Psychosocial consequences of gestational trophoblastic disease

Gestational trophoblastic disease (GTD) comprises a spectrum of interrelated diseases including partial and complete molar pregnancy and choriocarcinoma with varying propensity for invasion and metastasis [1—4]. Despite the presence of widespread metastases, persistent gestational trophoblastic neoplasia (GTN) is highly curable with chemotherapy [2—6]. However, psychological shock is anticipated and understandable when the woman and her partner discover that their pregnancy is considered potentially cancerous and life threatening. It is within this context that we address short and long-term issues central to psychological, social, sexual, and overall quality of life adaptation. Although a cure is generally anticipated, inherent psychosocial stressors exist for the patient and her partner. These stressors include loss of a pregnancy, a potentially life threatening diagnosis, surgical treatment and/or chemotherapy, and delay of future pregnancy. This diagnosis consequently poses a challenge to the woman and her partner since both are required to rapidly shift their sense of hopefulness and joy related to the pregnancy to a necessary challenge to manage a potentially life threatening condition. This unique set of circumstances has led to investigation of the psychosocial impact of GTD. This chapter outlines several issues considered germane to a comprehensive understanding of the psychosocial implications of a GTD diagnosis. First, a brief discussion of interpretations of childbearing is reviewed to provide a foundation to understand the distress which may occur if a pregnancy is threatened and abruptly halted, as is the case with GTD. This discussion is then supported by data relevant to reproductive concerns after GTD. Second, psychosocial issues of GTD are presented, illustrating the sense of threat and anxiety often associated with this diagnosis.. Third, perspectives on potential relationship issues and sexual dysfunction are reviewed. Finally, recommendations for future directions in an integrated clinical care and research approach are provided.