurses—Face Distinct Challenges

At Each Phase, Patients—and Their Oncology Nurses—Face Distinct Challenges

TORONTO—Beyond its physical effects, ovarian cancer presents women with
difficult emotional, social, and spiritual challenges every step of the way.
Each of the disease’s phases, from the first suspicions of something
seriously wrong, through diagnosis, treatment, survival, possible relapse,
and terminal disease, has its own particular psychosocial impact and its own
set of needs, said Margaret I. Fitch, RN, PhD, at an industry-sponsored
symposium held in conjunction with the Oncology Nursing Society annual
meeting.

She is head of oncology nursing and supportive care at the Toronto-Sunnybrook
Regional Cancer Center.

To provide their patients optimal care and support, oncology nurses must
understand the changes that women undergo as they pass through these phases.
The psychosocial issues surrounding ovarian cancer have received little
attention in the literature she said, but forums, a survey, and other
projects between 1998 and the present have begun to bring them to light.

Diagnosis to Treatment

As women try to get a definitive diagnosis, they also struggle with
uncertainty as they search for the right doctors and answers to their
questions, Dr. Fitch said. Many women also experience regret at not acting
sooner or mounting a more thorough response to often-vague symptoms. At the
time of diagnosis, deeply overwhelming emotions compete with the need to
understand complex information and make serious decisions in a short period
of time.

The treatment period is both physically arduous and highly emotional as
the woman loses organs "steeped in meaning of what it means to be a
woman," Dr. Fitch stated. Surveys reveal that for women over 65 years
old, chemotherapy side effects, bowel difficulties, fear of recurrence,
sleeping difficulties, fear of dying, and fulfilling household
responsibilities are the worst problems of this period. Younger women also
cite additional problems, including pain, sexual issues, difficulties
concentrating, menopause, and anger. Dr. Fitch said she could cite no
instances where "100% of the women felt they had been adequately
helped" with their problems. Most did feel that their physical concerns
got adequate attention, but Dr. Fitch was "disturbed" to report,
only small minorities of patients expressed satisfaction with the help they
received for emotional issues. "Busy clinics don’t lend
themselves" to dealing with these issues, she said.

The great majority of women were satisfied with the medical information
they received about their treatment and its effects. Many more, however,
felt dissatisfied with the psychosocial support they received, which has
"tremendous implications" for oncology nurses, Dr. Fitch said.

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