We investigated if a cancer patient's unrelieved symptoms during the last 3 months of life increase the risk of long-term psychological morbidity of the surviving partner. All women (n=506) living in Sweden under 80 years of age, who lost their husband/partner owing to cancer of the prostate in 1996 or of the urinary bladder in 1995 or 1996 were asked to answer an anonymous postal questionnaire, 2 -4 years after their loss. The widows' psychological morbidity was associated with the patient's unrelieved mental symptoms. When the patient was perceived to have been very anxious during last three months of life (compared to no observed symptoms) the relative risks for the widows' psychological morbidity were: 2.5 (1.4 -4.3) for depression and 3.4 (1.4 -8.2) for anxiety. When comparing reports of the patient's pain (much vs no), the relative risks were 0.8 (0.5 -1.2) for widowhood depression, and 0.8 (0.4 -1.7) for widowhood anxiety. The patients were found to have had adequate access to physical pain control but poor access to psychological symptom control. Efficiency in diagnosing and treating psychological complications of terminally ill cancer patients may not only improve their quality of life but possibly also prevent long-term psychological morbidity of their surviving partners.
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Summary and ConclusionsThis synthesis of the literature on the quality of life in relation to radiotherapy is based on 78 scientific articles. including 12 randomized studies, 25 prospective studies, and 20 retrospective studies. These studies involve 9 884 patients.Radiotherapy is often organ-preserving, which inherently promotes a better quality of life. Many quality of life aspects related to radiotherapy have been studied, but seldom by prospective randomized studies that compare radiotherapy t o other treatment (eg, surgery or chemotherapy). Radiotherapy involves numerous physical and psychological symptoms, mainly during the course of treatment. Examples include skin irritation and fatigue. Radiotherapy directed at the brain has delayed effects. in children treatment carries a substantial risk for lowering the IQ. The risk for encephalopathy in adults is probably underestimated. Patients with cancer in the head and neck may cxperience adverse side effects in the irradiated area long after the conclusion of radiotherapy. There are no confirmed differences in quality of life between breast cancer patients receiving adjuvant radiotherapy and those receiving chemotherapy. Impotency problems and urinary incontinence appear following radical surgery and radiotherapy for prostate cancer. The risk for delayed complications is low after radiotherapy for testicular cancer. Patients receiving radiotherapy for gynecologic cancers are often troubled by local side effects long after the conclusion of treatment.
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