Lifespan Development 233
Group Written Assignment
By Emma Van Wyke, Kate Povee, Jessica Parnell and Christine Smyth
Part One
What Is Testicular Cancer? Testicular cancer is a rare disease in men caused by abnormal growth of cells in the testicle. The most common types of testicular cancers are seminomas and non-seminomas (such as teratomas, embryonal carcinomas, choriocarcinomas and yolk sac tumours). Seminomas are made up of a single type of cell (immature germ cells) which generally affect the 25-55 male age group, whereas non-seminomas consist of more than one type of testicular cell (mature and immature germ cells) affecting mostly the 15-35 male year old age group. Occasionally, the cancer can be a combination of seminomas and non-seminomas. Other rare types of testicular cancer, such as lymphomas, arise from lymphatic tissue within the testicle. The direct causes of testicular cancer are unknown.
Prevalence: Testicular cancer is not one of the most common forms of cancer, however in males aged 15-45years it is the most common type. In 2003, in Western Australia, 73 cases of testicular cancer were diagnosed and there was one death. Nationally in 2000, there were 578 cases and 19 deaths related to testicular cancer. There is an estimated incidence of testicular cancer in approximately 6 in every 100,000 men according to the Cancer Council of Australia, and half of the new diagnoses being made are in men under the age of 33 years. Testicular cancer 5 year survival rates are extremely high (90-100%) for both stage 1 and 2A/B seminomatous and nonseminomatous testicular germ cell tumours (Trask, Paterson, Fardig & Smith, 2003).
Symptoms: Most common symptoms include swelling or a small hard lump in part of one testicle and a change in the consistency of the testicle, such as a sudden collection of fluid in the scrotum. Tumors are often painless, however some sufferers report an ache in the lower stomach or groin, or pain in one testicle. There are reports of a feeling of heaviness in the scrotum. In the majority of cases only one testicle is affected.
Treatment: Cancer of the testis is the most curable of all internal cancers. All testicular cancers can be treated if discovered early and if the right treatment is given. Surgical removal of the tumor, or an "orchidectomy" is the most common treatment. The majority of testicular cancer cases are cured using chemotherapy. This treatment can often be performed in an outpatient setting and refinements in techniques and therapies have reduced various side effects such as severe nausea (Trask, Paterson, Fardig & Smith, 2003). An artificial testicle is sometimes inserted into the scrotum to give a normal appearance.
Side Effects: These treatments can have some side effects, however the affect on fertility is usually temporary and the other testicle is usually sufficient to maintain fertility. Treatment does not normally affect long-term sexuality, masculinity or erectile function. Chemotherapy exerts significant physical side effects including: nausea, vomiting, fatigue, diarrhea, mouth and gastric ulceration, neuropathy and sexual problems (Trask, Paterson, Fardig & Smith, 2003).
Part Two
Justin lives in Collie. His parents are still happily married and they are a middle class family who live comfortably, but they have had to make some small sacrifices to afford Justin's transport to Perth every week. The family always spend the holidays together and are very close. In general Justin's family are very proud of him, and very supportive of the many sports and activities he is involved in. At high school Justin was a prefect and captain of the local footy club. He was also involved in a lot of other clubs and was renowned as an excellent all rounder. One of Justin's older brothers lives in Perth and Justin and his mother stay at his house when they travel to Perth. He has two younger sisters still at school in Collie. Justin is Catholic and he completed Secondary Education At Collie Senior High School. He is a healthy 20 year old who doesn't take drugs or smoke but does enjoy a few drinks on the weekends. Justin has been with his girlfriend Sally, 19, since high school and his family and friends love her and are very supportive of their relationship. Justin has planned to propose to her on her 21st birthday. He works as a first year apprentice electrician at griffin coal mining company, Tuesday-Friday, 0700-1800 Hours.
Part Three
__Collie General Information__
Collie is 60 kilometres from the City of Bunbury and 200 kilometres from Perth in the South West of WA. Population as of 2001 is 9056. Established as a coal-mining town, the mining industry remains the main source of employment and income. Other resources include livestock, water supply for the southwest, power stations, gas and forestry.
__Collie Health Information__
Health Services: CollieHealthServices
Collie District Hospital: 83 Beds. Services include; Emergency, geriatric, home and community care, maternity, medical (general), Occupational Therapy, outpatient, pathology, pharmacy, physiotherapy, speech therapy and general surgery. There is no oncology unit or significant facilities for this illness (testicular cancer).
Collie Transport Information
The Australind train runs twice daily between Perth and Bunbury, with a bus connection to Collie from Brunswick Junction five days per week (not on Tuesday or Thursday). South West Coachlines: Collie - Bunbury - Perth, Monday through Friday (except public holidays), with a morning and evening service to Perth, and one afternoon service from Perth to Collie. An airstrip is also located to the north of the townsite.
Part Four
To effectively examine the far reaching impact of a debilitating illness on an individual, a wholistic approach must be employed. Exploring the three lifespan developmental domains provides a means of enhancing one's appreciation of the many complex and varied factors influencing an individual at any one time. The three inter-related domains are; __Biosocial__: the brain and the body, __Cognitive__: thought processes, language and perpetual abilities and lastly, __Psychosocial__: relationships, emotions and personality (Berger, 2005). Using supporting related literature, this paper will investigate the psychosocial impact of testicular cancer on sufferer, Justin, in the context of both the biosocial and cognitive related factors he will be experiencing.
The effect of undergoing chemotherapy
Chemotherapy is a traumatic experience for a young man to undergo, and the effect can be extremely varied. Chemotherapy may cause some short-term side effects such as nausea, vomiting and temporary hair loss. This obviously imposes on a patient’s lifestyle throughout his treatment, and in Justin’s case this would mean that he was unable to be involved in many of the activities he was before. At such a crucial age of development this may lead to a breakdown in his many important social networks. It may also affect his relationship with his family and girlfriend, due to a lack of energy. Hair loss could affect his confidence, being at an age where self image is still uncertain. A study (Zoltick, B., Jacobs, L., & Vaughn, D., 2005) found that “chemotherapy used in the treatment of testicular cancer increases the risk of cardiovascular disease”. Since Justin is still very young and healthy this may pose as less of a risk to him.
Another study (Eberhardt, B., Dilger, S., Musial, F., Wedding, U., Weiss, T., & Miltner, W.H.R., 2006) found that “cognitive impairments of verbal learning, word fluency, and memory were observed following the first few days after treatment onset.” This would affect Justin every time he had treatment, but only for a short period of time.
Chemotherapy would have a great psychosocial effect on Justin. “I am afraid that all of the effort I put into making myself well might have been for nothing, because the cancer could come back.” (Pahl, B. 2004) According to this young survivor, “Three months of my life had been stolen from me”. This feeling of anger is common. Being so young he may have trouble getting back on track with the many activities he was once involved in. It may also affect his relationship with his girlfriend. Pahl (2004) also described how “it was of great importance for me to prove to myself and everyone else how strong and determined I was.” For a young man of 20 with these feelings, one way he may prove his strength could be showing no emotions or not accepting any help. On the other hand he may rebel against his previous behaviour and ‘go off the rails’. He may have also “stuffed my feelings inside because I wanted to take it like a man.” (Pahl, B., 2004). The great turmoil going through Justin’s mind would affect his relationships with everyone around him, so it is of extreme importance that he talks to people to work through his feelings.
Increased susceptibility to secondary cancers, relapse, and infection.
Many studies have shown that "men with testicular cancer continue to be at significantly elevated risk of second malignant neoplasms for more than two decades following initial diagnosis" (Travis, L.B., et. al, 1997, p. 1429). According to this study, the most prevalent secondary cancers among testicular cancer patients, are prostate cancer, leukaemia, colon, rectum, kidney, bladder, stomach and pancreatic cancers. According to a study investigating late relapse of testicular cancer, it is more common, than previously thought, that relapse will occur (Baniel, J., Foster, R.S., Gonin, R., Messemer, J.E., Donohue, J.P., & Einhorn, L.H., 1995, p.1170). According to this study "patients treated for testicular germ cell cancer need annual follow-up evaluations throughout their life due to the possibility of late relapse." Depending on Justin's regime of treatment, there is also an increased risk for infection due to the effect on his immune system, and if a prosthetic testicle is used, there is also a chance of rejection.
The lifetime burden of this condition causes many psychosocial strains. With the regular follow-up visits to doctors, counsellors and oncologists, to check for the occurrence of any secondary cancer, infection, disease or possible relapse, there are many external impacts placed upon Justin - particularly socially, financially, and on his family and relationships. As mentioned in Part 3, there are no oncological services available in Collie, therefore regular travel to Perth is required to use specialised equipment. Financial disadvantages experienced by Justin and his family extend from Justin and his mother having to take unpaid leave from work, travel costs, and medical bills to mention a few. With Justin and his mother being away from the family for periods of time, relationship strains have surfaced between his parents, and between himself and his sisters who feel disadvantaged and isolated by the attention paid to and money spent on Justin's treatment. Justin's relationship with his girlfriend is becoming shaky with his lack of energy, affection and both his physical and mental presence. Justin's social life is suffering due to his lack of ability to play football and lack of interest in socialising with his masculine friends.
The threat of infertility and reduced sexual function.
Intimacy emerges during the young adulthood period of the lifespan. That is, the desire for a sense of affection, belonging and love (Berger, 2005). Marriage, the most meaningful commitment, may eventuate from these feelings of intimacy. This period in an individual’s life is also the time when their sexual and reproductive systems are functioning at an optimum level. Given the level of fertility, sexual maturity and need for a sense of achievement in marriage, young adulthood is a common time for partners to become parents (Berger, 2005).
In terms of the biosocial domain, most testicular patients retain their fertility, but the risk of infertility is likely to be increased by chemotherapy (Huddart, Norman, Moynihan & Horwich, 2005). Chemotherapy, which will be a likely form of treatment for Justin, dramatically impairs normal male body functioning. This aggressive form of treatment adversely affects the number, shape and motility of sperm produced, long after treatment has ceased (Berger, 2005). Research indicates that it is likely that the patient will also experience a reduction in sexual activity (Huddart et al., 2005). Following chemotherapy, fertility is reduced to 71% and lowered to 67% if a combination of radiotherapy and chemotherapy is employed (“Testicular Cancer”, 2005).
But what impact will this have on Justin in a psychosocial sense? Undeniably, this significant decrease in fertility will have a profound impact on the patient’s emotional wellbeing. This highly personal and sensitive issue has a serious impact on a person’s sense of identity and self-esteem (Sanden & Hyden, 2002). Reduction in fertility and sexual function also often threatens the sense of masculinity (Sanden & Hyden, 2002). Justin may feel ‘less of a man’, and it is also possible that the reduced ability to have children will only fuel further feelings of social isolation.
Reduced ability to successfully have children is likely to also place increased pressure on his relationship with his girlfriend, Sally. Producing children is seen as a great achievement- an indication of a successful partnership (Berger, 2005). Research reveals that a major concern felt by the families of testicular cancer patients, is that they will be unable to have children or grandchildren with their son or husband as the biological father (Sanden& Hyden, 2002). Sanden & Hyden (2002) also found that the disappointment of not falling pregnant and the use of many fertility treatments also had a debilitating effect on the mental health of many of the wives of men with testicular cancer.
The effect of testicular cancer on Justin's cognitive development
Cognitive development in early adulthood is characterized by the emergence of postformal thought, a way of thinking that leads on from Piaget's formal operational stage (Berger, 2005). This is the stage of cognition which is relevant to Justin and it is signified by the incorporation of the subjective and personal as well as the objective reasoning of adolescence with the aim of finding a more integrated approach to thinking. Adult thinking becomes more contextual as learning moves away from the classroom (Berger, 2005) and into the world of work, relationships, and life events such as serious illness: testicular cancer, in Justin's case. In men with prostate cancer, the incomplete cognitive processing associated with their illness was the presence of intrusive thoughts and searching for meaning (Roberts, 2004). Although the type of cancer difers from Justin's and the sample group were in middle rather than early adulthood, the effect of the context of cancer on thought processes is relevant to Justin's development of postformal thought.
Another aspect of cognitve growth in early adulthood is the developement of adult moral reasoning, the way an adult thinks about morality, ethics and faith (Berger, 2005). The early adult's postformal thinking extends to moral reasoning as objectivity and rationality are mixed with personal experience and the ability to see solutions as neither black nor white, but the best possible option (Berger, 2005). Justin's personal experience of cancer would therefore be of some influence to his moral reasoning, particularly his cognition of faith, as "religion and coping tend to converge when people...are confronted with situations that challenge the boundaries of their biopsychosocial resources" (Fox, 2002). Justin's faith may reach new levels, spurred by a spiritual transformation following the traumatic event of his cancer (Fosse, 2005). Conversely the experience can lead to confusion, as a young survivor of leukemia writes "I try to understand the impact of having a life-threatening illness, with no satisfying resolution" (Lee, 2001).
The area of adult cognitive development of particular relevance to Justin's case is the impact of life events in triggering cognitive growth (Berger, 2001). In one case study, the effect of cancer on a woman in early adulthood was shown to manifest in her way of thinking, namely a feeling of being more mature than her peers, conflict about integrating cancer into her personal identity, and a shift in her life perspectives and personal choices (Lee, 2001). Case studies such as Lee's (2001) are obviously limited in their application as they recount experiences specific to one individual, in this case of the opposite gender to Justin, however this case study presents the account of an experience that is little documented in the literature: cognitive growth following the traumatic life event of cancer.
The interruption that testicular cancer poses to Justin at the time of early adulthood will have repercussions across the biosocial, psychosocial, and cognitive aspects of his life. The three domains are intertwined: the impact on one will have implications for the others. This can be seen in the biosocial impact of chemotherapy- hair loss, physical decine and potential infertility- and it's implications for Justin's psychosocial wellbeing, leading perhaps to feelings of reduced masculinity and relationship breakdown due to the threat of infertility, or the cognitive questioning of his faith and attempts to integrate cancer into his new self image, spurred by his hair loss. The psychosocial distress that Justin may expect of anger, fear, and feelings of injustice finds a counterpoint in the literature, with indications that young cancer sufferers have found the experience of cancer to have a transformative effect on their lives, such as increased feelings of maturity, a shift in personal and life perspectives, and spiritual transformations. Justin's case makes it apparant that no aspect of illness can be fully understood in isolation but rather must be viewed in the context of an individuals biosocial, cognitive, and psychosocial context.
Reference List
Comments (2)
Anonymous said
at 8:34 pm on Apr 22, 2006
All the sections were well attempted except for section 3 where you need to focus on facilities and services relevant to Justin. You also need to include 6 peer-reviewed journal articles covering the biosocial, psychosocial and cognitive aspects of testicular cancer.
Aggie
Anonymous said
at 11:09 am on May 26, 2006
hi christine, emma, and kate: cognitive section and conclusion are done. whho hoo. i have posted my references but the computer won't let me do italics for reasons best known to itself, so beware if you are compiling the reference list. Jess
You don't have permission to comment on this page.