274 Psychosocial Oncology
women (i.e., whether they regard their sexuality in a positive
light) is a signi“cant predictor of sexual adjustment after
cancer, whereas women with a negative self-schema were
less likely to resume sex or have good sexual functioning
after treatment for gynecologic cancer (Anderson, Woods, &
Copeland, 1997).
Physical factors from the cancer treatment itself can
contribute greatly to the patient•s sexual dysfunctions.
Chemotherapy, radiation, surgery, opiate and pain medica-
tions, antidepressant or antipsychotic medications can cause
sexual dysfunctions, as well as infertility, in patients. For ex-
ample, in men receiving prostatectomies, 85% to 90% expe-
rience erectile impotence (von Eschenbach, 1986). Loss of
sexual desire may be a result of fatigue, pain, or weakness
secondary to the cancer treatment, depression, body image
concerns, and feelings of guilt or misbeliefs about the devel-
opment and spread of cancer (Schover, 1997).
Psychological Issues among Terminal Patients
Cancer patients in the terminal phases of illness are especially
vulnerable to both psychiatric and physical complications.
Suicide is also more prevalent during such advanced stages.
For example, Farberow, Schneidman, and Leonard (1963)
found that out of several hundred suicides studied, 86% oc-
curred in the preterminal or terminal stages of illness. Persis-
tent pain and terminal illness were also the most requested
reasons for wanting physician-assisted euthanasia (Helig,
1988).
Patients may go through a grieving process as they face
their own mortality and the impact of their death on family
and friends. Some patients may experience emotional dis-
tress including symptoms of guilt, anger, depression, and
anxiety. It appears to be the process of dying, more than death
itself, that is feared most by the cancer patient (Cramond,
1970). Fear may prevent patients from discussing these con-
cerns with their physicians or others. Weisman and Worden
(1976...1977) have found that terminal patients with cancer
who survived longer are those who believed that death was
not inevitable and refused to •let others pull away from
them.Ž Those with shorter survival, on the other hand, ex-
pressed suicidal ideation and often wanted to die.
Psychological Responses to Specific Cancer Treatments
Although the medical recovery from cancer during the past
several decades has improved, treatments for cancer still en-
gender a signi“cant amount of psychological distress. In fact,
oncology patients often describe medical treatment for can-
cer (i.e., surgery, BMT, radiation, chemotherapy) as •worse
than the disease itself.Ž In addition to the physical side effects
speci“c to the treatments, the psychological consequences
are taxing. The uncertainty after diagnosis and before treat-
ment is stressful, as well as the fact that treatments are costly,
time-consuming, and impact negatively on the patient and his
or her family•s quality of life. For example, cancer treatments
may dictate when patients have to be admitted to the hospital
or they may require frequent outpatient visits. While in the
hospital, patients have schedules dictating when they can eat,
shower, take medications, or have visitors. Thus, it is not
uncommon for patients with cancer to experience a loss of
personal control.
The impact of cancer treatments has long-term conse-
quences as well. Individuals may experience adverse side
effects many years after the treatment. These include organ
dysfunction or failure, infection, bone deterioration,
cataracts, or even a secondary diagnosis of cancer (Knobf,
Pasacreta, Valentine, & McCorkle, 1998). For example, Byrd
(1983) found that as a result of certain treatments being car-
cinogenic, the incidence of developing a second malignancy
20 years after treatment is approximately 17%, about 20
times that of the general population. Common psychosocial
consequences related to various cancer treatments are dis-
cussed next.SurgerySurgery can be very stressful for the patient and family be-
cause of the diagnostic and prognostic information that fol-
lows most procedures. Also, surgery can result in scarring or
tenderness in the site of operation, impeding functioning as
well as patients• appraisal of their attractiveness (Jacobsen,
Roth, & Holland, 1998). Strain and Grossman (1975) identi-
“ed several patient concerns that can be elicited before
surgery„threats to your sense of personal invulnerability ,
concerns about entrusting your life to strangers, fears about
separating from home and family members, fears of loss of
control or death while under anesthesia, fears of being par-
tially awake during surgery, and fears of damage to body
parts.
There are often psychological reactions related to the site
of surgery or to the loss of a particular function, such as bowel
function as a result of a colostomy. Often these negative emo-
tional reactions arise from the signi“cance of the loss, espe-
cially when involving the face, genitals, breast, or colon. For
example, research suggests that women receiving a mastec-
tomy are likely to suffer from body image disturbance and
sexual and marital disruptions (Mock, 1993). In addition,
patients undergoing head and neck surgery must cope with
subsequent speech, taste, sight, and smell impairments. The