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Quality of Life Among Long-Term Survivors of Advanced Stage Ovarian Cancer: a Cross-Sectional Approach

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Quality of Life Among Long-Term Survivors of Advanced Stage Ovarian Cancer: a Cross-Sectional Approach Gynecologic Oncology 146 (2017) 101–108 Contents lists available at ScienceDirect Gynecologic Oncology journal homepage: www.elsevier.com/locate/ygyno Society Position Statements/White Papers Quality of life among long-term survivors of advanced stage ovarian cancer: A cross-sectional approach Susan K. Lutgendorf a,b,c,d,⁎,EileenShinne,JeanneCarterf,g,SusanLeightonh, Keith Baggerly i, Michele Guindani j,1, Bryan Fellman k,MarianneMatzol, George M. Slavich m, Marc T. Goodman n, William Tew o, Jenny Lester p, Kathleen M. Moore q,BethY.Karlanp, Douglas A. Levine f,2, Anil K. Sood r,s,t a Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA b Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA c Department of Urology, University of Iowa, Iowa City, IA, USA d Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA e Department of Behavioral Science, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA f Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA g Gynecology Service, Department of Psychiatry and Surgery Memorial Sloan Kettering Cancer Center, New York, NY, USA h Ovarian Cancer Research Fund Alliance, Washington, DC, United States i Department of Bioinformatics and Computational Biology, Division of Quantitative Sciences, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA j Department of Biostatistics, Division of Quantitative Sciences, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA k Department of Biostatistics, Division of Quantitative Sciences, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA l College of Family Medicine, Stephenson Oklahoma Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA m Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA n Cancer Prevention and Genetics Program, Samuel Oschin Comprehensive Cancer Institute, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA o Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, NY, USA p Women's Cancer Program, Samuel Oschin Comprehensive Cancer Institute, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA q Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stephenson Oklahoma Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA r Department of Gynecologic Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA s Department of Cancer Biology, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA t Center for RNA Interference and Noncoding RNA, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA 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. article info abstract Article history: Purpose. Long-term survival of women with advanced-stage ovarian cancer is relatively rare. Little is known Received 6 March 2017 about quality of life (QOL) and survivorship concerns of these women. Here, we describe QOL of women with ad- Received in revised form 5 May 2017 vanced-stage ovarian cancer surviving for 8.5 years or longer and compare women with 0–1 recurrence to those Accepted 7 May 2017 with multiple recurrences. Available online 17 May 2017 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 Keywords: – Ovarian cancer (IPAQ-SF), diet, and clinical characteristics. Median survival was 14.0 years (range 8.8 33.3). Long-term survivor Results. QOL and psychological adjustment of long-term survivors was relatively good, with mean FACT-G Psychosocial scores (multiple recurrences: 80.81±13.95; 0–1 recurrence: 89.05 ±10.80) above norms for healthy communi- Quality of life ty samples (80.1±18.1). Survivors with multiple recurrences reported more compromised QOL in domains of ⁎ Corresponding author at: Department of Psychological and Brain Sciences, W322 Seashore Hall, University of Iowa, Iowa City, IA 52242, United States. E-mail address: [email protected] (S.K. Lutgendorf). 1 Present address: Department of Statistics, University of California, Irvine, CA, USA. 2 Present address: Division of Gynecologic Oncology, New York University Langone Medical Center, New York, NY, USA. http://dx.doi.org/10.1016/j.ygyno.2017.05.008 0090-8258/© 2017 Elsevier Inc. All rights reserved. 102 S.K. Lutgendorf et al. / Gynecologic Oncology 146 (2017) 101–108 Mood physical and emotional well-being (p b.05), and endorsed a variety of physical and emotional concerns com- Lifestyle pared 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 com- pared to those with 0–1 recurrence. Limitations include a possible bias towards participation by healthier survi- vors, 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. © 2017 Elsevier Inc. All rights reserved. 1. Introduction The study was approved by the IRB of each academic site. Potentially eligible participants from medical centers were screened for eligibility Although the majority of advanced-stage ovarian cancer patients and enrolled at a clinic visit if interested in participation. OCRFA recruit- have poor survival, a subset of patients live for many years after diagno- ed participants via online advertisements; these survivors contacted sis. Women with stage III disease have 5- and 10-year survival rates of MDACC, and, if eligible, were enrolled by MDACC by phone. Surveys 36% and 23%, respectively, with rates of 17% and 8% for stage IV disease were completed at one time-point by internet or by hard copy if the pa- [1]. Clinical predictors of long-term survival have recently been de- tient was reluctant to use the internet-based-survey platform. Patients scribed [2]; however, quality of life (QOL) and survivorship concerns were eligible if they a) spoke English and b) were at least 8.5 years of long-term advanced-stage survivors have been minimally character- from diagnosis with stage III–IV epithelial ovarian cancer. All partici- ized, thus little is known about the needs of this population. pants provided written informed consent. Studies of ovarian cancer survivors within the first few years post-di- The precise cut-point for designating a woman as a long-term survi- agnosis frequently describe elevated distress, depression, anxiety, and vor of ovarian cancer is currently not specifically defined; however, ex- sexual concerns in this population [3]. These negative sequelae are amination of conditional survival rates in the general vicinity of 10 years compounded for survivors experiencing physical complications and (e.g., between 8.5 and 10 years) do not show clear differences [11].We treatment side effects. In contrast, some survivors report personal performed a sensitivity analysis to examine cutoffs of 8.5, 9, and growth and strengthened relationships post-diagnosis (3]. Prior studies 10 years, but changing this cutoff did not alter the pattern of results. of long-term adjustment of ovarian cancer survivors predominantly In the present study, therefore, a cutoff of 8.5 years was employed included early-stage survivors, or women surviving for at least three to maximize sample size while preserving relative homogeneity of or five years without recurrence [4–6]. In one study of women with ad- outcomes. vanced stage non-recurrent disease averaging 6 years post-diagnosis, 64% of survivors reported mental health at or above medical outpatient 2.2. Psychosocial assessments norms, and most (71.4%) reported a strong sense of life purpose [7]. However, a subset of these survivors (28.6%) reported feeling depressed Quality of Life was measured using the Functional Assessment of Cancer and 45.2% reported substantial anxiety [7]. Therapy-Ovarian (FACT-O), a validated 38-item questionnaire consisting The 2016 Institute of Medicine report on the state of ovarian cancer of physical, social, functional, and emotional well-being subscales (com- research highlighted the need for improved patient care across the con- prising the FACT-G) plus a disease-specific subscale measuring ovarian tinuum of survivorship [8]. Although ovarian cancer patients have been cancer-specific concerns [12,13]. An additional FACT-Spiritual subscale surviving longer [9,10] there has been minimal characterization of QOL was also included. Lower scores on the FACT indicate greater impairment. needs of advanced-stage ovarian cancer
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