Psychologic impact of follow-up after low-risk gestational trophoblastic disease.

OBJECTIVE: To investigate the psychological consequences of hCG measurements during follow-up in patients with low-risk gestational trophoblastic disease. The length of follow-up of patients with molar pregnancy and spontaneous normalization of the hCG level is currently discussed, in consideration of the low incidence of recurrent disease. STUDY DESIGN: Patients registered in the Dutch Central Registry of Hydatidiform Mole between January 2006 and December 2007 were eligible for this study. Patients received a questionnaire containing questions about follow-up and anxiety and stress during this period. RESULTS: Seventy-six patients were eligible for the study. An inverted correlation (r = -0.35, p = 0.003) was found between the age of patients and the level of anxiety. Anxious patients scored higher for fear of recurrence (r = 0.49, p < 0.0001), of infertility (r = 0.40, p = 0.001) and of conceiving again (r = 0.30, p = 0.01). They experienced the measurements as a burden (r = 0.35, p = 0.003). Fewer patients (24%) were insecure before the monthly hCG measurement, compared to 51% during weekly measurements. The majority of women (80%) completed the follow-up and confirmed that they would come for weekly and monthly hCG measurements if it were optional. CONCLUSION: Follow-up after low-risk GTD has psychologic consequences but provides reassurance as well. Therefore, women tend to accept the offered surveillance and refrain from pregnancy. Women with GTD should be counseled about the minor risk of recurrence and the consequences of follow-up.

Aspectos psicossociais da doença trofoblástica gestacional: importância dos grupos de ajuda / Psychosocial aspects of gestacional trophoblastic disease

Objetivo: relatar os aspectos sociais e emocionais que foram manejados individualmente ou nos "grupos de ajuda" e que foram trazidos por pacientes em acompanhamento de Mola Hidatiforme (MH), de Doença Trofoblástica Gestacional Persistente (DTGP) e de Tumor Trofoblástico Gestacional (TTG). Pacientes e métodos: a equipe multiprofissional do Centro de Referência faz acompanhamento prospectivo médico, e social de pacientes com Doença Trofoblástica Gestacional (DTG) desde 1985. Até maio/00 foram atendidas 650 pacientes. A abordagem psicológica, com atendimentos individuais e/ou em grupo começou em 1994. De out/97 a out/99 foram realizadas 61 sessões de "grupo de ajuda", todos coordenados por um dos autores (MCFD), abrangendo um universo de 191 pacientes. Procura-se que as pacientes participem de pelo menos um desse atendimento de grupo que são realizados a cada 2 a 4 semanas. Resultados: a média de participação foi de 2,5 grupos/paciente e 45 por cento delas participaram de pelo menos 1 grupo. Os aspectos emocionais observados foram alto grau de ansiedade, desconhecimento/medo da doença, distúrbios na área da sexualidade, impotência frente à maternidade, medo de perder/culpa projetada no companheiro, fantasias relacionadas à doença, culpa por estarem doentes, baixa auto-estima, etc. Conclusão: a participação das pacientes nos grupos de ajuda é fator importante no entendimento e aceitação das peculiaridades das DTG. Nos grupos também é reforçada a importância ao retorno periódico ao longo acompanhamento previsto. Para assegurar o restabelecimento da saúde integral das pacientes, a equipe multiprofissional dos Centros de Referência deve estar habilitada para manejar também as alterações emocionais verificadas nas pacientes com MH de evolução não complicada, com DTGP e com TTG.

Psychological, social and sexual effects of gestational trophoblastic disease on patients and their partners.

The psychological, social and sexual effects of gestational trophoblastic disease in both patients and their partners are reviewed. The results suggest that despite the favorable prognosis of this disease, mood disturbances, sexual disturbances and fertility concerns can persist in both patients and their partners. Recommendations are made concerning providing supportive care to meet the needs of patients and their partners.

Psychosocial impact of persistent trophoblastic disease.

The female identity of women who suffer from hydatidiform mole developing into persistent trophoblastic disease is threatened in two ways. The reproductive failure is shortly followed by a disease originating in the uterus requiring chemotherapy. Although somatic treatment results are excellent, the psychological effects may be severe and protracted. We conducted a study of 22 women who were between 6 months and 5 years after the end of successful treatment. It appeared that 19 women suffered from psychological sequelae. The three oldest women of the study group, 50 years or older, belonged to the group of women demonstrating signs of prolonged psychological effects.

The psychological, social, and sexual consequences of gestational trophoblastic disease.

Seventy-six women diagnosed with gestational trophoblastic disease (GTD) from 1985 to 1989 completed questionnaires evaluating their status on mood disturbance, marital satisfaction, sexual functioning, psychosocial response to illness, and report of the most stressful event occurring within the past year. Multivariate analyses of variance (MANOVA) were conducted on dependent measures to examine differences between diagnostic groups (partial mole, complete mole, persistent disease), time from diagnosis (less than 1 year, 1-2 years, or 3-5 years from diagnosis), and follow-up status (active disease or remission). MANOVAs revealed no significant differences in the dependent measures based on time from diagnosis, type of medical treatment received, or type of molar disease. The metastatic disease group displayed significantly greater mood disturbance (F(1, 66) = 17.63, P less than 0.0001) and reported suffering clinically significant levels of distress and significantly greater levels of distress in response to the illness (F(33, 39) = 2.32, P less than 0.006). Women with active disease also reported significantly greater levels of distress in response to the illness (F(33, 39) = 2.76, P less than 0.001). Across disease types, GTD patients experience clinically significant levels of anxiety, anger, fatigue, confusion, and sexual problems and are significantly impacted by pregnancy concerns for protracted periods of time.

Reproductive performance of patients with gestational trophoblastic disease in Hong Kong.

The reproductive performance of 110 patients who had had gestational trophoblastic disease was reviewed. There were 160 pregnancies and their outcomes were similar to that of the general population. The subfertility rate was also comparable to the general population. The high rate of failure of contraception resulting in a high rate of conception during the first year of follow-up warrants special attention. Reasons for the high failure rate and ways of prevention are discussed. Reasons for the deliberate delay in attempts to conceive in patients after the full year of postmolar human chorionic gonadotropin (hCG) surveillance were explored.

Psychosocial aspects of gestational trophoblastic disease in Chinese residents of Hong Kong.

Gestational trophoblastic disease has several special aspects as compared with others tumors of the female genital tract. It occurs in young women who want to start a family and expect to have a normal pregnancy. It can be very effectively treated with chemotherapeutic agents, and the subsequent reproductive potential of these young women is not affected. In a survey of 105 Chinese residents of Hong Kong who had had the disease, it was found that their emotional reactions to the disease and treatment, the effects of such on their self-esteem, martial and sexual life, and their attitudes towards their physicians and future pregnancy were different from those of their Western counterparts.