The psychology of six physical illnesses

6: Link between gynaecological cancer and depression

Like other cancer patients, women with different types of cancer of the reproductive system have a higher risk of becoming depressed because they know they may have less time to live.

But such patients also have to grapple with problems concerning their sexual function and body image, said Dr Cornelia Chee, the director of Women's Emotional Health Service at the National University Hospital (NUH).

As the tumour may block or adhere to the intestines, part of the intestines may need to be excised and a stoma bag attached to the remaining gut - temporarily or permanently - to collect faeces.

Patients who feel a loss of their 'female identity' because they have to remove certain parts of their reproductive system may be at risk of depression.

Younger patients - especially those who had wanted to start a family and are no longer able to do so - may also be at risk of depression.

The NUH Women's Emotional Health Service started to screen in-hospital patients with gynaecological cancers in September 2008.

It has also been checking up on women during their pregnancy and after, since March 2008.

About 300 - close to 100 per cent - women with various types of gynaecological cancer such as cancer of the ovary and uterus, have since been screened.

Of these, about 5 to 10 per cent had depression and were referred to a psychiatrist.

Some also received emotional support from the case managers - trained nurses or psychologists who call them once or twice a week.

Every week, the psychiatrist meets the medical team as well as the medical social worker to discuss the cases.

The results of the team approach have been positive.

Though patients did not necessarily live longer with the psychological treatment, they reported having a better quality of life or a sense of well-being after six months.

One 52-year-old cancer patient said in her early days of depression, her case manager, a trained nurse, would call her every week to find out how she was doing.

She said: 'It felt good to have someone to talk to.'

At the encouragement of her case manager, the mother of two also picked up swimming.

She now swims every morning and is no longer on medication.

'My mood has improved and I feel much better now,' she said.