Psychosocial factors, such as social support and distress, are associated with changes in the cellular immune response, not only in peripheral blood, but also at the tumor level. These relationships were more robust in TIL. These findings support the presence of stress influences in the tumor microenvironment.

The incidence and etiology of sexual difficulties for women with survivable cancer were studied. Women with early stage gynecologic cancer (n = 47) were assessed after their diagnosis but prior to treatment and then reassessed at 4, 8, and 12 months posttreatment. Sexual and medical outcomes were compared with data from members of two matched comparison groups who were also assessed longitudinally: women diagnosed and treated for benign gynecologic disease (n = 18) and gynecologically healthy women (n = 57). Global sexual behavior disruption did not occur, but the frequency of intercourse declined for women treated for disease, whether malignant or benign. In relation to the sexual response cycle, diminution of sexual excitement is pronounced for women with disease; however, this difficulty is more severe and distressing for women with cancer, possibly due to significant coital and postcoital pain, premature menopause, treatment side effects, or a combination. Changes in desire, orgasm, and resolution phases of the sexual response cycle may also occur, but they are of lesser magnitude or duration or both. Approximately 30% of the women treated for cancer were diagnosed with a sexual dysfunction. The nature, early timing, and maintenance of sexual functioning morbidity suggest the instrumental role that cancer and cancer treatments play in these deficits (particularly arousal problems) and suggest that preventive therapies are necessary.

The incidence and etiology of major life difficulties for women with survivable cancer were studied. Women with early stage cancer (n = 65) were assessed after their diagnosis but prior to treatment and then reassessed at 4, 8, and 12 months posttreatment. Two matched comparison groups, women diagnosed and treated for benign disease (n = 22) and healthy women (n = 60), were also assessed longitudinally. Results for four life areas are reported: (a) The emotional response to the lifethreatening diagnosis and anticipation of treatment was characterized by depressed, anxious, and confused moods, whereas the response for women with benign disease was anxious only. In both cases, these responses were transitory and resolved posttreatment. (b) There was no evidence for a higher incidence of relationship dissolution or poorer marital adjustment; however, 30% of the women treated for disease reported that their sexual partners may have had some difficulty in reaching orgasm (i.e., delayed ejaculation) after the subjects' treatment. (c) There was no evidence for impaired social adjustment. (d) Women treated for cancer retained their employment and their occupations; however, their involvement (e.g., hours worked per week) was significantly reduced during recovery.

BACKGROUND Quality of life (QOL) and mood were prospectively investigated during the first year of treatment among women with gynecologic cancers. Relationships of coping styles to QOL and mood were examined. METHODS Ninety‐eight patients with early stage or regionally advanced gynecologic cancers were recruited. Mood and QOL were assessed at initial clinic visit and at one year, and medical information was abstracted from charts at both time‐points. RESULTS Although decrements in physical, functional, and total well‐being were reported at baseline by regionally advanced patients, by one year, all patients reported significant improvements in QOL and mood. There were no differences between early stage and regionally advanced patients in their improvement for these measures. Controlling for medical variables and age, patients who coped using greater acceptance and positive reframing at their initial visits reported better one year QOL; those with continued higher levels of these adaptive coping strategies at one year reported better concurrent functional and emotional well‐being. Greater seeking of social support at one year was associated with better concurrent social well‐being and doctor‐patient relationships. In contrast, disengaged coping at study entry was associated with poorer doctor‐patient relationships at one year; continued disengagement at one year was associated with poorer concurrent QOL and greater distress. CONCLUSIONS During the first year following treatment, QOL and mood improved among both early stage and regionally advanced gynecologic oncology patients. Patients using disengaged coping are particularly at risk for poor QOL and distress. Cancer 2002;94:131–40. © 2002 American Cancer Society.