Changes in Cortisol Levels before and after Supportive Psychotherapy in Patients with Comorbid Cervical Cancer Distress with Depression Type

Perubahan Kadar Kortisol sebelum dan sesudah Psikoterapi Suportif pada Pasien Kanker Serviks dengan Komorbiditas Distres Tipe Depresi

Abstract

Objective: To prove the success of supportive psychotherapy that
was provided as a distress therapy on advanced cervical cancer.
Knowing the prevalence of distress type of depression in patient
with epithelial cervical cancer, proving the benefits of psychotherapy
supportive for distress can decreasing cortisol level in cervical
cancer patient, can assess distress thermometer score, HAM-D17
score and scoring incident predictors of distress with depression
type.
Methods: There were 32 subjects from 71 advanced cervical cancer
patients had mild-moderate depression. Then randomization
blocking was performed to determine a subject who entered the
treatment group (n = 16) who got supportive psychotherapy or
control group who got common psychotherapy (n = 16). All of
participants assessed the distress level with cortisol value, distress
thermometer score, and HAM-D17 score before and after they got
supportive psychotherapy.
Results: After the intervention of psychotherapy in the treatment
group decreased HAM-D17 score, the average decline 7.53 (SB 3.34).
The mean decreasing in the control group was 3.98 (SB 2.85). There
is a significant difference in mean reduction in HAM-D17 scores on
treatment and control groups with p = 0.003 (p <0.005). There was
decreasing blood cortisol level in the treatment group amounted to
39.43, while the control group there was a drop of 1.59. The reduction
of cortisol level in the treatment group and the control has a pvalue
0.302. After got supportive psychotherapy, found a decreasing
the average value of the thermometer distress in the treatment
group 3.02 and the control group 2.51, with a p value more than
0.492.
Conclusion: There were 45% of cervical cancer patients in the clinic
experiencing distress disorder with depressive type. The blood
cortisol level could be decreased by giving supportive psychotherapy
with a mean decrease of 39.43 nmol/l. There was a significant
reduction in the level of depression (HAM-D17 score) of 7.53 points
and distress thermometer impairment by 3 points after given
supportive psychotherapy. Obtained scoring predictors for the
occurrence of distress type of depression in patients with advanced
cervical cancer with a sensitivity of 46.15% and a specificity of
89.47%.
[Indones J Obstet Gynecol 2018; 6-3: 179-187]
Keywords: cervical cancer, cortisol, distress, distress thermometer,
HAM-D17 score