How can ovarian cancer patients relieve their psychological pain?

Liu Ling, a national anti-cancer star and president of the Cancer Rehabilitation Association of Henan Life Care Association, talked about her feelings when she was suffering from cancer: she had persistent abdominal pain and was diagnosed with ovarian cancer. Fear overwhelmed her heart, she couldn't sleep all night, and kept crying.

By chance, she attended a star anti-cancer lecture held by Zhengzhou Anti-Cancer Club. The anti-cancer stars were full of energy and high spirits. This rekindled her desire for health and life and she embarked on a positive anti-cancer journey.

Ovarian cancer is one of the most common malignant tumors in women, and its mortality rate ranks first among gynecological tumors. Due to its hidden early stage of onset, most patients are already in the late stage of tumor when obvious symptoms appear, which seriously threatens women's physical and mental health.

Studies have found that the incidence of depression and anxiety in ovarian cancer patients is significantly higher than that in healthy women.

The possible reasons are:

1. Cancer, as an adverse stress event, causes stress reactions in patients. Patients may have the following symptoms: anxiety, depression, emotional instability, irritability, sleep disorders, lack of concentration, unwillingness to communicate with others, etc. In addition, uncertainty in treatment and concerns about prognosis will also increase their mental burden.

2. Most ovarian cancer patients have a long course of illness. After surgery and chemotherapy, they experience changes in their image, hormonal imbalances, and side effects from chemotherapy. These can cause great psychological pain to the patients and make them feel inferior.

3. Ovarian cancer has a long course of disease and is expensive to treat, which increases the financial burden on the family and makes patients prone to feeling guilty and self-blaming.

4. Ovarian cancer has a poor prognosis, which can easily lead to pessimistic and hopeless negative thoughts in patients. These unhealthy mental states bring great pain to patients and seriously reduce their quality of life.

Research suggests that actively paying attention to and intervening in patients' psychological conditions can significantly alleviate their pain and improve their quality of life.

Here are a few easy-to-follow tips that have been shown to help relieve anxiety and depression in ovarian cancer patients and help improve their quality of life.

01 Increase physical activity

The study found that most ovarian cancer patients had significantly reduced physical activity from before to after diagnosis, and physical activity after diagnosis was also significantly insufficient. At the same time, the results also found that higher levels of physical activity in ovarian cancer patients were significantly associated with lower levels of anxiety and depression, and higher quality of life. Physical exercise is safe and feasible for ovarian cancer patients during and after treatment. Therefore, physical exercise is very beneficial to the physical and mental health of ovarian cancer patients.

Therefore, we recommend that ovarian cancer patients should actively participate in physical exercise. So how should ovarian cancer patients exercise? There are currently no specific guidelines for ovarian cancer patients, but the American Cancer Society has convened experts in the fields of nutrition, physical activity, and cancer to develop nutrition and physical activity guidelines for cancer patients, which can be used as a reference.

First, patients receiving chemotherapy and radiation therapy may only be able to exercise at a lower intensity or for shorter periods of time during treatment, but they should also maintain as much activity as possible. For patients who were sedentary before diagnosis, low-intensity activities such as stretching and slow walking should be adopted and gradually increased. For older people, those with bone metastases or osteoporosis, or severe injuries such as arthritis or peripheral neuropathy, attention should be paid to balance and safety to reduce the risk of falls and injuries. Regular physical activity is essential during the recovery period after treatment to help the recovery and improve the fitness process.

Secondly, a large number of studies have shown that physical activity after a cancer diagnosis can reduce the risk of cancer recurrence and improve overall survival in a variety of cancers (including ovarian cancer and breast cancer). Considering the particularity of the physical constitution of cancer patients, it is necessary to pay attention to the following in practice: patients with severe anemia should delay exercise (except for daily life activities) until the anemia is corrected, and patients with impaired immune function should avoid activities in public places until their white blood cell count returns to a safe level. For patients with severe fatigue and weakness, they can be encouraged to do 10 minutes of light exercise every day. Patients undergoing radiotherapy should avoid irradiating the skin and contacting it with chlorine (such as swimming pools), and patients with indwelling catheters or feeding tubes should avoid contact between the catheter and swimming pools, water, and other factors that may cause infection, as well as avoid catheter slippage when exercising the muscles in the catheter area.

Finally, the guidelines recommend resuming normal activities as soon as possible after diagnosis or treatment. Adults aged 18 to 64 should engage in at least 150 minutes per week of moderate-intensity, or 75 minutes per week of vigorous-intensity, aerobic physical activity.

Moderate-intensity activities include brisk walking, slow cycling, slow swimming, rowing, baseball pitching, softball, volleyball, doubles tennis, etc. A simple way to judge is that you can talk and chat during the activity, but you cannot sing. High-intensity aerobic sports activities include fast cycling, farming, mountain climbing, rope skipping, martial arts, race walking, jogging, basketball, football, fast swimming, singles tennis, etc. A simple way to judge is that you can only speak short sentences of a few words during the activity, and you cannot talk and chat. Even if you cannot fully complete the above-mentioned intensity activities, a small amount of activity can also bring benefits. Within the scope of physical strength, the more activities, the better, and exceeding the above amount of activities can bring additional benefits. Each activity should last at least 10 minutes and be distributed as evenly as possible throughout the week.

In addition, adults should perform muscle-strengthening exercises that involve all major muscle groups at least 2 days per week. Adults over 65 should also follow these recommendations, as long as their physical ability allows. If chronic conditions limit activity, older adults should try to be as physically active as possible and avoid prolonged periods of physical inactivity.

02 You need to learn some methods to understand your own psychological condition

Here are two easy-to-learn self-rating scales: the Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS). Please note that these two scales are used to assess an individual's subjective feelings over the past week. Score based on the frequency of symptoms: no or very little time, a small part of the time, quite a lot of the time, most of the time, or all of the time.

If it is a positive scoring question, the score is 1, 2, 3, 4 points. If it is a negative scoring question (in bold), the score is 4, 3, 2, 1. The self-assessment scale cannot replace the doctor's diagnosis. If you find a problem, seek help from a professional doctor in time.

Self-Rating Anxiety Scale (SAS)

01 I feel more nervous and anxious than usual

02 I feel scared for no reason (scared)

03 I get easily upset or panicky (panic)

04 I feel like I might go crazy (crazy feeling)

05 I feel that everything is fine and nothing bad will happen (premonition of misfortune)

06 My hands and feet are shaking (trembling hands and feet)

07 I suffer from headaches, neck pain, and back pain (body pain)

08 I feel easily weak and tired (fatigue)

09 I feel calm and have an easy time sitting still (akathisia)

10 I feel my heart beating very fast (palpitations)

11 I am troubled by bouts of dizziness (dizziness)

12 I have fainting episodes or feel like I am going to faint (syncope)

13 It is easy for me to breathe in and out (dyspnea)

14 I have numbness and tingling in my hands and feet (tingling in hands and feet)

15 I suffer from stomachache and indigestion (stomachache, indigestion)

16 I often have to urinate (frequent urge to urinate)

17 My hands are often dry and warm (excessive sweating)

18 My face gets red and hot (facial flushing)

19 I fall asleep easily and have a good night's sleep (sleep disturbance)

20 I have nightmares (nightmare)

Score the frequency of symptom occurrence as 1 2 3 4 (not all of the time, very little of the time, a small amount of the time, quite a bit of the time, most of the time, or all of the time). 4 3 2 1 in bold.

Self-rating depression scale (SDS)

01 I feel down and depressed (depressed)

02 I think the morning is the best time of the day (heavier in the morning and lighter in the evening)

03 I have bouts of tears or feel like crying (tearful)

04 I don’t sleep well at night (sleep disorder)

05 I eat as much as usual (loss of appetite)

06 I feel just as much pleasure as before when I have close contact with members of the opposite sex (decreased sexual interest)

07 I noticed that I was losing weight (weight loss)

08 I have constipation (constipation)

09 My heart beats faster than usual (palpitations)

10 I feel tired for no apparent reason (tired easily)

11 My mind is as clear as usual (difficulty thinking)

12 I don’t find it difficult to do things I normally do (decreased ability)

13 I feel uneasy and can't calm down (uneasy)

14 I have hope for the future (despair)

15 I get more angry and excited (irritable) than usual.

16 I find it easy to make decisions (difficulty in making decisions)

17 I feel that I am a useful person and that someone needs me (sense of uselessness)

18 My life is very interesting (life feels empty)

19 I think other people would be better off if I died (feelings of worthlessness)

20 I am still interested in things that I normally enjoy (loss of interest)

References

1. Watts, S., et al., Depression and anxiety in ovarian cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open, 2015. 5(11): p. e007618.

2. Zheng Ke, How should breast cancer patients exercise? Health Care News. 2020(09): p. 145.

Wang Yun and Gao Yan'e from Shanghai Jiao Tong University School of Medicine Mental Health Center

Wang Yun. Attending physician at Shanghai Mental Health Center, master's degree. Has been engaged in clinical diagnosis and treatment of psychiatric diseases and teaching of medical students for a long time.

Expertise: Clinical diagnosis and treatment of depression and anxiety disorders, neurosis, schizophrenia, and consultation on general psychological issues such as study, work, marriage, etc. Excellent teaching teacher of Shanghai Medical College, Fudan University in 2019. Secretary of CSNP Chinese Depression Researchers Alliance, the first author has published more than ten papers in domestic and foreign journals.

Gao Yan'e, Master of Medicine, resident physician at the Mental Health Center affiliated to Shanghai Jiao Tong University School of Medicine.

Research direction: Diagnosis and treatment of psychosomatic diseases.

Funded by Shanghai Science and Technology Commission's Science Popularization Project

(Project No.: 20DZ2311100)