Psychological Study of Patients with Lung Cancer

6.5. Psychological Study of Patients with Lung Cancer

Pestereva E.V., Chulkova V.A.

With regard to lung cancer, there is a firmly established belief about the influence of social factors and lifestyle on its onset. It may be assumed that people who have developed lung cancer, unlike patients with tumors of other localizations, may associate the onset of the disease with their lifestyle and harmful habits. This, in turn, may affect their perception of and attitude toward the illness.

Ninety-nine patients with lung cancer (76 men and 23 women) were studied at the stage of primary treatment at the thoracic department of the N.N. Petrov Research Institute of Oncology and at the Russian Scientific Center for Radiology and Surgical Technologies (RSCRST). Using the clinical-psychological method (observation, clinical interview), the substantive aspect of the patients' experiences was studied (Appendix 4). The experimental-psychological method was aimed at identifying neurotic symptoms in the patients (INDR-SI) and the type of their attitude toward the illness (TOBOL), as well as at studying the patients' internality, including in the domain of health (LSC) (Appendix 4).

As a rule, patients discovered their disease as a result of a routine examination (at work) after undergoing fluorography, or they consulted a physician on their own with complaints of ARVI symptoms (cough, shortness of breath, high fever) or other complaints (arrhythmia, pain in the lower back, joints). In the latter case, the initial diagnosis was often pneumonia, and only after some time was the patient referred for examination with suspicion of a cancerous disease. A neglected

cold or pneumonia was, in the patients' opinion, the cause of the disease in 32% of cases.

The malignant nature of their disease was accepted («cancer», «lung cancer», «oncology», «life can be prolonged, but it cannot be cured, because cancer is cancer») by 26.3% of patients; the malignant nature of the disease was denied («just a tumor», «a little something», «polyps», «I don't know the diagnosis», «some kind of shadow in the lungs») by 47.4% of lung cancer patients. In 26.3% of patients, the malignant nature of their disease was partially acknowledged. On the one hand, patients spoke about their disease, pointing to the severity of the forthcoming treatment; on the other hand, they were prone to statements such as: «They should let me go home, it can't be that everything is so serious,» and they offered their own versions of the disease.

Half of the patients (50%) believed that the onset of the disease was somehow related to smoking, 29% – to stress and nervous tension over the course of their life, 29% – to harmful working conditions, 13% – to exposure to various (non-cigarette) carcinogens («bad water», «medicines at the pharmacy are fakes»), 8% – spoke of heredity («my father and brother died of cancer»). At the same time, 32% of the examined patients indicated that «looking for causes just clutters your mind.» These same patients noted that «there is no need for extra information about the disease; what the doctor reports is enough.»

The majority of patients (71%) expressed their attitude toward treatment as follows: «one must not despair,» «I will try to get treatment and not change the pace of my life.» The remaining 29% indicated that treatment of the disease was associated with great uncertainty; they complained of a depressive state, of «apathy – you'd have to drag me by a rope.»

A quarter of the patients (24%) noted that their life had changed significantly because of the disease («my circle of contacts has narrowed,» «I'm not earning money,» «I was very abruptly dismissed from work,» «a lot has changed, I can't walk»), while 55% of patients indicated minor changes («I quit smoking,» «something has changed, it seems»).

The study of the features of reacting to the disease (TOBOL) revealed a conditionally adaptive attitude toward the illness in 53.5% of patients, with the ergopathic type predominating, which indicates a striving to continue one's usual active life and to work despite the illness. In patients with a maladaptive attitude toward the illness, the anxious, sensitive, mixed, and diffuse types predominated.

Analysis of the results of the attitude toward the illness showed that in patients who denied the malignant nature of the disease and in patients who accepted the malignancy of their disease, adaptive types of attitude toward the illness predominated (61.5% and 55.3%, respectively). With partial acknowledgment of the malignant nature of the disease, a maladaptive attitude toward the illness was revealed in the majority of patients (57.6%).

Analysis of the results of the severity of neurotic symptoms (INDR-SI) showed a predominance in patients of the following neurotic-spectrum complaints: sleep disorders, asthenia, affective lability, affective tension, hypochondriasis, and somatovegetative disorders. This symptomatology was more pronounced in patients with partial acknowledgment of the malignant nature of the disease, compared with those who denied the malignant process of the disease (p<0.005). In patients with denial, in 81% (20 persons) of cases the severity of neurotic symptoms was low. With acknowledgment of the malignant process, neurotic symptoms had a high level of severity in 6% (3 persons) of patients and a moderate level in 47% (22 persons) of patients, which was adequate under the conditions of the disease and its acknowledgment by the patient.

The study of internality (LSC) showed that, on the whole, lung cancer patients have reduced scores on the internality scale in relation to health and illness (3–4 stens), even if their scores on the general internality scale were high (5 stens and above). Patients did not perceive themselves as responsible for their health and treatment, but relied on other people, primarily on physicians. At the same time, a reduced and

low locus of control of the personality was characteristic precisely of patients with denial and partial acknowledgment of the malignant nature of the disease, which suggests such personality features as insecurity and emotional instability, that is, a lack of faith in one's own strength and resources. Thus, in the majority of patients who denied and partially acknowledged the malignant nature of the disease (65% and 73%, respectively), scores were low both for general internality and for internality in the domain of health. These patients perceived the state of their health as depending on external influences and chance rather than on their own lifestyle; they did not take responsibility for their health and life as a whole, but were treated «because that's what has to be done» and preferred dependence on physicians.

At the same time, 70% of patients who acknowledged the malignant nature of the disease were characterized by a moderate general level of internality, which is associated with such personality features as emotional stability, confidence, social activity, and self-respect. Of these, 59.6% showed a moderate level of internality in the domain of health. These patients allowed for a causal relationship between their actions, the disease, and the possibility of recovery, and were aware of the role of their own conscious activity in the treatment process. Acceptance of a disease with a vital threat is associated with the patient's responsibility for their life and health, and with the ability to be aware of what is happening in their life and to understand their condition.

Thus, in lung cancer patients who deny the malignant nature of the disease, a conditionally adaptive attitude toward the illness and a low severity of neurotic symptoms were revealed in most cases. Denial, which is an unconscious defense of the personality, softens the patient's psychological traumatization in connection with the disease and its treatment but, at the same time, hinders the assimilation of information and the acceptance of the illness. These patients are not inclined to bear responsibility for their health and

life as a whole. This position contributes to an inadequate attitude of the patient toward the disease, complicates their relationships with loved ones (especially in a situation of worsening condition), and forms emotionally dependent relationships with those around them, including with medical staff. Excessive accommodation by the physician of the patient's defensive reactions, and joint denial of the malignancy of the disease, may lead to a breakdown of communication, to isolation, and to loneliness of the patient.

In the majority of patients with partial acknowledgment of the malignant nature of their disease, pronounced neurotic symptoms and a maladaptive attitude toward the illness are diagnosed. The rapid destruction of the personality's psychological defense made them very vulnerable. A low level of internality does not allow them to mobilize new resources, both internal and external.

Patients who acknowledge the malignant nature of their disease are characterized by a moderate level of general internality: a responsible attitude toward the events of their life facilitates the acceptance of reality. The patients' internality in the domain of health indicates that they relate to the treatment process consciously and take responsibility in order to analyze their lifestyle and the feelings that do not facilitate treatment.

6.6. Psychological Study of Patients with Prostate Cancer

Vagaitseva M.V.

At present, the age structure of prostate cancer (PC) has changed both worldwide and in Russia: over the past 15 years, the number of affected men aged 50–55 years has doubled. The latent course of the disease, as a rule, leads to surgical intervention

– prostatectomy. In doing so, the non-specific experience of having cancer in PC patients, which is characteristic of all cancer patients and associated with the threat to life, is, as a rule, supplemented by an emotionally significant experience of a threat to sexual competence. After the operation, the patient must adapt not only to the changes directly related to the cancer (drug-related intoxication, asthenia, the possibility of recurrence), but also to the specific consequences of treatment, which gives rise to a whole gamut of psychological problems that the patient faces after the operation.

A total of 107 men with prostate cancer at various stages of the disease and treatment were studied: 37 persons in the process of treatment, 35 persons in remission of 3 to 10 years, and 35 persons at the stage of palliative treatment. The distribution by age was as follows: from 48 to 63 years –

30.8%, from 64 to 72 years – 38.3%, and from 73 to 84 years – 30.8%. The study was conducted at the N.N. Petrov Research Institute of Oncology and at Hospice No. 1 (Lakhta, St. Petersburg).

The majority of patients did not experience physical discomfort at the moment of the cancer diagnosis: 89% learned of their disease by chance.

At the same time, 84% of the men describe strong distress associated with the discovery of the disease; the remaining patients, in their own words, relate to the disease calmly or deny any distress in connection with the cancer.

The majority of patients (76.6%) relate calmly to the diagnosis itself («this can happen to anyone»); a feeling of shame is experienced by

6.5% of patients, a feeling of fear is experienced by 4.7% of patients, and some patients (2.8%) exhibit a heroic experience. Statistically significant differences were found depending on 1) age: in the group of 64 to 72 years, the answer «this can happen to anyone» was chosen less often than in the group of 73 to 84 years, and 2) the stage of the disease's development: the answer «this can happen to anyone» was chosen more often in the remission group than in the treatment and palliative treatment groups, while the answer «it doesn't matter» was chosen less often in the remission group than in the palliative group.

Clinical-psychological method

A predominant number of patients (71%) believe that the decision to perform the operation belongs exclusively to the physician, and that they were merely forced to submit to the physician's decision. A quarter of the patients

(29%) note that, after the physician's information, they themselves took part in making the decision about the operation.

The distribution of the patients' opinions about the difficulties of the disease period turned out to be roughly equal: 29.9% of patients considered the choice of treatment the most difficult period, 26.2% – the recovery period, 24.3% – the period after the operation, and 19.6% of patients – the period of establishing the diagnosis. Patients who have been in remission for more than 3 years and are over 65 years of age demonstrate acceptance of their disease and its associated consequences. Patients aged 48 to 65 years describe anxiety in connection with the consequences of the disease, note a feeling of resentment, or suppress their feelings: «I try not to think about it.»

For more than half of the patients (55.1%), the most important factor was their own character; the support of their wife proved very important for 28.0% of patients; and being informed about the disease supported 12.1% of patients. Most of the patients surveyed have been married for more than 30 years. They rate relationships in the family as good, with a high level of mutual understanding (86.0%). They note that relationships in the family did not change after the disease (67.3%), and for some

they even improved (29.9%). They feel that they are loved (48.6%) and supported (29.6%) in the family, and that they are needed by the family (25.1%). Only 5.7% of patients believe that their loved ones are merely doing their duty («I'm a burden,» «nobody needs me like this»). Practically all of them (89.7%) note that the wife plays a leading role in the family of a prostate cancer patient. She bears responsibility not only for resolving family and household matters, but also for resolving difficulties and problems in the patient's life. During the interview, single men demonstrate a higher level of anxiety.

The attitude toward the disease changed: in 42.1% of patients it improved,

and it worsened in only 7.5% of patients. In 31.8% of patients, the attitude toward the disease remained unchanged, while 18.7% of patients avoid thinking about the disease. Statistically significant differences were found in the choice of the answer «it worsened.» The attitude toward the disease worsened in the palliative treatment group.

Life did not change as a result of the disease in 34.6% of patients, while 31.8% of patients changed their lifestyle. A change in relationships was noted by

6.5% of patients. Physical pain appeared in 16.8%, and emotional distress in 10.3% of patients. Statistically significant differences between the groups were distributed as follows: 1) in the palliative treatment group, the answer «no changes» was chosen more often than in the treatment group; 2) in the treatment and remission groups, the appearance of physical pain was reported more often than in the palliative treatment group.

Changes in life are viewed calmly by 31.8% of patients; anxiety and unease are experienced by 23.4% of patients, and fear and despair by 7.5%.

At the same time, fear and despair arise more often in the treatment group than in the remission group (p<0.05), while anxiety and unease arise more often in the remission group than in the palliative group (p<0.01).

Experimental-psychological method

The profile of attitude-toward-illness types for the entire sample shows that the ergopathic component of the attitude toward the illness has the highest mean scale score (56.1%). This indicates a striving of patients

to continue active activity. The anosognosic component, second in magnitude of scale score (45.%), indicates a striving to suppress the fact of the disease. The third-largest component of the scale score – the harmonic one (39.3%) – indicates adaptation to the changes associated with the disease. The further distribution of mean scale scores in the sample is as follows: anxious (15.9%), hypochondriac (14%), neurasthenic (10.3%), egocentric (8.4%), apathetic (7.5%), paranoiac (6.5%), sensitive (4.7%), and melancholic (1.9%).

Ammon's Ego Structure Test

Only 84 persons were tested; the test is very lengthy, so it was not offered to some patients with pronounced anemia from the palliative treatment group. Ammon's Ego Structure Test indicates the level of the patient's adaptation to the disease situation: normal or impaired. On this basis, all patients were divided into two groups: group 1 (61.6%) – a normal level of adaptation to the disease situation; group 2 (38.4%) – an impaired level of adaptation to the disease situation.

After mathematical-statistical processing of the data, statistically significant differences were obtained between group 1, with a normal level of adaptation to the disease, and group 2, with an impaired level of adaptation to the disease, according to the following psychological methods and tests:

Clinical interview

Patients of group 1, with a normal level of adaptation, were characterized by the fact that they, more often (26.4%) than patients of group 2 (0%), related to the disease as an event that can happen to anyone. In group 1, the presence of sexual dysfunction was noted less often (49.1%) than in group 2 (87.9%). Patients of group 1 more often had a job or a pension, which gave them social status, occupation, and financial security. Patients of group 2 did not have jobs.

Type of attitude toward the illness (TOBOL)

The anosognosic type of attitude toward the illness, which indicates denial of the malignant nature of the disease or its suppression, is more characteristic of patients of group 1 (62.3%) than of patients of group 2 (30.3%). Conversely, the hypochondriac component of the attitude toward the illness is represented more often in patients of group 2 (21.2%) than in patients of group 1 (5.7%). This circumstance indicates that patients of group 2 more often experience unease and distress in connection with the disease.

Level of subjective control of the personality (LSC)

Patients of group 1 show higher internality (2.36+0.11); they, more often than patients of group 2 (2.03+0.13), take responsibility for failures.

Semantic Differential of Time

Patients of group 1 (6.07+0.41) perceive their past more positively than patients of group 2 (4.05+0.90), and it is better structured for them (5.08+0.76 and 2.33+1.19, respectively).

Dembo-Rubinstein Self-Esteem Scale

According to this method, a greater number of patients in group 1 than in group 2 consider their disease curable, and they are more strongly supported by their family. On the whole, the self-esteem of patients in group 1 is higher, including in the categories of «intelligence» and «character.» They more often experience a feeling of joy.

Thus, a comparison of the study results allows the following conclusions to be drawn:

Patients with a normal level of adaptation are characterized by an anosognosic type of attitude toward the illness, a positive attitude toward the past, and higher self-esteem.

In the group of men in the process of treatment, a reduced level of self-acceptance, acceptance of one's achievements and competence, a sense of insufficient attractiveness of one's personality to those around one, and moderate social dependence are noted. There is a tendency toward

the emergence or current presence of anxious, depressive, and asthenic states. This correlates with the physical state of the postoperative period, the initial period of adaptation to the changes associated with the disease.

Patients who have been in remission for more than 3 years demonstrate acceptance of their disease and its associated consequences.

Patients aged 48 to 65 years describe anxiety in connection with the consequences of the disease, note a feeling of resentment, or suppress their feelings – «I try not to think about it.» Men, for the most part, describe the distress associated with sexual dysfunction sparingly. Most often, the word «resentment» is heard in this connection. In cases of a calm attitude toward the consequences of the operation, they describe a natural fading of sexual function by the time of the diagnosis.

The state of their health is considered by 92% of the study participants as depending on external influences and chance rather than on their own lifestyle. In the first year of the disease, they associate the possibility of recovery predominantly with the activity of physicians or with a favorable course of circumstances; during treatment, they orient themselves toward methods that do not presuppose the active participation of the patient. In prolonged remission, most of those studied demonstrate a striving to overcome the disease, a rejection of the «sick» role, restoration of the value structure, and active social functioning without distinct manifestations of psychological

and social maladaptation.

Based on the results of the study, it can be concluded that the compensating factors in the attitude toward the disease in prostate cancer patients are the patient's personality features, the patient's family status and the support of his wife, as well as the elderly age of the affected man.

6.7. Psychological Study of Patients with Oncogynecological Pathology

Pestereva E.V., Chulkova V.A. Oncogynecological cancer carries a threat of psychological

traumatization for the affected woman. The content of the psychological trauma for women with oncogynecological pathology consists not only of the fear of a disease with a vital threat, but also of the so-called «feminine factor,» which includes the fear of losing femininity in connection with the loss of the organs that symbolize it, the fear of the breakup of the family, and, in young women, the fear of losing reproductive function. In addition, the localization of the oncological process in hormone-dependent and hormone-producing organs often causes the development of a psychoendocrine symptom complex with specific clinical manifestations. As a result, women with this pathology experience severe emotional distress.

At the oncogynecological department of the N.N. Petrov Research Institute of Oncology, medical psychologists examined 41 female patients aged 19

to 45 years with diagnoses of cervical cancer (CC), cancer of the uterine body (CUB), and ovarian cancer (OC), with stages I, II, and III of the disease (34.1%, 34.1%, and 31.8%, respectively) at various stages of the disease: 15 persons – «before the operation,» 26 persons – «after the operation.» The majority of the examined women had higher and incomplete higher education (60.9%), were employed (82.9%), were married (68.3%), and were mothers (75.6%).

Using the clinical-psychological method (observation, clinical interview), the substantive aspect of the female patients' experiences was studied (Appendix No. 4). The experimental-psychological method was aimed at studying the features of the female patients' reaction to the disease (TOBOL), assessing their quality of life (EORTC QLQ-C30) and the severity of anxiety/depressive states (Hospital Anxiety and Depression Scale), as well as the nature and intensity of somatic complaints related to their health condition (Giessen Somatic Complaints Questionnaire) [1–2] (Appendix No. 5).

The clinical-psychological interview made it possible to identify the features of the female patients' attitude toward the illness (attitude toward the diagnosis and treatment, subjective perception of the illness), as well as to reflect their social-psychological situation in connection with the disease. Thus, despite the fact that 51.2% of women at the moment of diagnosis had no prior experience of illness

(«I didn't even have a medical record»), the majority of the examined female patients acknowledged the malignant nature of their disease: 60% – at the «before the operation» stage, 73% – at the «after the operation» stage. At the same time, at the «before the operation» stage, female patients without preoperative therapy more often believed that they had a «precancerous condition,» unlike those who had already undergone a course of therapy (p=0.03).

In 70.7% of cases, women believed that the onset of the disease was somehow related to their life history, noting a connection between the disease and their lifestyle. Analyzing their past, 63.4% of female patients believed

that the causes of their disease were psychogenic in nature and associated with stresses, distressing experiences, and family conflicts.

Female patients noted that they experience difficulties in communicating their diagnosis and health condition to other people. Moreover, the most difficult person to tell about their disease was their parents (41.5%), their husband (29.3%), and their neighbors (17.1%). However, 73.2% of female patients indicated that it was precisely informing their loved ones of what had happened that allowed them to receive support, especially during the period from the discovery of the disease to admission to the clinic.

The majority (65.9%) of female patients denied a change in family relationships in connection with the disease. Of the 68.3% of married female patients, 75% denied changes in their marital relationships: the husbands of these women behaved according to the pattern of behavior that had developed before the disease («everything as usual»). This denial reflects the fears of oncogynecological patients in connection with the disease; it may also be assumed that the husbands, in turn, are inclined to defend themselves against the psychologically traumatic fact of their wife's disease.

A strong fear of medical procedures was noted by 61% of the women: they were frightened by the state of helplessness that might arise in connection with treatment, and they feared the loss of feminine attractiveness (castration fear). The most severe and dangerous type of treatment (in the female patients' view) was chemotherapy. At the same time, 24.4% of patients exhibited a total fear («everything is frightening»). It should be noted that at the «after the operation» stage, female patients expressed more fears regarding treatment (they were frightened by helplessness, exhaustion, pain, disability) – the expectation of negative consequences associated with treatment created additional psychoemotional tension, which also manifested at the somatic level.

The study of the features of the oncogynecological patients' reaction to the disease (TOBOL) revealed in 39% of patients an attitude toward the illness without signs of impaired psychosocial adaptation, with

the ergopathic type predominating: these women strove, despite the illness, to continue active activity, including professional activity. In 61% of the patients, an attitude toward the illness with signs of psychosocial maladaptation was revealed: in 60% of female patients at the «before the operation» stage and in 73% at the «after the operation» stage. The maladaptive attitude toward the illness was for the most part represented by mixed and diffuse types. At the same time, in the structure of the attitude toward the illness in patients «before the operation,» the anxious component was pronounced: female patients felt uncertainty in connection with the forthcoming operation, listened to the conversations of women who had already been operated on, and worried about the consequences of the operation. Unlike them, in female patients at the «after the operation» stage, the dysphoric component was pronounced in the structure of the attitude toward the illness: dysphoria in the attitude toward the illness manifested in the form of irritability, angry outbursts, a gloomy mood, a feeling of envy toward the healthy, and dissatisfaction that treatment does not bring a distinct and rapid result. At the same time, women who were aware of their heightened irritability were inclined to explain their mood by climacteric manifestations in connection with treatment. Nevertheless, suffering reflected at the psychological level, regardless of its physiological component (for example, hormonal restructuring), is always emotional pain, which, having no constructive outlet, creates in the patient an inner tension and affects her attitude toward treatment, toward the illness, and toward life as a whole.

Analysis of the scale scores of the EORTC QLQ-C30 questionnaire did not reveal statistically significant differences in individual quality-of-life indicators of the female patients depending on the localization of the oncological process (CC, CUB, OC). Differences in quality of life were revealed depending on the stage of treatment of the disease: at the «before the operation» stage, women, regardless of whether or not they had undergone preoperative therapy, had higher scores of role (p<0.02) and cognitive functioning (p<0.03),

less pronounced symptoms of fatigue (p<0.01), pain (p<0.02), constipation (p<0.04), and also less frequently reported complaints of financial difficulties in connection with the disease (p<0.02).

The female patients' acknowledgment of the malignant nature of the disease was combined with lower scores on the «cognitive functioning» scale (p<0.01) and more pronounced symptomatic scales «fatigue» (p<0.02) and «loss of appetite» (p<0.03). The decrease in the quality of life of a cancer patient in the process of accepting the malignant nature of their disease is not unexpected: this is natural, because the patient experiences emotional suffering. Only through suffering does a person become capable of relating the history of their life to what is happening and of restoring the emotional equilibrium that was disturbed by the news of the disease. A connection was revealed between the quality of life of oncogynecological patients and their ability to find a subjective cause of their disease: patients who perceived the disease as «something external,» as «an event that fell on their head and defies comprehension,» as «something not from my life,» had lower scores on the

«physical functioning» scale (p<0.03).

Female patients with higher and incomplete higher education had higher scores on the «emotional functioning» scale compared with those who had secondary education (p<0.04). It may be assumed that a higher educational level of the patient is a predictor of her emotional competence in her own inner world: the woman is better oriented in the subjective space of her life and is aware of the significance of emotional work. Analysis of the literature confirms that the emotional state of a cancer patient is determined not only by the circumstances of the disease's onset and the treatment process, but also by the goals, motives, and values of the affected person.

Personal experience of previously suffered illnesses (non-oncological) did not significantly affect the female patients' quality-of-life scores. However,

the presence of experience interacting with a cancer patient was interrelated with a higher quality of life on the «emotional functioning» scale, compared with those who lacked such experience (p<0.04). Caring for a person in a situation of a disease with a vital threat is a presence in the space of strong experiences, which fosters the helper's contact with their own existentials.

The female patients' family status was reflected in their quality of life: women in a registered marriage had the highest scores on the «role functioning» scale, compared with those who were divorced or in a common-law marriage (p<0.002). In addition, female patients (34.1%) who noted that their family relationships had «become better and stronger» in connection with the disease had higher scores on the «role functioning» scale (p<0.01) and minimal scores on the «financial difficulties» scale of life, compared with those whose family relationships «did not change»: significant differences were found on the scales

«fatigue» (p<0.05), «pain» (p<0.03), «nausea» (p<0.01), «constipation»

(p<0.03), «diarrhea» (p<0.03). All this emphasizes that, for a person in a situation of illness, the family is one of the main resources. No statistically significant interrelations were found between quality-of-life scores and the presence of children in the women, but at the level of a trend it was noted that patients with children had higher scores on the functional scales – «social functioning,» «role functioning» («caring for children will pull you out of any state»).

However, they also had higher scores on the scales «fatigue,» «sleep disturbance,» and «financial difficulties.»

The study of anxiety and depression (Hospital Anxiety and Depression Scale) showed that pronounced anxiety symptoms were found in only 39% of women with oncogynecological pathology: in 24.4% of cases – subclinically pronounced anxiety, in 14.6% – clinically pronounced anxiety. In the majority of patients, however, both «before the operation» and

«after the operation,» the anxiety level score corresponded to normative indicators (70.1% and 71.5%, respectively). However, considering the severity of the anxious component in the structure of the attitude toward the illness, as well as the data of observation of the female patients, one may assume the existence in them of anxiety masked, as a result of unconscious psychological defense, under a «defensive optimism» beneath which severe negative emotions are hidden. Pronounced depressive symptoms (subclinical level) were diagnosed in 15.4% of patients at the «after the operation» stage.

The study of the oncogynecological patients' complaints regarding their health condition showed that complaints of an asthenic nature had the greatest severity – a feeling of weakness, fatigue, lethargy, drowsiness (the «exhaustion» scale). Asthenic symptoms are associated with the disease and its treatment, and may also indicate the female patients' need for emotional support. Along with asthenic complaints, «rheumatic» complaints predominated: pain in the lower back or back, in the neck or shoulder joints, headaches, a feeling of heaviness in the legs. These complaints, in the form of algic or spastic pains in various parts of the body, reflected the subjective suffering of the female patients. The intensity of asthenic and «rheumatic» complaints was higher in patients at the «after the operation» stage (p<0.05). Female patients at the «after the operation» stage, compared with the «before the operation» stage, expressed complaints regarding their health condition as a whole more intensely. Thus, the total integral indicator (the «complaint pressure» scale) was significantly higher in patients «after the operation» (14.7 points), compared with patients «before the operation» (7.7 points) (p<0.05).

The majority (68.3%) of female patients believed that the intensity and emotional coloring of their complaints regarding their health condition were associated with a psychological factor – strong negative experiences in connection with the disease. It was shown that these patients, unlike those who associated complaints regarding their health condition with

physical/physiological/hormonal factors, had a higher quality of life (p<0.05): expressing and understanding, and acknowledging the adequacy of, one's experiences allows the patient to feel control over her emotional state, which, in turn, is reflected in her quality of life.

It should be noted that oncogynecological patients are characterized by a high severity of so-called non-specific complaints, which were not included in the main scales of the questionnaire. Some of them reflected the specific nature of the course of the oncogynecological disease – pain in the lower abdomen, hot flashes and flushes, sweating, constipation and diarrhea, urinary urgency; while others – trembling, sore throat, sleep disorders, increased sensitivity to cold or heat, numbness of the extremities, a tendency to cry – attested to the psychosomatic component of the female patients' suffering. The severity of non-specific complaints had a negative interrelation with the patient's quality of life (p<-0.01).

Thus, when providing psychological assistance to oncogynecological patients, it is necessary to take into account the features of their attitude toward the illness at different stages of treatment of the disease, as well as the social-psychological status of the affected women.

6.8. Psychological Study of the Mother During the Treatment of Her Child in an Oncological Clinic

Chulkova V.A., Chernenko O.A., Pestereva E.V., Kuleva S.A.

A child's illness is a difficult life ordeal for parents. Especially strong experiences are characteristic of the parent who is directly with the child during their treatment in an oncological clinic. The above represents a danger of psychological traumatization of the parent.

Thirty-two mothers of children undergoing treatment at the R.M. Gorbacheva Institute of Hematology and Transplantology and at the department of chemotherapy and combined treatment of malignant tumors in children of the N.N. Petrov Research Institute of Oncology were studied. The clinical-psychological method, aimed at identifying the features of the mothers' personal reaction to the child's illness, and the experimental-psychological method were used: the Impact of Event Scale, the self-actualization test (SAT), and the questionnaire for diagnosing the mother's attitude toward the child's illness (DMAI) (Appendix 5).

The entire sample of mothers studied was divided into three groups, according to the level of traumatic stress described by N.V. Tarabrina (2010) in the «Impact of Event Scale» (IES) method:

Group 1 included mothers with a total IES score of up to 35, which can be considered a low level of impact of the traumatic event.

Group 2 – mothers with a total IES score of 36 to 50 points; the impact of the event is strong.

Group 3 – mothers with a total IES score above 51 points; the traumatic event is very strong.

Analysis of the clinical interviews and the mothers' questionnaire data revealed certain patterns. Thus, it was found that in mothers with an ultra-high level of psychological traumatization, the sick child was significantly more often the only child in the family and was undergoing treatment in connection with a recurrence of the disease. In addition, the majority of women in the group with an ultra-high level of psychological traumatization were from out of town. This circumstance created additional difficulties. The out-of-town mothers of sick children were isolated from their families, unlike mothers from St. Petersburg and the Leningrad Region, who could see their husband and other family members more often and who could sometimes care for the child on a «rotational» basis: the mother and father took turns staying at the clinic. Women from other cities of Russia, however, often said in the interview that the family now seemed to consist of two halves: «me and the child» and «everyone who stayed back there, at home.» These mothers often pointed out that, being in a strange city, they felt lonely and unprotected.

In the groups with different levels of psychological traumatization, a comparative analysis of the data obtained by the SAT assessment method and the diagnosis of the mother's attitude toward the child's illness (DMAI) was conducted. The Mann-Whitney rank U-test was used (Table 1).

Table 1 – Comparison of groups by the values of the indicators of the methods for assessing self-actualization and diagnosing the mother's attitude toward the child's illness

Analysis of the results obtained by the method for assessing the self-actualization of the mother of a sick child showed that mothers with a high level of psychological traumatization are inclined to express their feelings spontaneously and directly: the higher the degree of traumatic stress, the higher the expressiveness in behavior, which often manifests not in interaction with the child, but in relationships with other people, primarily with physicians; mothers with a high level of traumatization to a greater degree accept their irritability, anger, and aggression (p≤0.01). The study of the mother's attitude toward the child's illness (DMAI) revealed that mothers with a high level of traumatization feel powerlessness in the disease situation and an inability to influence the outcome of the illness, which increase as the duration of the child's illness grows, especially in the case of recurrence of the disease.

The general exhaustion of the mother, at both the psychological and physical levels, reduces her control over the child's behavior during the treatment process, which leads to a decrease in her responsibility and attests to her asthenization and depressive state. These mothers are oriented toward external support: the more tragically a woman perceives her child's oncological disease, the more she needs the support of her husband or family.

A correlation analysis of the obtained results showed that the parents' ability to cope with their emotional state is important for successful and timely treatment, since it largely determines the behavior of the sick child, and their attitude toward both the treatment and the physician.

Thus, a child's oncological disease is a traumatic event for mothers: in 68% of them, a high indicator of psychological traumatization was noted; the mothers' experiences determine their reactions and behavior, which the medical staff must take into account

Analysis of the results obtained by the method for assessing the self-actualization of the mother of a sick child showed that mothers with a high level of psychological traumatization are inclined to express their feelings spontaneously and directly: the higher the degree of traumatic stress, the higher the expressiveness in behavior, which often manifests not in interaction with the child, but in relationships with other people, primarily with physicians; mothers with a high level of traumatization to a greater degree accept their irritability, anger, and aggression (p≤0.01). The study of the mother's attitude toward the child's illness (DMAI) revealed that mothers with a high level of traumatization feel powerlessness in the disease situation and an inability to influence the outcome of the illness, which increase as the duration of the child's illness grows, especially in the case of recurrence of the disease.

The general exhaustion of the mother, at both the psychological and physical levels, reduces her control over the child's behavior during the treatment process, which leads to a decrease in her responsibility and attests to her asthenization and depressive state. These mothers are oriented toward external support: the more tragically a woman perceives her child's oncological disease, the more she needs the support of her husband or family.

A correlation analysis of the obtained results showed that the parents' ability to cope with their emotional state is important for successful and timely treatment, since it largely determines the behavior of the sick child, and their attitude toward both the treatment and the physician.

Thus, a child's oncological disease is a traumatic event for mothers: in 68% of them, a high indicator of psychological traumatization was noted; the mothers' experiences determine their reactions and behavior, which the medical staff must take into account when interacting with the patient's parents. Mothers of sick children need psychological assistance and correction of their emotional state just as much as their children do. The work of the psychological service must be directed not only at helping and supporting the child as a patient, but also at helping the parents (mothers) as direct participants in the process of the child's treatment.