Gynecological cancers: an alternative approach to healing

Abstract

Grief and hope are two conflicting emotions that a patient recently diagnosed with cancer has to master. The real challenge for gynecologic oncologists is how to reach out. Conventional wisdom states that offering patients focus and belief when combating cancer in their lives allows them to embrace hope with greater confidence, which minimizes their grief. Three pictorial models are presented: '4-cusp approach' model used at the initial consultation; 'tapestry of bereavement or landscape of grief' model at the postsurgery consultation; and 'Venn-diagram' model at any time during patient management. We have applied these models in our practice and believe that they can act as a fulcrum for the patient, the family and healthcare team around which therapy should be centered.

Keywords: cancer; coping strategies; doctor–patient communication; gynecology; holistic approach; psychology; religion; spirituality.

Figure 1.. The ‘4-cusp’ approach showing figure a row of four cusps.

Each cusp represents a patients’ state in terms of cure and life expectancy. Reproduced with permission from [2].

Figure 2.. Cusp A: the cured circle.

If it is demonstrated that the cancer has been completely removed, the conclusion is that the patient is presumed cured, in other words, she remains at cusp A. Reproduced with permission from [2].

Figure 3.. Cusp B: diagnosis.

Following adjuvant treatment with chemo- or radiotherapy, the patient may or may not be cured. She is psychologically ‘living with her cancer’ and should recognize that at this point she is not dying from her disease. Reproduced with permission from [2].

Figure 4.. Living with cancer circle.

A good response is found initially but the patient develops recurrence of her cancer. She is treated again with the same adjuvant therapy and remains in cusp B. Reproduced with permission from [2].

Figure 5.. The ‘preterminal cusp’.

A poor response is observed however following treatment of the recurrence – this patient has now entered cusp C. Reproduced with permission from [2].

Figure 6.. ‘Tapestry of bereavement or a landscape of grief’: the DABDAH model.

The various emotions crop up not in any particular order but more randomly, with some predominating at one point and others at another. Over time, acceptance and hope arrive (represented by the letters A and H at the center of the figure), causing other parts of the tapestry to fade. Reproduced with permission from [2].

Figure 7.. Venn diagram: crossover between sprituality, psychology and religion.

When it comes to living with cancer, they all seem to have the capacity to provide reassurance and hope in equal measure to each other. Reproduced with permission from [2].