Living With Gynecologic Cancer: Experience of Women and Their Partners

By Akyuz, Aygul Guvenc, Gulten; Ustunsoz, Ayfer; Kaya, Tulay

Purpose: To describe the experiences of Turkish women with gynecologic cancer and their partners. Design and Methods: Qualitative research using a descriptive phenomenological approach.

Setting: Gynecologic oncology outpatient clinic of the Gulhane Military Medical Academy in Ankara, Turkey. Nineteen women with gynecologic cancer aged 43-70 years and 12 partners aged 46-73 years were recruited. Data were obtained through open-ended and in-depth, audio-taped interviews which lasted approximately 35-45 minutes each.

Findings: Seven themes emerged from the participants’ description of their experience: (a) experiences during the diagnosis period; (b) experiences during the treatment period; (c) the effect of cancer on family life; (d) changes in daily life; (e) coping methods and support sources; (f) the meaning of illness; and (g) experiencing the illness as a woman.

Conclusions: Receiving the diagnosis of gynecologic cancer was remembered as a very dramatic experience. The women and partners reported many physical and psychosocial difficulties relating to the treatment period. Healthcare professionals must understand and recognize cancer patients’ and their partners’ experiences to provide appropriate holistic care.

Clinical Relevance: Nurses can only provide effective and comprehensive nursing care to gynecologic cancer patients and their families if they fully understand the physical, emotional, social, and spiritual experiences in their lives.

[Key words: gynecologic cancer, women’s experience, partners’ experience]

JOURNAL OF NURSING SCHOLARSHIP, 2008; 40:3, 241-247. (c)2008 SIGMA THETA TAU INTERNATIONAL.

Every year, 10 million people worldwide are diagnosed with cancer and 6 million die because of it. Cancer is the second leading cause of death in Turkey (Akyuz et al., 2007; Gozum & Aydm, 2004). Ovarian, endometrium, and cervical cancers are the fourth, seventh, and ninth reasons for death respectively among Turkish women (Ministry of Health, 2007). Gynecologic cancers pose special problems because they involve organs related to femininity, fertility, and sexual life, and the diagnosis and treatment of gynecologic cancer is stressful for women and their families (Costanzo, Lutgendorf, Rotrock, & Anderson, 2006; Ekwall, Ternestedt, & Sorbe, 2003).

Patients treated for gynecologic cancer experience physical symptoms such as pain, nausea, vomiting, insomnia, and lethargy and they suffer psychological symptoms, including stress, anxiety, depression, and fear of death. Cancer treatment changes a woman’s daily routine, social relations, employment status, and quality of life (De Groot et al., 2005; Ekwall et.al., 2003; Holzner et al., 2003; Howell, Fitch, & Deane, 2003; Reis, 2003).

Gynecologic cancer can affect the whole family because women play a central role in the management of the family in daily life. During the intensive treatment period, most of the cancer patients’ roles are taken over by their partners, adult children, and relatives. People caring for cancer patients can experience helplessness, uncertainty, stress-related agitation, depression, and fear of loneliness. Children are also affected in various ways by cancer, depending on their age and developmental stage (De Groot et al., 2005; Ferrell, Ervin, Smith, Marek, & Melancon, 2002; Hodgkinson et al., 2007; Lowdermilk & Germino, 2000; Northouse, 2005).

Nurses can only provide effective and comprehensive nursing care to gynecologic cancer patients and their families if they fully understand their experiences in every area of their lives. Nursing studies on the subject of gynecologic cancer experiences have, therefore, increased rapidly, although only a limited number of studies on the effect of diagnosis of gynecologic cancer were present until 10 years ago. Currently, studies that include the experience of families and especially partners, in addition to the women, are still limited. Few studies have been undertaken on the subject in Turkey and no reported studies included partners.

Many women in Turkey do not work in paid employment. They play a more active role at home and have more responsibility for housework and childcare than in some other societies, and this might influence the experience of gynecologic cancer (Turmen, 2003). The purpose of this study is to describe the meaning of the gynecologic cancer experience from the perspective of Turkish women participants and their partners in Turkey, a society where women’s work centers on the home and family. We believe that this study is going to provide important information for nurses globally in that nurses caring for women who work at home can understand how gynecologic cancer might influence a woman who is primarily a homemaker.

Methods

Study Design

Based on the study’s purpose, descriptive phenomenology was selected as the appropriate design to discover the essence of the experience. Phenomenology, a frequently used approach in qualitative nursing research, is focused on the experience of individuals as the major way to understand the broader meaning of people’s life experiences. Phenomenologists assert that reality is not a fixed entity, it changes and develops according to people’s experiences and the social context within which they find themselves (Dowling, 2007; Duffy, 2005; Rapport & Wainwright, 2006; Schultz & Cobb- Stevens, 2004).

Sample and Setting

This research was performed in the gynecologic oncology outpatient clinic of the Gulhane Military Medical Academy (GMMA) in Ankara, Turkey. The clinic is provided every Tuesday and Thursday and three to four patients per week are followed up for gynecologic cancer. The study was approved by the ethics committee of the GMMA. This study was started in January and completed in April 2006. Participants were recruited until the data saturation limit was reached, that is, when no new information was obtained. During the study period, two couples refused to be interviewed. In addition, it was not possible to interview the partners of seven women: four partners did not come for the check-up and three women were widows. In all, 19 women diagnosed with gynecologic cancer and 12 husbands making a total of 31 voluntary participants were interviewed.

Of the women interviewed, seven were being followed for endometrial cancer, five for ovarian cancer, four for cervical cancer, and three for uterine corpus cancer. The time since diagnosis was between 6 months and 10 years. The average age was 55.5 (SD, 6.85; range 43-70 years) for the women and 64.5, (SD, 9.73; range 46-73 years) for their partners. Two couples had no children.

Data Collection

Data were obtained through a semistructured interview schedule. All interviews were done in Turkish. Interviews began with a broad open-ended introductory question specific to the purpose of the study: “What was the experience of gynecological cancer like for you?” This was followed by some more open-ended questions such as: “What were your thoughts and feelings when you first learned you (your wife) had cancer?””What difficulties did you encounter in (your wife) seeking treatment?” and “What effect has the disease had on your family daily life as you cope with your (your wife’s) disease?” The introductory question and the other open-ended questions were formulated in the interview guide, which was generated from issues identified in the investigators’ clinical practice, an extensive review of the literature, and consultation with both methodologie and clinical experts. Also, during the progress of the interviews, some questions were provoked by participants’ statements. Open-ended questions made the dialogue easier and helped us get patients and their partners to describe their experiences of the disease.

Participants included in the study were informed about the study and written permission was obtained to interview and make audio recordings. One woman and one partner were interviewed per day at the most. The same researcher carried out the audiotaped interviews for both women and men. Men and women were interviewed separately one after another in a quiet and private room. Each interview took approximately 35-45 minutes.

Data Analysis

Analysis of interview transcriptions was based on Colaizzi’s phenomenologic methodology. During the analysis, women and men informants’ oral descriptions were read separately by researchers to gain a general understanding. Significant statements and phrases that pertained to the study objectives were identified. Meanings were formulated from these significant statements and phrases. The formulated meanings were then organized into clusters of themes. Results of the data analysis were integrated into a description of the experience.

To maintain the credibility of data analysis, the transcripts were examined repeatedly by each researcher in order to include them into the data. Two researchers worked independently to identify the major categories of the transcripts. The coding was compared. Between the coding of the two researchers, which mainly related to the choice of words, were minor differences. Differences were discussed until a final agreement was reached. To achieve final validation (Colaizzi, 1978; Wong & Chan, 2006), four informants (two men and two women) were selected randomly and contacted again to read the descriptions; they agreed that the analyses had accurately represented their personal experiences. Common themes were created by merging similar statements for every category. Overall, consistent with the question format, seven major themes were formulated from the analysis of the statements and the transcript that reflected the common experiences of gynecologic cancer.

A manuscript about the study was written in Turkish following completion of the study and analysis of the interviews. The patient and partner statements were then translated into English, retaining the original meaning. The English translation was then back- translated into Turkish by a bilingual speaker to make sure that the translation was accurate. Finally, the two translations were matched for the original meaning of the Turkish version.

Results

Theme 1: Experiences During the Diagnosis Period

Signs of disease and emotions prior to diagnosis. This period was described as difficult and stressful by many women and partners. Both the men and women stated that they experienced anxiety once advanced tests were performed and feared the diagnosis would be cancer. Nine patients and five partners used the term “a bad result” instead of “cancer disease.”

* I did not know what to do during this period. My older sister has ovarian cancer. I tried not to think of bad things. But I also thought if I would also go through the same sorrows if I were found to have cancer (Participant 3, cervix carcinoma, 61 years old).

Some of the patients and partners stated that they had not guessed that a diagnosis of cancer would be made:

* I felt anxious when a lot of tests were [requested] for my wife. However, I had never guessed that it would be a bad disease. I did not think that such a disease would affect my family (Participant 9’s partner, 51 years old).

Emotions when the diagnosis was first received. Many participants stated that when they were informed of the gynecologic cancer diagnosis, they experienced a huge shock followed first by denial and then acceptance. The women asked themselves and others: “Why me?””Why has this happened to me?” Some of the women faced their fear of death directly and became anxious about their future and their children and then tried to find a way out. Both men and women noted that when informed of the diagnosis they mostly focused on “death” instead of what they would experience as a result of the cancer treatment. Some partners mentioned that once the diagnosis was made they feared that their wives would die. For the emotions experienced when the diagnosis was first stated, 12 women and 5 partners used the term “a big shock:”

* It was as though I was shot at. I felt a big shock. My whole life passed before my eyes. When they said cancer I thought I would just die (Participant 10, endometrial carcinoma, 58 years old).

* I lived the first shock when the diagnosis was explained. I felt as though they poured boiling water on me. My whole body was burning (Participant 11’s partner, 73 years old).

* Cancer is a bad disease just like its name. We were retired. We had dreams. Our projects were always for the future. Now you have to live in this way if you can (Participant 8’s partner, 60 years old).

Theme 2: Experiences During the Treatment Period

Difficulties during the treatment period. All participants stated that the treatment was stressful and described many physical and psychosocial difficulties. Many of the women described physical difficulties such as pain, nausea, vomiting, insomnia, fatigue, and hair loss plus psychological problems such as stress, fear, and anxiety because of the radiation treatment and chemotherapy. Half of the partners noted that they had experienced some physical and emotional difficulties such as fear, anxiety, stress, fatigue, and insomnia during this period.

* The main difficulty was during chemotherapy. Losing my hair affected me a lot. I did not want to look in the mirror after I lost my hair. It was as if I was looking at someone else (Participant 13, ovarian carcinoma, 58 years old).

* It was really difficult. I lost sleep during treatment. My wife couldn’t eat much. I also had difficulty swallowing my food. Stress made my stomach ache and the physician prescribed medication for it (Participant 2’s partner, 68 years old).

Emotions experienced during the treatment period. Many patients and their partners experienced various phases of showing their sadness, dependency, despair, hopelessness, and hope during treatment. Many patients mentioned that they were afraid of the treatment they would receive. More than half of the women were in tears when sharing their feelings related to the treatment. Many partners classified the treatment period as difficult and a time they did not want to remember and some used the term “our treatment” to describe the process.

* It’s as though there are two lives for me. It’s as though I am on a razor’s blade and the others are living (Participant 8, ovarian carcinoma, 58 years old). The partner of Participant 8 stated his feelings as follows:

* Some of the patients we were treated [with] died. I took over everything during this period. I don’t even want to remember those days. Despite all, I never lost hope (Participant 8’s partner, 60 years old).

Coming for follow-up was described by all participants as stressful but necessary to follow the disease and plan the treatment. The vulnerability for recurrent disease was explained as a continuing, present concern for both women and partners.

* My disease recurred. This was found during the followup. I always feel anxious and I can’t sleep when I am going to go for follow-up [visits]. (Participant 10, endometrial carcinoma, 58 years old).

* I was even more anxious than my wife. I put every test result in the folder. I collect them all. We compare results ourselves after the physician (Participant 9’s partner, 51 years old).

Theme 3: Effect on Family

Changing roles, responsibilities. Almost all patients and their partners reported that the household roles were taken over by their partners, older family members (especially mothers and older sisters), and grown-up daughters during the postoperative phase and while receiving chemotherapy and radiotherapy. Many of the women stated that they felt uncomfortable and anxious as they became dependent on others and were unable to carry out the duties they had easily taken care of previously. The partners noted that they and other family members assumed the responsibility for daily chores and they felt the need to “be strong” for their wives and children.

* My husband and my daughter are doing all they can. My daughter is getting very tired with housework, cooking, etc. I am sad because I am preventing her from studying and I feel as though I am having a negative influence on her future (Participant 14, endometrial carcinoma, 46 years old).

* I supported my wife in every way. Housework, cleaning, cooking. I did not let her tire herself at all. There is nobody closer than your wife. I did not used to do housework before. I started when my wife became ill. I was getting very tired but did not let her know (Participant 10’s partner, 62 years old).

The effects on the partners and the children. The men stated their fear that their wives would die of this disease. Women expressed their fear of death as well as their anxieties about their family members.

* My partner was worse than me, he thought I would die. He even had a nervous breakdown on the night I had the surgery (Participant 1, ovarian carcinoma, 43 years old).

* My wife’s disease was advanced when she was diagnosed. However, during the long treatment, we saw the people we talked with die in front of our eyes. These affected me and my wife a lot. I am very scared that something will happen to her (Participant 19’s partner, 62 years old).

Many of the women and partners stated various anxieties according to the age and gender of the children.

* When I fell ill, my son was five and my daughter seven. One becomes more attached to life after seeing the state they are in. The children also became more attached to me. My children are young. Who will look after them if I die (Participant 1, ovarian carcinoma, 43 years old)?

* I’ve heard that hereditary transmission is seen frequently in this disease. When the doctor suggested that my daughter have a check-up regularly, I was very scared considering the possibility that it might develop in my daughter as well. Our family is already ruined (Participant 9, ovarian carcinoma, 49 years old).

Sexual relations. Many of the participants explained that it was difficult to talk about sexual relations with the physician or nurses and they did not receive adequate information from healthcare staff. Women mentioned that they had avoided sexual relations in the 6 months after treatment believing it would cause pain or harm. On the other hand, the men stated that their sexual life had been affected because they were trying to avoid harming their wives and because their wives expressed little sexual desire. Some women said that to be in good health and alive were more important than were sexual relations.

* I was scared for the first 5-6 months. Just in case. But I felt that my surgical wounds had not healed completely. So I did not want it much. Then we started doing it slowly but I had pain, especially at the back. We did not have sex for awhile and my partner understood. We don’t have any problems now (Participant 17, cervical carcinoma, 57 years old).

One patient stated that no significant changes in their sexual relations occurred while the partner thought their sexual relations were almost over.

* [O]f course our sexual relations changed a lot. Now, we have it now and then. It has been a long time since the treatment ended but we are both scared. I am anxious something will happen to my wife and she is not that keen either, so it doesn’t happen often (Participant 18’s husband, 46 years old). Theme 4: Changes in Daily Life

Friendships and social relations. About half of the patients stated that their friendships and social relations did not change while half reported a decrease. The men mostly made their decisions regarding social life according to their wife’s preference but they were less affected in their friendships than were the women. One husband stated that he had been forced to retire because his wife’s treatment was in another city and their social relations therefore suffered greatly and he was unable to see his good friends anymore.

* I don’t want to join any group. Everyone asks what happened and how it happened. It makes me feel bad. They wish me good health. But I don’t want to respond. Sometimes I want to get rid of these feelings and talk to a friend (Participant 8, ovarian carcinoma, 58 years old).

The same patient’s husband said the following about social relations:

* Previously we used to go to activities with friends, go to the theatre and go for walks. She was very tired. It is also not nice to be exposed to the questions of others (Participant 8’s partner, 60 years old).

Theme 5: Coping Methods and Support Sources

Many of the patients and their partners reported that they prayed, received psychological help, talked to other patients, or accepted the disease and complied fully with the treatment as coping mechanisms. Many women stated that they received the most support from their partner, mother, daughters, and friends during the treatment. Also, several women noted that their husbands reassured them saying: “We’ll go through this together.”

* Of course I did everything for her to get better. We go to follow-ups on time. We are happy when the results are good. I found peace in praying. I felt happy when the results were good. It is God’s will, after all (Participant 5’s partner, 49 years old).

Theme 6: Finding Meaning in Disease and Future Views of the Participants

About half of the participants expressed the view that they had discovered certain positive gains from the disease experience. Many participants made different deductions about the meaning of life, the future, and what they expected from the future. Some of the women and partners stated that they recognized an increase in spiritual presence in their lives. Learning that they might die meant that they had felt drawn to re-evaluate their relationships with God and recognized that they needed something more powerful than themselves to see them through.

* You’ll get nowhere by crying and complaining. We’ll all die some day. I am not afraid of dying. Praying makes me comfortable. I don’t want to feel sick (Participant 4, endometrial carcinoma, 64 years old).

* I feel much better though when my wife has a good day. So I thank God each day for one more day of healthy life (Participant 18’s husband, 46 years old).

Some of the participants explained the women’s disease as “fate”. One husband said: “I told my wife that a lot of women got this disease. This is our fate and we have to face it” (Participant 2’s partner, 68 years old).

Theme 7: Disease Experience as a Female

Statements of patients regarding having gynecologic cancer varied depending on their ages and whether they had children.

* As a woman I was not saddened by having a cancer of women but by having cancer. I did not care at all whether I had a womb or not. I am not going to have any other children anyway. My health is more important (Participant 12, cervical carcinoma, 50 years old).

* I felt very sad because I wouldn’t have children. I wouldn’t be this sad if I had a child. I was most saddened for children. I felt incomplete. I felt as though I had lost my femininity (Participant 18, corpus carcinoma, 45 years old).

Discussion

In this study, the experiences of gynecologic cancer patients and their partners were summarized under seven main themes. Although each story was unique, some concepts were more prominent and it was seen that gynecologic cancer had important effects on family life.

Many participants used the term being afraid of “a had result” instead of “cancer” and avoided using the word “cancer.” Both the women and their partners talked about the fear and marked stress and anxiety caused by cancer, as reported in other articles (Friedrichsen, Strang, & Carlsson, 2001; Saegrov & Halding, 2004).

Cancer is a difficult disease for the whole family. Almost all patients and their partners in our study emphasized that they felt huge shock, uncertainty, hopelessness, fear of death, and a deep sadness when they first learned of the diagnosis and some did not believe the diagnosis but only accepted it later. Other investigators also report marked stress when the patient and family first heard of the cancer diagnosis (Friedrichsen et al., 2001; Iconomou, Vagenakis, & KaIafonos, 2001; Kozachik et al., 2001; Saegrov & Halding, 2004).

Intensive fatigue and pain are common symptoms in gynecologic cancer patients and have a direct effect on daily activities, work life, self-perception, and psychosocial status in these patients (Holzner et al., 2003; Howell et al., 2003; Molassiotis, Chan, Yam, Chan, & Lam, 2002).

Some researchers emphasize frequent psychological problems and physical signs such as insomnia, fatigue, and loss of appetite in those caring for cancer patients (Fang, Manne, & Pape, 2001; Ferrell et al., 2002; Northouse, 2005). In our study, the women reported many physical and psychosocial difficulties during the treatment. The most common physical side effects were pain, nausea, vomiting, fatigue, and hair loss and these side effects affected the role and responsibilities of the women within their families, social lives, and psychological outlooks.

In addition to these known effects of cancer in women, approximately half of the husbands in this study reported symptoms such as fatigue, insomnia, stress, anxiety, and fear-the same findings reached by Demiralp, Hatipoglu, Basbozkurt, Demiralp, and Erler, (2004) in their study about difficulties experienced by family members of patients with orthopedic tumors in Turkey.

In our study, women and partners experienced dependency, hopelessness, fear, anxiety, and stress during treatment. Studies show that many women with gynecologic cancer experience psychosocial difficulties such as anxiety, depression, and fear of recurrence and of dying (De Groot et al., 2005; Ferrell et al., 2005; Steginga & Dunn, 1997). In our study, as in other studies, men also experienced psychosocial problems during the treatment of gynecologic cancer because they need information regarding the disease and are anxious about their wives’ condition (Hodgkinson et al., 2007; Lalos, 1997). A study on the psychosocial effect of gynecologic cancer on the community indicated that both partners had similar problems and no difference was noted between the difficulties experienced by the women and their partners regarding cancer (De Groot et al., 2005). We therefore believe it is important for the nurses providing care to a patient with gynecologic cancer, to take this fact into account and plan care with a view to including the partner.

We found that the women were unable to take care of their everyday responsibilities because of physical problems that surfaced, especially during the intensive treatment period, in addition to the psychological effects of cancer. Every society around the world assigns gender roles that direct activities and govern behavior for women and men. In traditional countries like Turkey, where women work mostly at home, it is the women who usually take care of responsibilities such as housework, cooking, cleaning, ironing, childcare, and child education (Turmen, 2003). From the nursing point of view, these can be seen as the “daily living activities” of a family. Having gynecologic cancer creates problems in the flow of daily life. The other members of the family (partner, oldest daughter, the patient’s mother) therefore assume these responsibilities to preserve the balance of family dynamics in line with the observations by Howell et al. (2003) that the partners take on most of the household roles during the intensive treatment period. However, because of the traditional structure of Turkish society it is not common for men to take over housework even in such extraordinary conditions. Depending on the strength of the family ties, it is more common that the patient’s mother, mother-in-law, or daughter take the responsibility.

We understood that most of the women and partners in the study did not want to talk with their physicians or nurses about sexual relations, and avoided sexual relations, because they feared that sexual relations might negatively influence the quality of life. Many studies indicate that sexual and psychosexual problems are often related to gynecologic cancer treatment (Donovan et al., 2007; Lowdermilk & Germino, 2000; Molassiotis et al., 2002; Reis, 2003), and that sexual life should receive as much attention as other aspects of cancer treatment (Ekwall et al., 2003; Molassiotis et al., 2002). It is important that nurses play a significant role in the sexual rehabilitation of women with gynecologic cancer and their partners.

In society, pregnancy and childbirth are important duties of women. We found that some women with gynecologic cancer also felt anxiety because of losing their ability to become pregnant and have children. This anxiety about sexual relations was felt mostly by young patients in relation to fertility while elderly patients did not see loss of fertility as a threat to their femininity or sexual life. Loss of fertility is especially a significant problem for women who plan to have children in the future (Molassiotis et al., 2002). However, we noticed that gynecologic cancer did not affect the concept of femininity greatly for those of older age, and that concepts of “living” and “being healthy” came first.

We found that the effects of gynecologic cancer on the social life of the women and their partners varied according to stage of the cancer, post-treatment duration, the person’s characteristics, and the social environment. Patients with more advanced cancer and those whose treatment took 6 months to a year had a significant decrease in social life and relationships. Many studies from Turkey and other countries show that social relations are affected for various reasons (Ferrell et al., 2002; Howell et al., 2003; Lowdermilk & Germino, 2000; Sevil, Ertem, Kavlak, & Coban, 2006). We observed that not only the women but also their partners were affected socially and that they arranged their social and even work lives according to the wish of the women to be isolated. This finding is important in that it shows how much their life is affected. Nurses should, therefore, keep in mind that these physical effects may push not only the woman but also her partner towards loneliness.

Patients and their partners were seen to use methods such as praying, obtaining psychological help, abiding by all instructions, asking for support from friends, and continuing social relations in order to cope. Akyuz et al. found that 95% of the gynecologic cancer patients in Turkey used worship and prayer as disease-control methods, for feeling good, increasing quality of life, and constructing psychological support mechanisms (Akyuz et al., 2007).

Turkish society has a more fatalist approach to events than do some societies, in other words, a more subservient approach, because of religious beliefs. This fatalism might affect the use of coping methods of patients and their relatives (Tan, 2007).

Many cancer patients receive a lot of help and support from family and friends (Howell et al., 2003; Isaksen, Thuen, & Hanestad, 2003; Liu, Mok, & Wong, 2005). In this study, some of the participants accepted women’s disease as their fate, and because fate cannot be changed, one has to endure it with courage. This result might be explained as the role of God in disease and death, which is common in Muslim cultures like Turkey (Gozum & Aydin, 2004). Other studies on cancer patients and their careers report that religious beliefs and spiritual applications are important in coping with and fighting the disease and increasing the hope for survival (Boscaglia, Clarke, Jobling, & Quinn, 2005; Ferrell et al., 2002; Northouse, 2005; Weaver & Flannelly, 2004).

Conclusions

Although the sample in this study is nonrandom and therefore cannot be generalized, the goal of this qualitative study was to describe how women and their partners experience gynecologic cancer. Among Turkish women, and their partners, it has been determined that gynecologic cancer has important effects on life. However, in this study more reports of general experiences of the women and their partners regarding almost all aspects of life with cancer were provided. It is recommended for future studies that the effects of gynecologic cancer should be investigated in-depth for each aspect of life.

Integrated holistic care provided by Healthcare professionals upon understanding the physical, emotional, social, and spiritual experiences of both women with gynecologic cancer and their partners is important. We believe that studies which indicate the results of nursing applications directed towards detailed experiences and helping families to cope with these experiences are required so that healthcare staff can assume responsibility properly.

Clinical Resources

* American Cancer Society: www.cancer.org

* Oncology Nursing Society: www.ons.org/

* Association of Cancer Online Resources (ACOR): www.asco.org

* Women’s Cancer Network/Gynecologic Cancers Foundation: www.wcn.org/gc

* The Society of Gynecologic Nurse Oncologists (SGNO): www.sgno.org/

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Aygul Akyuz, RN, PhD, Assistant Professor; Gulden Guvenc, RN, PhD; Ayfer Ustunsoz, RN, PhD, at Obstetric Gynecologic Nursing Department; Tulay Kaya, PhD, Assistant Professor, at Public Health Nursing Department; all at School of Nursing Gulhane Military Medical Academy, Ankara, Turkey. Correspondence to Dr. Akyuz, Obstetric Gynecologic Nursing Department, School of Nursing Gulhane Military Medical Academy, Ankara, Turkey. E-mail: [email protected]

Accepted for publication March 13, 2008.

Copyright Blackwell Publishing Ltd. Third Quarter 2008

(c) 2008 Journal of Nursing Scholarship. Provided by ProQuest LLC. All rights Reserved.

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