Elsevier

Gynecologic Oncology

Volume 103, Issue 1, October 2006, Pages 120-126
Gynecologic Oncology

Longitudinal assessment of quality of life and lifestyle in newly diagnosed ovarian cancer patients: The roles of surgery and chemotherapy

https://doi.org/10.1016/j.ygyno.2006.01.059Get rights and content

Abstract

Objectives.

To prospectively evaluate quality of life (QoL), use of complementary and alternative medicine (CAM), and diet/exercise changes in ovarian cancer patients during the first 6 months following diagnosis.

Methods.

Patients with newly diagnosed ovarian cancer were enrolled pre- or post-operatively and surveyed at 3 and 6 months. The Functional Assessment of Cancer Therapy (FACT-G), Medical Outcomes Survey (SF-36), and CAM/diet/exercise questionnaires were used. Independent samples t test and repeated measures ANOVA were used.

Results.

Forty-two patients underwent surgical debulking and staging prior to chemotherapy. Patients completing the initial surveys post-operatively had significantly lower physical FACT-G and SF-36 physical scores compared to patients completing the surveys pre-operatively. In patients completing the baseline survey pre-operatively, there was a decrease in physical scores at 3 months (after surgery and during chemotherapy). There was no change observed at 3 months relative to baseline when patients completed the baseline survey post-operatively. Increases in physical and functional well-being were seen at 6 months relative to 3 months. There were no changes in emotional or social scores over time. CAM use increased over time; main reasons were to improve QoL and relieve symptoms. Alterations in diet and exercise were not seen.

Conclusions.

These data highlight the need to conduct assessments before and after surgery to identify effects due to surgery and/or chemotherapy. Patients may be using CAM during chemotherapy to deal with symptoms and compensate for decreased QoL. Intervention trials should be implemented to increase QoL following surgery and during adjuvant chemotherapy.

Introduction

An estimated 22,220 women will be diagnosed with ovarian cancer in the United States during 2005, and 16,210 women will die from this disease [1]. The current standard treatment of ovarian cancer is to optimally debulk the disease surgically and follow with adjuvant chemotherapy. The goals of treatment for women with ovarian cancer are to increase survival and disease-free intervals and to improve quality of life. The clinical course of quality of life (QoL) in newly diagnosed ovarian cancer patients has been characterized using initial measurements after surgery as baseline [2], [3], [4]. A recent study, which included newly diagnosed ovarian cancer patients, examined mean QoL scores as a function of response to chemotherapy treatment but did not include an assessment of these values in terms of pre-surgical or pre-chemotherapy values [5]. Assessment of longitudinal outcomes should include patients' surgical and chemotherapy experiences, requiring measurement of patients' QoL before surgery.

Patients are increasingly involved in their own health care. Cancer patients are altering their diets, exercising, taking nutritional supplements, and using complementary and alternative medicines (CAM) [6], [7], [8]. A study conducted by our group demonstrated that significantly more gynecologic oncology patients use CAM than gynecologic patients without a malignancy [9]. Reasons that CAM and nutritional changes may be appealing are that cancer patients want more control to improve their QoL and that the use of CAM may be filling unmet needs [10], [11]. Differences inherent in the stages and type of cancer, and where patients are in the trajectory of disease (with or without evidence of disease), may influence patient's QoL and may also alter the patient's lifestyle which includes CAM use, diet, and exercise.

Our group designed a study to evaluate changes in QoL, general health status, CAM use, and diet/exercise in women with newly diagnosed ovarian cancer receiving surgery and adjuvant chemotherapy over 6 months. Our objective was to assess patients at the beginning (pre-operatively) of their disease course and follow them throughout chemotherapy treatment. However, at one office, research staffing was only available for post-operative visits, and thus patients were only enrolled following surgery at this site. This allowed us to study two cohorts of patients. Our goal was to assess response to surgery and chemotherapy in relation to measurements made before either event occurred.

Section snippets

Materials and methods

Patients who were scheduled to undergo surgery for ovarian cancer and a group of ovarian cancer patients at their post-operative visit were enrolled in this prospective study from two gynecologic oncology offices located in Northeast Ohio from December 2000 to June 2004. The two distinct cohorts (those enrolled pre-operatively and those enrolled post-operatively after a confirmed diagnosis of ovarian cancer) were enrolled from different offices. This enabled us to look at the effect of surgery

Subjects

Sixty-five women were invited to participate in this longitudinal study, and 52 (80%) agreed. Ten patients did not complete both the 3- and 6-month measurements (due to death: 3; hospice: 2; refused chemotherapy and/or continuing study: 5), and 42 patients completed all three time points. The only difference in demographic and clinical variables between enrollment groups was that patients enrolled pre-operatively had a higher educational level as compared to those enrolled post-operatively (P

Discussion

QoL is altered in women with ovarian cancer during chemotherapy [2], [4], [22], [23]. However, it has been unclear whether the changes of QoL are due to surgical therapy or chemotherapy as prior studies have traditionally enrolled patients in the post-operative period. The two cohorts of ovarian patients enrolled pre-operatively or post-operatively in this study allowed us to reveal differences of QoL measures due to surgery and chemotherapy. Physical well-being scores were lower when measured

Acknowledgments

Supported by the Irene H. Smith Memorial Fund of The Stark Community Foundation, the Akron General Development Foundation, and the Northeastern Ohio Universities College of Medicine Foundation.

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