Emotional and Clinical Aspects Observed in Women with Gestational Trophoblastic Disease: A Multidisciplinary Action

Abstract

Objective To evaluate the emotional and clinical aspects observed in women with gestational trophoblastic disease (GTD) followed-up in a reference center (RC) by a multidisciplinary team.

Methods Retrospective cohort study of the clinical records of 186 women with GTD and of the emotional aspects (EA) observed in these women by a team of psychologists and reported by the 389 support groups conducted from 2014 to 2018.

Results The women were young (mean age: 31.2 years), 47% had no living child, 60% had planned the pregnancy, and 50% participated in two or more SG. Most women (n = 137; 73.6%) reached spontaneous remission of molar gestation in a median time of 10 weeks and had a total follow-up time of seven months. In the group of 49 women (26.3%) who progressed to gestational trophoblastic neoplasia (GTN), time to remission after chemotherapy was 18 weeks, and total follow-up time was 36 months. EA included different levels of anxiety and depression, more evident in 9.1% of the women; these symptoms tended to occur more frequently in women older than 40 years (p = 0.067), less educated (p = 0.054), and whose disease progressed to GTN (p = 0.018), as well as in those who had to undergo multi-agent chemotherapy (p = 0.028) or hysterectomy (p = 0.001) adjuvant to clinical treatment.

Conclusion This study found several EA in association with all types of GTD. It also highlights the importance of specialized care only found in a RC, essential to support the recovery of the mental health of these women.

Resumo

Objetivo Avaliar aspectos emocionais e clínicos observados em mulheres com doença trofoblástica gestacional (DTG) acompanhadas em um centro de referência (CR), por equipe multiprofissional.

Método Estudo de coorte retrospectivo nos prontuários clínicos de 186 mulheres com DTG, e dos aspectos emocionais (AE) observados nessas mulheres pela equipe de psicólogas e registrados nos 389 grupos de apoio (GAs), ocorridos de 2014 a 2018.

Resultados As pacientes eram jovens (idade média 31,2 anos), 47% sem filhos vivos, 60% tinham desejado ou planejado esta gravidez e 50% delas participaram de dois ou mais GAs. A maioria (n = 137–73,6%) apresentou remissão espontânea da gestação molar com mediana de 10 semanas e um tempo total de seguimento de 7 meses. Quarenta e nove mulheres (26,3%) evoluíram para neoplasia trofoblástica gestacional (NTG); a mediana para atingir a remissão após tratamento com quimioterapia foi de 19 semanas e o tempo total de seguimento foi de 36 meses. Os AE incluíram variados graus de ansiedade e depressão, mais evidentes em 9,1% das nossas pacientes; tais AE tenderam a ocorrer mais em mulheres com idade acima de 40 anos (p = 0,067), com menor escolaridade (p = 0,054), com evolução para NTG (p = 0,018), e nas que necessitaram de tratamento quimioterápico com regime de múltiplos agentes (p = 0,028), ou de histerectomia complementar ao tratamento clínico (p = 0,001).

Conclusão Este estudo mostrou presença de vários AE associados em todos os tipos de DTG. Destaca também a importância de um atendimento psicológico especializado, somente encontrado nos CR, que é essencial para ajudar na recuperação da saúde mental dessas mulheres.

Keywords

gestational trophoblastic disease - psychological aspects - support group - mental health

Palavras-chave

doença trofoblástica gestacional - aspectos psicológicos - grupos de apoio - saúde mental

Publication History

Received: 27 April 2021

Accepted: 13 October 2021

Article published online:
09 February 2022

• References

• 1 Caldas DB, Silva AL, Böing E, Crepaldi MA, Custódio ZA. Atendimento psicológico no pré-natal de alto-risco: a construção de um serviço. Psicol Hosp 2013; 11 (01) 66-87
• 2 Kliemann A, Böing E, Crepaldi MA. Fatores de risco para ansiedade e depressão na gestação: revisão sistemática de artigos empíricos. Mudanças. 2017; 25 (02) 69-76
• 3 Sun SY, Goldstein DP, Bernstein MR. et al. Maternal near miss according to World Health Organization classification among women with a hydatidiform mole: experience at the New England Trophoblastic Disease Center, 1994-2013. J Reprod Med 2016; 61 (5-6): 210-214
• 4 Braga A, Mora P, de Melo AC. et al. Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide. World J Clin Oncol 2019; 10 (02) 28-37
• 5 Freitas F, Braga A, Viggiano M. et al. Gestational trophoblastic neoplasia lethality among Brazilian women: A retrospective national cohort study. Gynecol Oncol 2020; 158 (02) 452-459
• 6 Belfort P, Barros RB. Aspectos psicossociais da neoplasia trofoblástica gestacional. In: Madi JM, Grillo BM. editores Neoplasia trofoblástica gestacional. Rio de Janeiro: Colina/Revinter; Caxias do Sul: EDUCS; 2007: 209-11
• 7 Berkowitz RS, Marean AR, Hamilton N. et al. Psychological and social impact of gestational trophoblastic neoplasia. J Reprod Med 1980; 25 (01) 14-16
• 8 Velasco M. A mulher diante da doença trofoblástica gestacional. In: Belfort P, Grillo BM, Madi JM, Viggiano M. editores Neoplasia trofoblástica gestacional: controvérsias. Rio de Janeiro: Rubio; 2007: 263-7
• 9 Cagayan MS. Sexual dysfunction as a complication of treatment of gestational trophoblastic neoplasia. J Reprod Med 2008; 53 (08) 595-599
• 10 Diestel MC, Uberti EM, Lacerda ME, Spagnol LO, Silva IL. Aspectos psicossociais da doença trofoblástica gestacional: importância dos grupos de ajuda. Acta Oncol Bras 2001; 21 (01) 183-186
• 11 Ferreira EG, Maestá I, Michelin OC, de Paula RC, Consonni M, Rudge MV. Assessment of quality of life and psychologic aspects in patients with gestational trophoblastic disease. J Reprod Med 2009; 54 (04) 239-244
• 12 Horowitz NS, Wenzel LB. Psychosocial consequences of gestational trophoblastic disease [Internet]. In: Hancock BW, Seckl MJ, Berkowitz RS. editors Gestational trophoblastic disease. 4th ed.. London: International Society for the Study of Trophoblastic Disease; 2015. [cited 2020 Dec 10]. Available from: https://isstd.org/uploadedfiles/chapter-23-psychological.pdf
• 13 Braga A, Maestá I, Michelin OC. et al. Maternal and perinatal outcomes of first pregnancy after chemotherapy for gestational trophoblastic neoplasia in Brazilian women. Gynecol Oncol 2009; 112 (03) 568-571
• 14 Braga A, Torres B, Burlá M. et al. Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6months after uterine evacuation?. Gynecol Oncol 2016; 143 (03) 558-564
• 15 Pires LV, Uberti EM, Fajardo MdoC. et al. Role of hysterectomy in the management of patients with gestational trophoblastic neoplasia: importance of receiving treatment in reference centers. J Reprod Med 2012; 57 (7-8): 359-368
• 16 Li L, Wan X, Feng F. et al. Pulse actinomycin D as first-line treatment of low-risk post-molar non-choriocarcinoma gestational trophoblastic neoplasia. BMC Cancer 2018; 18 (01) 585
• 17 Ngan HYS, Seckl MJ, Berkowitz RS. et al. Update on the diagnosis and management of gestational trophoblastic disease. Int J Gynaecol Obstet 2018; 143 (Suppl. 02) 79-85
• 18 Uberti EM, Diestel MdoC, Guimarães FE, Goloubkova T, Rosa MW, De Nápoli G. Gestational trophoblastic disease: one more risk in adolescent pregnancy. Acta Obstet Gynecol Scand 2002; 81 (04) 356-363
• 19 Ngan HY, Bender H, Benedet JL, Jones H, Montruccoli GC, Pecorelli S. FIGO Committee on Gynecologic Oncology. Gestational trophoblastic neoplasia, FIGO 2000 staging and classification. Int J Gynaecol Obstet 2003; 83 (Suppl. 01) 175-177
• 20 Garner E, Goldstein DP, Berkowitz RS, Wenzel L. Psychosocial and reproductive outcomes of gestational trophoblastic diseases. Best Pract Res Clin Obstet Gynaecol 2003; 17 (06) 959-968
• 21 Gillett S, Singh K, Ireson J. et al. Evolution of a teenage and young adult service, in Sheffield, U.K., for patients with gestational trophoblastic neoplasia. J Reprod Med 2016; 61 (5-6): 235-237
• 22 Di Mattei VE, Mazzetti M, Carnelli L. et al. [Gestational Trophoblastic Disease: psychological impact and the role of defence mechanisms during illness and follow-up]. Recenti Prog Med 2015; 106 (12) 641-645 Italian
• 23 Ngan HY, Tang GW. Psychosocial aspects of gestational trophoblastic disease in Chinese residents of Hong Kong. J Reprod Med 1986; 31 (03) 173-178
• 24 Kohorn EI. The new FIGO 2000 staging and risk factor scoring system for gestational trophoblastic disease: description and critical assessment. Int J Gynecol Cancer 2001; 11 (01) 73-77
• 25 Petersen RW, Ung K, Holland C, Quinlivan JA. The impact of molar pregnancy on psychological symptomatology, sexual function, and quality of life. Gynecol Oncol 2005; 97 (02) 535-542
• 26 Stafford L, McNally OM, Gibson P, Judd F. Long-term psychological morbidity, sexual functioning, and relationship outcomes in women with gestational trophoblastic disease. Int J Gynecol Cancer 2011; 21 (07) 1256-1263
• 27 Quinlivan JA, Ung KA, Petersen RW. The impact of molar pregnancy on the male partner. Psychooncology 2012; 21 (09) 970-976
• 28 Jorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, Pollitt P. “Mental health literacy”: a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Med J Aust 1997; 166 (04) 182-186
• 29 Katz MG, Jacobson TA, Veledar E, Kripalani S. Patient literacy and question-asking behavior during the medical encounter: a mixed-methods analysis. J Gen Intern Med 2007; 22 (06) 782-786
• 30 Stafford L, Judd F. What do women with gestational trophoblastic disease understand about the condition?. Int J Gynecol Cancer 2011; 21 (01) 161-166