OVQUEST – Life after the diagnosis and treatment of ovarian cancer - An international survey of symptoms and concerns in ovarian cancer survivors
Introduction
There are a large and growing number of women who are long term survivors after a diagnosis of ovarian cancer [[1], [2], [3]]. The number of ovarian cancer survivors is expected to increase worldwide, due to the continued development of novel active therapeutics [4]. Ovarian cancer survivors are a relatively understudied population with limited data published on the long-term impact of the diagnosis and treatment on quality of life, and the major issues that concern women living with recurrent ovarian cancer (ROC) as well as long-term disease-free survivors. Survivorship concerns expressed by women include symptoms of the disease and symptoms related to adverse effects of treatment. The psychosocial challenges of living with recurrent ovarian cancer as well as fear of recurrence following chemotherapy are also substantial concerns [5,6].
Standard treatment of ovarian cancer includes radical surgery with an attempt to resect all macroscopically visible disease and platinum and taxane-based combination chemotherapy. [7]. Although treatment-related toxicity is routinely reported by clinicians in clinical trials, relatively few studies have focussed on patient-reported outcomes including the prevalence and trajectory of adverse effects after treatment in ovarian cancer survivors. Most reports have included only small cohorts, with sample sizes of one hundred patients or fewer [[8], [9], [10]]. Better understanding of the symptoms and concerns of ovarian cancer survivors, along with early identification of the subset of patients at high risk of ongoing morbidity after treatment for ovarian cancer could lead to better utilisation of resources and facilitate targeted interventions to address and manage symptoms in these patients.
Section snippets
Methods
The OvQuest survey was an international, internet-based, cross-sectional questionnaire to explore the follow-up care, symptoms and quality of life concerns of women after treatment for ovarian cancer. The survey was developed in cooperation with the Australia New Zealand Gynaecological Oncology Group (ANZGOG) and Ovarian Cancer Australia in collaboration with ovarian cancer consumer groups in the USA, United Kingdom, Canada and Germany (NOGGO). Eligible participants were women over the age of
Results
Surveys were submitted by 1360 eligible women, whose clinical and demographic characteristics are shown in Table 1. Respondents had a median age of 51 to 60 years. The majority had been diagnosed with stage III/IV OC (62.5%) and had received platinum and taxane chemotherapy (83%). The average duration since the last chemotherapy was 2.3 years (SD 3.7). Almost one third had received treatment for recurrent OC (31%), and one in five (21.7%) were currently on treatment. Just over half (53.7%)
Discussion
To the best of our knowledge this is the largest international survey of the health status of women treated for ovarian cancer reported to date. It provides a clear insight of life for women following diagnosis and treatment for ovarian cancer using validated questionnaires and symptom scales. On the whole, the health-related quality of life of the study cohort was inferior to the Australian and US population norms, as measured by the FACT-G. This deficit was seen in overall, physical and
Conclusions
The OvQuest study has demonstrated that women living after a diagnosis of ovarian cancer experience a substantial and often persisting physical and psychosocial symptom burden which impacts significantly on their quality of life across multiple domains. The strong associations seen between obesity, physical inactivity and quality of life argue for prospective evaluation of lifestyle interventions in this at-risk population as there are effective strategies available that may lead to significant
Acknowledgements
This survey was developed in conjunction with ANZGOG and Ovarian Cancer Australia, whose representatives also provided consumer input. Thanks are given to the ANZGOG team (co-investigators Dr Webber, Dr Dirkje Sommeijer, A/Prof Linda Mileshkin and Michael Friedlander; ANZGOG staff Alison Evans, Sarah Hope) as well as the following international collaborators:
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UK: Dr Sarah Blagden (University of Oxford, London), Gilde Witte (Ovarian Cancer Action)
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USA: Prof Rob Coleman (MD Anderson Cancer Center),
Declaration of competing interest
Dr. Coleman reports personal fees from Tesaro, Agenus, Eisai, Gamamab and incyte; grants from Merck, Abbvie and Esperance; grants and personal fees from Roche/Genentech, Clovis, AstraZeneca, Janssen, Oncomed, Novartis and Genmab; outside the submitted work. Dr. Herzog reports personal fees from J & J, Clovis, AstraZeneca, Tesaro, Roche and Caris, outside the submitted work. Dr. Friedlander reports personal fees from AstraZeneca, MSD, Lilly and Takeda and non-financial support from AstraZeneca,
Author contributions
Conception or design of the work – KW, LM, DS, JM, MF.
Data collection – KW, JM, SB, RC, TH, JS, SN, GI, MF.
Data analysis and interpretation – KW, EC, LM, DS, JM, SB, RC, TH, JS, SN, GI, MF.
Drafting the article – KW, EC, MF.
Critical revision of the article - KW, EC, LM, DS, JM, SB, RC, TH, JS, SN, GI, MF.
Final approval of the version to be published - KW, EC, LM, DS, JM, SB, RC, TH, JS, SN, GI, MF.
References (40)
Front-line therapy of advanced ovarian cancer: new approaches
Ann. Oncol.
(2017)- et al.
Front-line therapy of advanced epithelial ovarian cancer: standard treatment
Ann. Oncol.
(2017) - et al.
A study of symptoms described by ovarian cancer survivors
Gynecol. Oncol.
(2012) - et al.
Clinical and genetic predictors of paclitaxel neurotoxicity based on patient-versus clinician-reported incidence and severity of neurotoxicity in the ICON7 trial
Ann. Oncol.
(2017) - et al.
Carboplatin plus paclitaxel once a week versus every 3 weeks in patients with advanced ovarian cancer (MITO-7): a randomised, multicentre, open-label, phase 3 trial
Lancet Oncol.
(2014) - et al.
Sleep disturbance in cancer patients
Soc. Sci. Med.
(2002) - et al.
Sleep disturbance in adults with cancer: a systematic review of evidence for best practices in assessment and management for clinical practice
Ann. Oncol.
(2014) - et al.
Epidemiology of ovarian cancer: a review
Cancer Biol. Med.
(2017) - S.I. Ferlay J, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray, F., GLOBOCAN 2012 v1.0,...
- A.I.o.H.a.W. 2017., Cancer in Australia 2017, Cancer Series No. 101. Cat. No. CAN 100. Canberra:...
Ovarian Cancers: Evolving Paradigms in Research and Care
A literature review of the social and psychological needs of ovarian cancer survivors
Psychooncology
Controlled study of fatigue, quality of life, and somatic and mental morbidity in epithelial ovarian cancer survivors: how lucky are the lucky ones?
J. Clin. Oncol.
Long-term adjustment of early-stage ovarian cancer survivors
Int. J. Gynecol. Cancer
The Functional Assessment of Cancer Therapy scale: development and validation of the general measure
J. Clin. Oncol.
Reliability and validity of the functional assessment of cancer therapy-ovarian
J. Clin. Oncol.
Psychometric evaluation of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (Fact/GOG-Ntx) questionnaire for patients receiving systemic chemotherapy
Int. J. Gynecol. Cancer
Reversibility of symptomatic peripheral neuropathy with bortezomib in the phase III APEX trial in relapsed multiple myeloma: impact of a dose-modification guideline
Br. J. Haematol.
Development of a simple screening tool for common mental disorders in general practice
Med. J. Aust.
Empirical validation of the Insomnia Severity Index in cancer patients
Psychooncology
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2022, Cancer Treatment ReviewsCitation Excerpt :Global quality of life assessed with the FACT-G questionnaire did not differ between survivors and controls. [27] The international OvQuest survey, initiated by the ANZGOG study group, showed high levels of neuropathy (78%), fatigue (60%), mood disturbance (48%) and insomnia (59%) in ovarian cancer patients with a mean of 2 years after completion of adjuvant chemotherapy [28]. The international ENGOT and GCIG survey “Expression VI – Carolin meets HANNA” initiated by the NOGGO study group is recruiting long-term survivors who have survived at least eight years after initial diagnosis.
Genetic variants predictive of chemotherapy-induced peripheral neuropathy symptoms in gynecologic cancer survivors
2021, Gynecologic OncologyCitation Excerpt :Conservative estimates suggest up to 36% of older patients with ovarian cancer and 20% of patients under the age of 70 experience grade 2 or higher peripheral neuropathy during and following treatment [3]. Prevalence is reported to be even higher in some studies; a recent international, internet-based survey of patients with ovarian cancer who had received chemotherapy found 78% of patients report symptoms of peripheral neuropathy [4]. Further, almost half of female cancer survivors report persistent or worsening neuropathy more than 5 years after treatment, leading to worsening physical function, increased disability, increased risk of falling, and lower quality of life [5,6].