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Should Every Woman with Gynecologic Cancer Undergo Routine Screening for Psychological Distress and Sexual Dysfunction?

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Controversies in the Management of Gynecological Cancers

Abstract

Arguments in support of and against routine screening for psychological distress, including depression, and sexual dysfunction among women with gynecologic cancer are considered. Proponents of universal screening note the high prevalence of distress and the options for successful treatment of such distress if detected. Patient-initiated or oncologist-determined detection of distress, however, is highly unreliable and the distress of many patients goes unrecognized. Routine use of self-report screening instruments to rapidly and prospectively identify those patients who are struggling with the challenges of cancer diagnosis and treatment is promoted as the most efficient solution to providing equitable access to psychosocial and mental health care in oncology settings. Critics of universal screening point to the absence of data on the practical utility of screening and provide evidence suggesting that screening is an inefficient method of improving patient well-being. Systematic evidence demonstrating the benefits of screening for distress in general or depression specifically are lacking. Potential harms of screening have not been considered. We conclude that stronger, high-level evidence demonstrating that routine screening results in better outcomes is needed before such programs will or should be broadly adopted. In relation to screening for sexual dysfunction, the situation is not much different. Sexual dysfunction is frequent among survivors of gynecologic cancer and is related to emotional changes, as well as physical changes in vaginal function and hormone status, mainly premature menopause. The effects in some patients significantly impair quality of life for years. Patients and physicians are often reluctant to discuss these issues openly; therefore a screening questionnaire would be of benefit to select patients who need further evaluation and treatment. A variety of treatment options have been described. Unfortunately, there is no consensus regarding the best questionnaire to use; reports in the literature often contain only a limited number of patients with various malignancies in different stages of survival, and there are very few randomized studies evaluating treatment outcomes. In addition, only limited resources are available. For these reasons, we conclude that at this time, universal screening cannot be recommended. More research is definitely needed; however, we still encourage physicians to at least ask their patients about sexual function.

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Authors and Affiliations

  1. Centre for Women’s Mental Health, Royal Women’s Hospital, Corner Grattan Street and Flemington Road, Parkville, 3052, VIC, Australia

    Lesley Stafford MA (Psych), MPsych (Clin), PhD

  2. Oncology, Carolinas Medical Center, 100 Medical Park Drive, Suite 110, Concord, NC, 28025, USA

    Brigitte Miller MD

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  1. Lesley Stafford MA (Psych), MPsych (Clin), PhD
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  2. Brigitte Miller MD
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Correspondence to Lesley Stafford MA (Psych), MPsych (Clin), PhD .

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Editors and Affiliations

  1. UCL Cancer Institute, University College London, London, United Kingdom

    Jonathan A. Ledermann

  2. Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands

    Carien L. Creutzberg

  3. Royal Women’s Hospital, The University of Melbourne, Melbourne, Australia

    Michael A. Quinn

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Stafford, L., Miller, B. (2014). Should Every Woman with Gynecologic Cancer Undergo Routine Screening for Psychological Distress and Sexual Dysfunction?. In: Ledermann, J., Creutzberg, C., Quinn, M. (eds) Controversies in the Management of Gynecological Cancers. Springer, London. https://doi.org/10.1007/978-0-85729-910-9_27

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