Quality of life
Psychotherapy eases emotional anxiety
Although gestational trophoblastic disease is a rare illness, it has one of the highest cure rates for solid tumors in the female reproductive system. That makes it suitable for longterm studies on the emotional impact of cancer treatment in women of childbearing age.
Because the New England Trophoblastic Disease Center at Dana-Farber/Brigham and Women's Cancer Center has the largest registry in the Western hemisphere of patients with this illness, it was the logical choice for a quality-of-life study funded by the National Cancer Institute. The aim was to evaluate the emotional health of trophoblastic disease patients who are cancer-free five to 10 years after chemotherapy.
"Trophoblastic disease is unusual in that, unlike many adult solid cancers, it is curable with chemotherapy," explains Ross Berkowitz, MD, director of gynecologic oncology services at the Gillette Center for Women's Cancers at Dana-Farber and co-director of the trophoblastic disease center with founder Donald Goldstein, MD. "Not many cancers are eradicated this way, and those that are tend to be in children. This study provided an opportunity for us to look at long-term psychological and emotional consequences for women who knew the odds were in their favor and their fertility would likely be maintained."
Affecting 1 in 1,500 pregnancies, gestational trophoblastic tumors (GTTs) are formed by a group of related diseases arising in placental tissue. The disease grows in the placenta after conception and can spread to other parts of the body.
The center has followed more than 3,000 patients diagnosed with trophoblastic disease since 1965, and is recognized internationally as one of the foremost sites for advancing the understanding and treatment of GTTs.
The most striking finding of the study was that survivors remained anxious despite being cured. The anxiety level was lower in those who received early counseling. Many women underwent psychotherapy after their diagnosis and during their treatment, but, years later, still felt frightened about trying to get pregnant or concerned about their ability to have healthy kids.
Patients in the research group were asked if they would interested in participating in a counseling program now, even after they had been cured for many years; 51 percent said yes.
"This is significant," says Berkowitz, "because it emphasizes half of all patients — despite being cured — still felt they needed professional help."
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