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. 2018 Jul;150(1):119-126.
doi: 10.1016/j.ygyno.2018.05.017. Epub 2018 May 18.

Quality of life, symptoms and care needs in patients with persistent or recurrent platinum-resistant ovarian cancer: An NRG Oncology/Gynecologic Oncology Group study

Vivian E von Gruenigen  1 , Helen Q Huang  2 , David Cella  3 , MichaelA Zevon  4 , Jason A LaChance  5 , Joan L Walker  6 , Ritu Salani  7 , Susan C Modesitt  8 , Robert T Morris  9 , William H Bradley  10 , Matthew P Boente  11 , Lari Wenzel  12
Affiliations

Quality of life, symptoms and care needs in patients with persistent or recurrent platinum-resistant ovarian cancer: An NRG Oncology/Gynecologic Oncology Group study

Vivian E von Gruenigen et al. Gynecol Oncol. 2018 Jul.

Abstract

Objectives: The goals of treating recurrent platinum-resistant ovarian cancer are palliative, aimed at reducing symptoms and improving progression free survival. A prospective trial was conducted to determine the prevalence and severity of symptoms, and associated care needs.

Methods: Eligible women included those with persistent or recurrent platinum-resistant ovarian cancer with an estimated life expectancy of at least 6 months. The Needs at the End-of-Life Screening Tool (NEST), FACIT-Fatigue (FACIT-F), NCCN-FACT Ovarian Symptom Index [NFOSI-18]; Disease Related Symptoms (DRS), Treatment Side Effects (TSE), and Function/Well Being (F/WB) were collected at study entry, 3 and 6 months.

Results: We enrolled 102 evaluable patients. Initiation of Do Not Resuscitate (DNR) discussions increased over time from 28% at study entry to 37% at 6 months. At study entry, the most common disease-related symptoms were fatigue (92%), worry (89%), and trouble sleeping (76%); 73% reported being "bothered by treatment side effects", which included nausea (41%) and hair loss (51%) neither of which changed over time. The most common NEST unmet needs were in the symptom dimension. The social dimension was associated with F/WB (p = 0.002) and FACIT-F (p = 0.006); symptoms were associated with DRS (p = 0.04), TSE (p = 0.03), and FACIT-F (p = 0.04); existential was not associated with any of the patient-reported symptoms; therapeutic was associated with F/WB (p = 0.02).

Conclusions: In patients nearing the end of life, there are significant associations between disease and treatment related symptoms and unmet patient needs, which do not change substantially over time. Careful exploration of specific end-of-life care needs can improve patient-centered care and QOL.

Keywords: Care needs; Ovarian cancer; Quality of life; Symptoms.

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Conflict of interest statement

CONFLICTS OF INTEREST

Dr. David Cella receives money from GOG for travel to meetings for the study or other purposes.

Dr. Joan Walker receives money from Mateon for consultancy, as well as travel/accommodations/meeting expenses unrelated to activities listed.

Dr. Susan Modesitt receives grant money for the University of Virginia.

Dr. Matthew Boente receives money from Genentech Inc. for consultancy, employment and stock/stock options. He also receives money from Genentech Inc. and Clovis Inc. for payment for lectures including service on speakers bureaus, as well as travel/accommodations/meeting expenses unrelated to activities listed.

Dr. Lari Wenzel receives money from NRG Oncology Group for support for travel to meetings for the study or other purposes.

All other co-authors having no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Percentage of patients reporting any other than ‘not at all’ of the FOSI-18 symptoms Baseline is blue bar, 3 months is red bar, 6 months is green bar.
Figure 2.
Figure 2.
Percentage of patients reporting ‘Quite a bit/very much’ of the FOSI-18 symptoms Baseline is blue bar, 3 months is red bar, 6 months is green bar.
Figure 3.
Figure 3.
Percentage of patients reporting unmet needs. Baseline is blue bar, 3 months is red bar, 6 months is green bar.
Figure 4
Figure 4
A. NFOSI-18 Subscale score by physical care need cut score. P-values are for the associations between the NFOSI-18 subscale scores and physical health care needs explored with a linear mixed model with adjustment for age, performance status at baseline and assessment time. B. NFOSI-18 Subscale score by mental care need cut score. P-values are for the associations between the NFOSI-18 subscale scores and mental health care needs explored with a linear mixed model with adjustment for age, performance status at baseline and assessment time.
Figure 4
Figure 4
A. NFOSI-18 Subscale score by physical care need cut score. P-values are for the associations between the NFOSI-18 subscale scores and physical health care needs explored with a linear mixed model with adjustment for age, performance status at baseline and assessment time. B. NFOSI-18 Subscale score by mental care need cut score. P-values are for the associations between the NFOSI-18 subscale scores and mental health care needs explored with a linear mixed model with adjustment for age, performance status at baseline and assessment time.
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References

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