Understanding the different ways cancer can affect men and women may improve their care.
WHEN cancer looms, do men and women react to it differently? Are the issues they deal with similar, or unique? Does gender really matter when it comes to cancer?
The answers may seem obvious. After all, we are talking about two groups of people who are – to a great extent – unique in biological make-up, thinking pattern, and the way they are socialised to adopt gender-specific behaviour.
The reality is that these differences can be reduced or increased when it comes to the type of cancer, treatment options, and the side effects involved.
There are some similarities in men’s and women’s issues in cancer, in terms of their reactions to chemotherapy, for example,” said Dr Joanna Lin, a Singapore-based visiting oncologist at the Beacon International Specialist Centre in Kuala Lumpur.
“The main difference probably lies in women’s concerns regarding their physical appearances, eg. hair loss, which is a huge issue with women, especially those younger than 60,” she replied in an email interview.
“Removing a woman’s breast for cancer therapy is also a very obvious physical insult that many women are very concerned about. These physical changes can cause significant psychological and emotional trauma.
“Men are often not too concerned with regards to hair loss, but they are less likely to talk about their issues during treatment,” she elaborated.
Dr Ibrahim ... Communicating treatment alternatives is important, because some patients who are reluctant to undergo a particular treatment may not come back for follow-ups.
She was speaking in general terms. Certainly, all of us have known a woman who is not concerned about her appearance, and a man whose knowledge of skin care products exceeds that of his female peers. But understanding the motivations and priorities of both genders can be an important factor in the way doctors, nurses and caretakers provide treatment and care for people living with cancer.
Much like how a good personal trainer will tailor training programmes according to a client’s motivations, a caregiver who understands the different issues men and women face when they are diagnosed with cancer will be able to effectively work with them to achieve therapeutic goals.
“In most situations however, the patients often do not tell their treating doctor what their real worries and concerns are,” said Dr Lin. “Often, it is because the doctor is too busy and rushed, or is perceived to be too busy by the patient; or the patient does not feel comfortable troubling the doctor with these worries.”
It depends on the site
In an article, Psychology of cancer, published in a US quarterly magazine for cancer patients, writer Leslie Johnston wrote, “How people adjust emotionally to that reality depends on a number of factors, including type of cancer, stage of the cancer, the patient’s age, marital status, ethnicity, culture, profession and – perhaps the most important of all – gender.”
However, Johnston continued, “where the cancer strikes makes a difference”. He then quoted Les Daroff, the director of psychoneuroimmunology and mind-body medicine at the Cancer Treatment Centers of America, to explain.
“If it is stomach cancer, it is perceived as an attack on their stomach, not on their identity,” said Daroff. “However, if it is breast cancer, uterine cancer, prostate cancer or testicular cancer, it attacks their whole psychosocial identity, their way of life and their relationships. Everything they have known is up for grabs.”
Men and women have different risks of developing cancer at different sites. According to the latest Health Ministry national cancer statistics (2006), the top five most common cancers among men are cancers of the colon and rectum, lung, nasopharynx (nose and airways), prostate and liver.
Women, however, suffer most commonly from cancers of the breast, colon and rectum, cervix and uterus, ovaries, and the thyroid gland. (See table: Top ten cancers for men and women in 2006)
While cancers of organs that are associated with femininity (like the breasts, ovaries, uterus, cervix) and masculinity (like the prostate and testicles) can affect the way people view themselves as men and women, the effects may be more obvious in women.
Four out of the five commonest cancers in women are related to the sexual and reproductive system, and the possibility of having them removed or their functions affected could impact both the woman’s body image, and her relationship with her partner or spouse.
Datuk Dr Mohamed Ibrahim Wahid, president of the Malaysian Oncological Society and a consultant oncologist, sees this trend in his patients.
“Of course, when a man loses his libido, it is a big thing (psychologically), but that loss does not necessarily cause a major impact in their family life. You still see their partners staying with them.
“Sometimes, there are medications that can help them, which may or may not work ... but at some point, men accept it and get on with life,” he explained.
Women, who often have to continue fulfilling their responsibilities as wives and mothers, have greater challenges. A woman who is undergoing radiotherapy for cervical cancer, for instance, may experience pain during intercourse and shy away from sexual activity.
“This can cause relationship problems,” said Dr Ibrahim. ”I’ve also had (women) who complain that even when they were tired and fatigued from chemotherapy, they still need to cook for their husbands.”
Common fears
Some fears are universal. A colostomy bag, for instance, is difficult to deal with for both men and women who need to have their rectum (and the cancer in it) removed.
“Psychologically, you know the bag is there ... and you’re emptying your waste in front as opposed to at the back. And you can imagine this can impose a lot of problems with sex,” said Dr Ibrahim.
Surely, between life and a bag to collect the body’s waste, people would choose life, wouldn’t they? “Yes,” said Dr Ibrahim. “But there are patients who, despite life threatening situations, do not want to go through life with a bag on their ‘tummy’.”
There are alternatives, if the tumour is not too advanced. Doctors can try to shrink the tumour through chemotherapy or radiotherapy to avoid removing the rectum.
“Communicating these alternatives are important,” said Dr Ibrahim. “Because if you don’t give patients a choice, and if they don’t want it, they are not going to come back. They worry other doctors might say the same, they resort to alternative ways, and the cancer gets worse.”
Besides doctors’ busy schedules and patients’ reluctance to discuss these issues with them, many doctors do not take the time to really find out the issues that trouble their patients. They focus on the medical issues at hand, said Dr Lin.
“We are problem solvers first, listeners second.”
There is, however, one subject that patients are reluctant to talk about even when the doctor makes time to offer information. Sex.
“This is a big issue, but nobody talks about it openly. When patients come in for consultation, 95% never talk about their relationship with their spouses. They never discuss sex, or other personal issues because they see it as an embarrassment or a taboo,” said Dr Ibrahim. If they do talk about it, and they rarely do, they might prefer to talk to their nurses as they find it difficult to speak to their doctors directly.
Then again, there may be more pressing issues at hand. “Most of the time, patients are so worried about treatment and side effects and have a lot of other things to discuss, so sexual issues are usually at the bottom of the list in our discussion,” Dr Ibrahim noted.
It does not make the issue less important.
One of the myths that have been going around among patients, is that sexual activity will either spread the cancer to their partners, or aggravate the cancer or make the cancer spread, said both Dr Lin and Dr Ibrahim. “Which is absolute nonsense,” Dr Ibrahim added.
It may sound clichéd, but having cancer can make both men and women feel sick, tired, irritable, depressed, anxious and in pain.
It can also bring about bowel, bladder, mouth and breathing problems, depending on the site of the cancer. Changes in sex hormones may occur, and physical changes due to the cancer or surgery may make both genders feel unattractive.
“Because we’re all so different and have different sexual needs, it’s impossible to say exactly how cancer will affect each person’s sexuality and sex life,” read a CancerHelp UK (http://www.cancerhelp.org.uk/) web page on how cancer can affect your sexuality and life (http://http//bit.ly/lifeandcancer).
Some people may lose interest in sex while others say they want to make love more than usual, the website explained. And, “some types of cancers and their treatments affect your ability or desire to have sex more than others.”
Yet if some of these symptoms get in the way, there are ways to overcome them so that couples can have their moments of intimacy. If only they would ask.
Take vaginal dryness – a condition that can come along with the generalised dryness after chemotherapy – for example. A water-based lubricant may help, but patients may not know that until they talk to their doctor, or nurse, about it.
“Maybe patients feel that they should see a urologist or a gynaecologist for these sort of problems ... and that’s okay, as long as they discuss it with somebody, because there may be ways to help them,” said Dr Ibrahim.
Gender sensitive care
If there is an indicator of success, in business, in life or in treatment, motivation is a strong one. When healthcare professionals understand their patients’ priorities, which can change according to circumstance, personality, and gender, they can work with them to achieve outcomes that would be both acceptable and beneficial.
The support men and women need may also be different.
In April 2006, a BBC report of a UK qualitative study by sociology professor Clive Seale noted that men in the study were found to be primarily concerned about treatments, tests, symptoms, procedures and the side effects of drugs.
Women, in contrast, “were more likely to seek social and emotional support, share personal experiences and talk about the impact of cancer on relationships and family.”
“One could imagine that each gender could benefit from what the other gender is interested in,” said Prof Seale in the report.
These are broad strokes, but healthcare providers can certainly use the rough guide and complement these help-seeking behaviours by offering social and emotional support for men and medical information for women, even when they are less likely to seek it.
In spite of our efforts to level the gender playing field in as many areas as possible, we have to recognise that there are inherent, genetically encoded, and often complementary, differences in both genders in the way we think, respond, and behave.
It may be difficult to prove whether healthcare providers’ understanding of this difference may influence treatment outcomes, but it may enhance patients’ willingness to undergo treatment.
“I think it has more of a role in terms of support, but not really the outcome of treatment, but it sometimes can play a major role in a patient’s decision to have treatment or not,” said Dr Ibrahim.
“Some patients can be very adamant about things like not wanting a colostomy. And if you don’t give them a choice, they will say, ‘No’.”
sources- thestar.com.my
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