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.

Posttreatment and Recurrence

The posttreatment period requires women to "re-establish themselves," sort out the impact of their experience and adapt to change. Somewhat surprisingly, many reported very positive changes in their relationships as well as "increased enjoyment" of life and "spiritual enrichment," Dr. Fitch said.

When the disease recurs, women feel overwhelmed once again, but also disillusioned. Some perceived negative changes in health care professionals’ attitudes toward them, especially an emotional distancing, and a new feeling of hopelessness about the outcome. As the disease advances toward a terminal state, women grapple with the loss of their hopes, dreams, and future and with their feelings about dying.

Strategies for Nurses

Several strategies can make the oncology nurse more effective in helping patients cope with these changes, according to Dr. Fitch.

• Comprehensive physical and social assessment will aid in identifying each woman’s specific needs.

• Focusing on each patient as an individual will aid the nurse in getting the patient the help she needs.

• Being a sympathetic listener to the patient is crucial.

• The oncology nurse can provide patients with extensive and accurate information about side effects and other available resources and services.

Most importantly, Dr. Fitch advised, "don’t try to deal with all the issues on your own." Effective oncology nurses collaborate with all the other health care providers involved in the case. They know when their patients need referrals to other experts or services, and they provide them promptly.