OVQUEST – Life after the diagnosis and treatment of ovarian cancer - An international survey of symptoms and concerns in ovarian cancer survivors

doi:10.1016/j.ygyno.2019.08.009

Gynecologic Oncology

Volume 155, Issue 1, October 2019, Pages 126-134

https://doi.org/10.1016/j.ygyno.2019.08.009 Get rights and content

Highlights

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There are a growing number of long term ovarian cancer survivors for whom quality of life is an important issue.
•
The health related quality of life of the study cohort was inferior to general population norms.
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A strong association has been seen between obesity, physical inactivity and quality of life.
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Recurrent disease status did not appear to be a significant contributor to symptom burden.

Abstract

Objectives

Our aim was to investigate the prevalence and potential risk factors for persistent and troublesome physical and psychological symptoms following treatment for ovarian cancer (OC).

Methods

OvQuest is an international, internet-based, cross-sectional questionnaire which explored symptom burden and quality of life (QOL) after treatment for OC. Eligible women were aged 18 and over, diagnosed with OC at least 6 months previously and had received chemotherapy. Self-report data were collected including demographics, diagnosis and treatment, and standardised instruments for treatment-related toxicities, QOL, physical activity (PA) and supportive care needs.

Results

The survey included 1360 patients, of whom 421 (31%) had been treated for recurrent OC. 78% reported symptoms of peripheral neuropathy, 60% significant fatigue, 48% mood disturbance and 59% moderate-severe insomnia. Rates of fatigue, mood disorders, neuropathy and insomnia did not differ between women with or without recurrence. The majority of respondents were overweight or obese (high BMI, 59%) and 35% reported low PA. Low PA and high BMI were associated with poorer QOL scores and higher symptom burden across a range of domains.

Conclusion

Women living after a diagnosis of OC report a substantial and ongoing symptom burden which impacts significantly on their quality of life across multiple domains. The reported associations between obesity, physical inactivity and poor QOL warrant prospective evaluation of lifestyle interventions to improve QOL.

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.

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OVQUEST – Life after the diagnosis and treatment of ovarian cancer - An international survey of symptoms and concerns in ovarian cancer survivors

Highlights

Abstract

Objectives

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Conclusions

Acknowledgements

Declaration of competing interest

Author contributions

Ann. Oncol.

Ann. Oncol.

Gynecol. Oncol.

Ann. Oncol.

Lancet Oncol.

Soc. Sci. Med.

Ann. Oncol.

Epidemiology of ovarian cancer: a review

Cancer Biol. Med.

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