A SCOPING REVIEW PROTOCOL ON THE EFFECT OF GYNAECOLOGICAL CANCERS: THEIR DIAGNOSES AND MANAGEMENT ON THE MENTAL HEALTH OF AFFECTED WOMEN IN SUB-SAHARAN AFRICA

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O.C. Idowu¹, O.S. Oyerinde¹, A.A. Odukogbe^1,2, O.A. Awolude^1,2,3, C.C. Asuzu^4,5, I.O. Morhason-Bello^1,2,6, I.F. Adewole^1,2

1. Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria.
2. Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Nigeria.
3. Infectious Disease Unit, University College Hospital /University of Ibadan, Ibadan, Nigeria.
4. Department of Counselling and Human Development Studies, College of Medicine, University of Ibadan, Nigeria
5. Department of Radiation Oncology, College of Medicine, University of Ibadan, Nigeria.
6. Institute of Advanced Medical Research and Training (IAMRAT), University College Hospital/University of Ibadan, Ibadan, Nigeria.

Abstract

Introduction: Mental health describes an individual’s emotional, psychological, and social well-being. The diagnosis of precancers and cancers may result in different mental health manifestations. This review will examine the existing evidence on the effects of diagnosis, management, and prognosis of the four common gynaecological malignancies (ovarian, endometrial, cervical cancer, and endometrial trophoblastic neoplasia) and two precursor lesions (premalignant lesions of the cervix and hydatidiform mole) on the mental health of affected women in Sub-Saharan Africa (SSA).

Materials & Methods: Electronic databases will be thoroughly searched, all potentially eligible studies will be downloaded and reviewed, and the data mapping will be done to present the study findings.

Conclusion: The outcome of this scoping review may showcase existing information, gaps in knowledge, and the future direction of research on mental health problems associated with common gynaecological cancers in SSA.

Keywords: Gynaecological cancers, Precancers, Premalignant lesions, Mental health

Introduction

The global cancer burden is rising with an increasing number of women being diagnosed with gynaecological cancers; nearly 20 million new cases of cancers are diagnosed yearly, and about 10 million cancer-related deaths occur each year.^1–4 Sub-Saharan Africa (SSA) has the highest age-adjusted mortality rates for many cancers including gynaecological cancers.^2,5 The cancer burden in sub-Saharan Africa is expected to increase and almost double by 2040. High mortality rates are often associated with cancers in SSA due to late presentation and suboptimal healthcare facilities among other factors. This often implies that a diagnosis of cancer is interpreted as a death sentence.^7–10

Gynecological cancers contribute a large proportion of the cancer burden globally. Ovarian cancer has an annual incidence of over 300,000 cases globally and contributes to about 200,000 cancer-related deaths.¹¹ About 400,000 cases of endometrial cancers are diagnosed each year with nearly 100,000 cancer-related deaths.¹² Cervical cancer has an annual incidence of about 600,000 and over 300,000 cancer-related deaths.¹³ In most cases, cervical cancer is preceded by a well-understood premalignant lesion which may persist for 10 – 20 years.¹⁴ Gestational trophoblastic disease is a spectrum of placenta-related pathologies ranging from benign molar pregnancies to neoplastic choriocarcinoma and placenta site trophoblastic neoplasia; molar pregnancies are known precursors of choriocarcinoma.¹⁵

Mental health describes an individual’s emotional, psychological, and social well-being. According to the World Health Organization (WHO), mental health is “a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community.”¹⁶ Examples of mental health disorders include anxiety disorders (such as panic disorders, and generalized anxiety disorders),post-traumatic stress disorders, social phobias (specific phobias and obsessive-compulsive disorders), and mood disorders (major depressive disorders and dysthymia), etc.¹⁷

The diagnosis of cancer and/or precancer often results in psychological distress or other wide range of mental ill health manifestations to the patient and their family.¹⁸ The mental health of women and girls with gynaecological cancers in high-income countries is receiving attention and is being documented.^19,20 It has been shown that at least 20% of women with gynecological cancers may have significant mental illness.²¹ whereas some studies have shown a higher incidence of 44% with major depressive episodes being the most common.²² Interventions are being made through various initiatives, programs, and organized support systems.^23,24 Chow et al. reported the impact of theory-driven psycho-educational intervention on the mental and sexual health of women with gynecological cancers. The culturally appropriate psycho-education intervention was made up of four sessions and given over 12-week intervals in China.²³

Chieffo et al. also described psycho-oncology intervention sessions with a reduction in attending distress, depression, and anxiety among women with gynaecological cancers in Italy.²⁵ Prior to intervention, a high prevalence of anxiety and depression (36.6% and 37.4% respectively) was noted among these women in Italy.²⁵ Even with such well-established systems in developed nations, mental health problems among patients with cancers result in a high financial burden and remain fraught with myriads of challenges.^26–28

In SSA, the integration of mental health assessment of women diagnosed with gynaecological cancer has not been adopted because of the paucity of experts and professionals skilled in performing these roles. Rather, most institutions often offer cancer care based on the clinical assessment of the disease progression, and mental illnesses complicating gynaecological cancers may often go unnoticed. Quality of life including mental health assessment is an important precursor for survivorship after cancer diagnosis in addition to the stage of the disease.^29,30The level of existing knowledge of the effects of gynaecological cancers on the mental health of affected individuals in Sub-Saharan Africa remains low.

Aim: This scoping review aims to examine the existing evidence regarding the effects of four gynaecological cancers and two precursor lesions and their management on the mental health status of these women in Sub-Saharan Africa.