title: The Paradox of Pelvic Exenteration: The Interaction of Clinical and Psychological Variables.
abstract: OBJECTIVE
  To text the feasibility of a psychological intervention package administered to 49 pelvic exenteration candidates, aimed at evaluating the preoperative prevalence of psychological distress and assessing the presence of any correlation between preoperative psychological distress and clinical variables such as pain and hospitalization length.
  
  
  METHODS
  Patients were referred to the psychology unit from the very beginning of their clinical pathway and were administered the Psychological Distress Inventory (PDI) and the Mini-Mental Adjustment to Cancer (Mini-MAC) questionnaire at prehospital admission. Patients presenting with a significant level of distress received nonstandardized psychological support. Statistical analyses were performed to detect the presence of any correlation between psychological variables at prehospital admission and clinical outcomes.
  
  
  RESULTS
  The 40% of patients had significant levels of distress at prehospital admission (PDI ≥ 30). As regards Mini-MAC, the mean value of fighting spirit attitude and fatalism was higher in our sample than in the normative sample of the Mini-MAC validation study in the Italian cancer population. Their anxious preoccupation attitude was lower. There were no correlations between clinical and psychological variables: level of postsurgery pain was higher (3.7) in the subgroup of patients with presurgery PDI < 30 compared with those with PDI ≥ 30 (3.5). However, this difference was not statistically significant (P = 1.00). Considering hospitalization length, the above described trend was similar.
  
  
  CONCLUSIONS
  Although highly distressed, pelvic exenteration candidates show an adaptive range of coping mechanisms. This calls for a greater effort in studying the complexity of their psychoemotional status to provide them with the best multidisciplinary care. Extensive study of the real effectiveness of psychological intervention is warranted: randomized clinical trials could help in detecting the presence of any correlation between clinical and psychological variables in a multidisciplinary approach.
authors.affiliation: *Applied Research Unit for Cognitive and Psychological Science and †Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy; ‡Department of Health Sciences, University of Milan, Milan, Italy; and §Gynecology Oncology Division, European Institute of Oncology, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Arnaboldi
authors.forename: Luigi
authors.initials: L
authors.lastname: Santoro
authors.forename: Ketti
authors.initials: K
authors.lastname: Mazzocco
authors.forename: Serena
authors.initials: S
authors.lastname: Oliveri
authors.forename: Angelo
authors.initials: A
authors.lastname: Maggioni
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pravettoni
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D016889:Endometrial Neoplasms / Q000473:pathology / Q000523:psychology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010385:Pelvic Exenteration / Q000523:psychology*; D011379:Prognosis; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000523:psychology* / Q000601:surgery