Fear of recurrence, emotional well-being and quality of life among long-term advanced ovarian cancer survivors

Kathryn Osann¹, Lari Wenzel², Chelsea McKinney³, Lynne Wagner⁴, David Cella⁵, Giulia Fulci⁶, Mary J Scroggins⁷, Heather A Lankes⁸, Victoria Wang⁹, Kenneth P Nephew¹⁰, George L Maxwell¹¹, Samuel C Mok¹², Thomas P Conrads¹³, Austin Miller¹⁴, Michael Birrer¹⁵

Affiliations

¹ Department of Medicine and Program in Public Health, University of California, 839 Health Sciences Rd, Irvine, CA 92697, USA. Electronic address: kosann@uci.edu.
² Department of Medicine and Program in Public Health, University of California, 839 Health Sciences Rd, Irvine, CA 92697, USA. Electronic address: lwenzel@uci.edu.
³ Department of Medicine and Program in Public Health, University of California, 839 Health Sciences Rd, Irvine, CA 92697, USA. Electronic address: comckinn@uci.edu.
⁴ Department of Social Sciences and Health Policy, Wake Forest University, 475 Vine Street, Winston-Salem, NC 27101, USA. Electronic address: lywagner@wakehealth.edu.
⁵ Department of Medical Social Sciences, Northwestern University Health System, 633 N St Clair St, Chicago, IL 60611, USA. Electronic address: d-cella@northwestern.edu.
⁶ GlaxoSmithKline, 1000 Winter St, Waltham, MA 02451, USA.
⁷ International Gynecology Cancer Society, PO Box 170645, Austin, TX 78717, USA.
⁸ The GOG Foundation, Inc., Edgewater, MD 21037, USA; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA. Electronic address: hlankes@gog.org.
⁹ Dana-Farber Cancer Institute, Department of Data Science, 450 Brookline Ave LC1052 or LC9310, Boston, MA 02215, USA. Electronic address: vwang@jimmy.harvard.edu.
¹⁰ Medical Sciences Program, Indiana University School of Medicine-Bloomington, 1001 E 3rd St, Bloomington, IN, 47405, USA. Electronic address: knephew@indiana.edu.
¹¹ Women's Health Integrated Research Center at Inova Health System, Women's Service Line, Inova Health System, 8110 Gatehouse Rd, Falls Church, VA 22042, USA. Electronic address: george.maxwell@inova.org.
¹² Department of Gynecological Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, P.O. Box 301439, Houston, TX 77230, USA. Electronic address: scmok@mdanderson.org.
¹³ Women's Health Integrated Research Center at Inova Health System, Women's Service Line, Inova Health System, 8110 Gatehouse Rd, Falls Church, VA 22042, USA. Electronic address: conrads@whirc.org.
¹⁴ Roswell Park Comprehensive Cancer Center, 665 Elm St, Buffalo, NY 14203, USA. Electronic address: millera@nrgoncology.org.
¹⁵ Winthrop P. Rockefeller Cancer Institute University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR 72205, USA. Electronic address: mjbirrer@uams.edu.

PMID: 36905875
PMCID: PMC10681156
DOI: 10.1016/j.ygyno.2023.02.015

Fear of recurrence, emotional well-being and quality of life among long-term advanced ovarian cancer survivors

Kathryn Osann et al. Gynecol Oncol. 2023 Apr.

. 2023 Apr:171:151-158.

doi: 10.1016/j.ygyno.2023.02.015. Epub 2023 Mar 9.

Authors

Affiliations

¹ Department of Medicine and Program in Public Health, University of California, 839 Health Sciences Rd, Irvine, CA 92697, USA. Electronic address: kosann@uci.edu.
² Department of Medicine and Program in Public Health, University of California, 839 Health Sciences Rd, Irvine, CA 92697, USA. Electronic address: lwenzel@uci.edu.
³ Department of Medicine and Program in Public Health, University of California, 839 Health Sciences Rd, Irvine, CA 92697, USA. Electronic address: comckinn@uci.edu.
⁴ Department of Social Sciences and Health Policy, Wake Forest University, 475 Vine Street, Winston-Salem, NC 27101, USA. Electronic address: lywagner@wakehealth.edu.
⁵ Department of Medical Social Sciences, Northwestern University Health System, 633 N St Clair St, Chicago, IL 60611, USA. Electronic address: d-cella@northwestern.edu.
⁶ GlaxoSmithKline, 1000 Winter St, Waltham, MA 02451, USA.
⁷ International Gynecology Cancer Society, PO Box 170645, Austin, TX 78717, USA.
⁸ The GOG Foundation, Inc., Edgewater, MD 21037, USA; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA. Electronic address: hlankes@gog.org.
⁹ Dana-Farber Cancer Institute, Department of Data Science, 450 Brookline Ave LC1052 or LC9310, Boston, MA 02215, USA. Electronic address: vwang@jimmy.harvard.edu.
¹⁰ Medical Sciences Program, Indiana University School of Medicine-Bloomington, 1001 E 3rd St, Bloomington, IN, 47405, USA. Electronic address: knephew@indiana.edu.
¹¹ Women's Health Integrated Research Center at Inova Health System, Women's Service Line, Inova Health System, 8110 Gatehouse Rd, Falls Church, VA 22042, USA. Electronic address: george.maxwell@inova.org.
¹² Department of Gynecological Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, P.O. Box 301439, Houston, TX 77230, USA. Electronic address: scmok@mdanderson.org.
¹³ Women's Health Integrated Research Center at Inova Health System, Women's Service Line, Inova Health System, 8110 Gatehouse Rd, Falls Church, VA 22042, USA. Electronic address: conrads@whirc.org.
¹⁴ Roswell Park Comprehensive Cancer Center, 665 Elm St, Buffalo, NY 14203, USA. Electronic address: millera@nrgoncology.org.
¹⁵ Winthrop P. Rockefeller Cancer Institute University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR 72205, USA. Electronic address: mjbirrer@uams.edu.

PMID: 36905875
PMCID: PMC10681156
DOI: 10.1016/j.ygyno.2023.02.015

Abstract

Objective: Although advanced stage epithelial ovarian cancer is widely considered life-threatening, 17% of women with advanced disease will survive long-term. Little is known about the health-related quality of life (QOL) of long-term ovarian cancer survivors, or how fear of recurrence might affect QOL.

Methods: 58 long-term survivors with advanced disease participated in the study. Participants completed standardized questionnaires to capture cancer history, QOL, and fear of recurrent disease (FOR). Statistical analyses included multivariable linear models.

Results: Participants averaged 52.8 years at diagnosis and had survived >8 years (mean:13.5); 64% had recurrent disease. Mean FACT-G, FACT-O, and FACT-O-TOI (TOI) scores were 90.7 (SD:11.6), 128.6 (SD:14.8), and 85.9 (SD:10.2) respectively. Compared to the U.S. population using T-scores, QOL for participants exceeded that of healthy adults (T-score (FACT-G) = 55.9). Overall QOL was lower in women with recurrent vs. non-recurrent disease though differences did not reach statistical significance (FACT-O = 126.1 vs. 133.3, p = 0.082). Despite good QOL, high FOR was reported in 27%. FOR was inversely associated with emotional well-being (EWB) (p < 0.001), but not associated with other QOL subdomains. In multivariable analysis, FOR was a significant predictor of EWB after adjusting for QOL (TOI). A significant interaction was observed between recurrence and FOR (p = 0.034), supporting a larger impact of FOR in recurrent disease.

Conclusion: QOL in long-term ovarian cancer survivors was better than the average for healthy U.S. women. Despite good QOL, high FOR contributed significantly to increased emotional distress, most notably for those with recurrence. Attention to FOR may be warranted in this survivor population.

Keywords: Emotional well-being; Fear of recurrence; Long-term survival; Ovarian cancer; Quality of life.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest None of the authors associated with the Ovarian Cancer Consortium for Long-Term Survival have any commercial association that might pose or create a conflict of interest with the information presented in this manuscript. Further, there exist no consultancies, stock ownership, or other equity interests, patent licensing arrangements or payments for conducting or publicizing the study described in the manuscript.

Figures

**Fig. 1.**
Emotional Well-Being (EWB) by Disease Recurrence and FOR (Low, Moderate, High). EWB decreased with increasing FOR in long-term survivors with recurrent disease. However, no trend was observed for EWB with increasing FOR in survivors without recurrence (interaction p = 0.034).

See this image and copyright information in PMC

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Fear of recurrence, emotional well-being and quality of life among long-term advanced ovarian cancer survivors

Affiliations

Fear of recurrence, emotional well-being and quality of life among long-term advanced ovarian cancer survivors

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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Medical