Elsevier

Gynecologic Oncology

Volume 146, Issue 1, July 2017, Pages 101-108
Gynecologic Oncology

Society Position Statements/White Papers
Quality of life among long-term survivors of advanced stage ovarian cancer: A cross-sectional approach

https://doi.org/10.1016/j.ygyno.2017.05.008Get rights and content

Highlights

  • QOL of long-term advanced-stage ovarian cancer survivors is relatively good.

  • Survivors with multiple recurrences reported more compromised QOL.

  • Low levels of exercise were reported by 43% of long-term survivors.

  • Among these survivors, 52% were overweight or obese.

  • Sexual health concerns are common in long-term survivors.

Abstract

Purpose

Long-term survival of women with advanced-stage ovarian cancer is relatively rare. Little is known about quality of life (QOL) and survivorship concerns of these women. Here, we describe QOL of women with advanced-stage ovarian cancer surviving for 8.5 years or longer and compare women with 0–1 recurrence to those with multiple recurrences.

Methods

Participants (n = 56) recruited from 5 academic medical centers and the Ovarian Cancer Research Fund Alliance completed surveys regarding QOL (FACT-O), mood (CESD), social support (SPS), physical activity (IPAQ-SF), diet, and clinical characteristics. Median survival was 14.0 years (range 8.8–33.3).

Results

QOL and psychological adjustment of long-term survivors was relatively good, with mean FACT-G scores (multiple recurrences: 80.81 ± 13.95; 0–1 recurrence: 89.05 ± 10.80) above norms for healthy community samples (80.1 ± 18.1). Survivors with multiple recurrences reported more compromised QOL in domains of physical and emotional well-being (p < .05), and endorsed a variety of physical and emotional concerns compared to survivors with 0–1 recurrence. Difficulties in sexual functioning were common in both groups. Almost half (43%) of the survivors reported low levels of physical activity.

Conclusions

Overall, women with advanced-stage ovarian cancer who have survived at least 8.5 years report good QOL and psychological adjustment. QOL of survivors with multiple recurrences is somewhat impaired compared to those with 0–1 recurrence. Limitations include a possible bias towards participation by healthier survivors, thus under-representing the level of compromise in long-term survivors. Health care practitioners should be alert to psychosocial issues faced by these long-term survivors to provide interventions that enhance QOL.

Introduction

Although the majority of advanced-stage ovarian cancer patients have poor survival, a subset of patients live for many years after diagnosis. Women with stage III disease have 5- and 10-year survival rates of 36% and 23%, respectively, with rates of 17% and 8% for stage IV disease [1]. Clinical predictors of long-term survival have recently been described [2]; however, quality of life (QOL) and survivorship concerns of long-term advanced-stage survivors have been minimally characterized, thus little is known about the needs of this population.

Studies of ovarian cancer survivors within the first few years post-diagnosis frequently describe elevated distress, depression, anxiety, and sexual concerns in this population [3]. These negative sequelae are compounded for survivors experiencing physical complications and treatment side effects. In contrast, some survivors report personal growth and strengthened relationships post-diagnosis (3]. Prior studies of long-term adjustment of ovarian cancer survivors predominantly included early-stage survivors, or women surviving for at least three or five years without recurrence [4], [5], [6]. In one study of women with advanced stage non-recurrent disease averaging 6 years post-diagnosis, 64% of survivors reported mental health at or above medical outpatient norms, and most (71.4%) reported a strong sense of life purpose [7]. However, a subset of these survivors (28.6%) reported feeling depressed and 45.2% reported substantial anxiety [7].

The 2016 Institute of Medicine report on the state of ovarian cancer research highlighted the need for improved patient care across the continuum of survivorship [8]. Although ovarian cancer patients have been surviving longer [9], [10] there has been minimal characterization of QOL needs of advanced-stage ovarian cancer patients surviving for 8.5 years or longer post-diagnosis. Furthermore, there is substantial heterogeneity in disease course among long-term survivors [2]. Although some live for many years recurrence-free and disease-free, others have multiple recurrences, and may have long-lasting intermittent treatment. From a clinical perspective, long-term survivors with a single recurrence tend to be regarded similarly as those with no recurrence in terms of prognosis and clinical management [2]. This study thus examined QOL, survivorship concerns, and lifestyle factors (e.g. exercise) among long-term (8.5 + years) survivors of advanced-stage epithelial ovarian cancer, and compared women with 0–1 recurrences to those with multiple recurrences. We hypothesized that survivors with multiple recurrences would have poorer QOL, more survivorship concerns, higher levels of distress, poorer well-being and relationships, and be less physically active than those with 0–1 recurrence.

Section snippets

Participants

Women with epithelial ovarian, peritoneal, or fallopian tube cancer were recruited from Cedars-Sinai Medical Center, Memorial Sloan Kettering Cancer Center, University of Iowa Holden Comprehensive Cancer Center, Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, University of Texas MD Anderson Cancer Center (MDACC), and the Ovarian Cancer Research Fund Alliance (OCRFA). The study was approved by the IRB of each academic site. Potentially eligible participants from

Participant characteristics

Of the potentially eligible patients at referring sites, 6 refused and 8 were not approached because of health issues. Of the 84 women who indicated interest, 51 were from OCFRA and 33 were from consortium sites. Two were ineligible, 5 withdrew, and 21 did not complete surveys. (Fig. 1). The final sample included 56 long-term survivors with advanced-stage disease at diagnosis (34 from OCRFA and 22 from clinical sites). Of these women, 91.1% (n = 51) were at least 10 years post-diagnosis (median

Discussion

Key findings from this study indicate that QOL and psychological functioning of long-term advanced-stage ovarian cancer survivors tends to be relatively good, with mean QOL scores commensurate with those of healthy community samples. To our knowledge, this is the first study characterizing QOL in this unique population, including contrasts between survivors with differing disease trajectories. QOL of survivors with multiple recurrences was more compromised for all domains except social and

Disclosures/Conflicts of Interest

Dr. Moore reports advisory board honoraria from Astra Zeneca, Clovis, Immunogen, Genentech/Roche, steering committee from Tesaro, steering committee/advisory board from Advaxis, outside the submitted work; other authors declare no competing financial interests.

Acknowledgements

Funding support: this research was supported in part by Department of Defense CDMRP Grant W81XWH-13-1-0192 (AKS), SIOP-06-258-01-COUN (BK), and National Institutes of Health grants CA109298 (AKS), CA140933 (SL), grant P30CA086862 to the Holden Comprehensive Cancer Center, and grant CA016672 to the Biostatistical Service at MD Anderson Cancer Center.

We would like to express our gratitude to all the ovarian cancer survivors who participated in the study and to Ainslee Johnson for administrative

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