Quality of life in patients with ovarian cancer: current state of research

Preliminary guideline for reporting bibliometric reviews of the biomedical literature (BIBLIO): a minimum requirements

BACKGROUND

A bibliometric review of the biomedical literature could be essential in synthesizing evidence if thoroughly conducted and documented. Although very similar to review papers in nature, it slightly differs in synthesizing the data when it comes to providing a pile of evidence from different studies into a single document. This paper provides a preliminary guideline for reporting bibliometric reviews of the biomedical literature (BIBLIO).

METHODS

The BIBLIO was developed through two major processes: literature review and the consensus process. The BIBLIO started with a comprehensive review of publications on the conduct and reporting of bibliometric studies. The databases searched included PubMed, Scopus, Web of Sciences, and Cochrane Library. The process followed the general recommendations of the EQUATOR Network on how to develop a reporting guideline, of which one fundamental part is a consensus process. A panel of experts was invited to identify additional items and was asked to choose preferred options or suggest another item that should be included in the checklist. Finally, the checklist was completed based on the comments and responses of the panel members in four rounds.

RESULTS

The BIBLIO includes 20 items as follows: title (2 items), abstract (1 item), introduction/background (2 items), methods (7 items), results (4 items), discussion (4 items). These should be described as a minimum requirements in reporting a bibliometric review.

CONCLUSIONS

The BIBLIO for the first time provides a preliminary guideline of its own kind. It is hoped that it could contribute to the transparent reporting of bibliometric reviews. The quality and utility of BIBILO remain to be investigated further.

Quality of life of ovarian cancer patients treated with combined platinum taxane chemotherapy: a systematic review of the literature

PURPOSE

Chemotherapy is the cornerstone of adjuvant therapy in ovarian cancer. Its impact on the quality of life (QoL) has been addressed in several studies; however, several misperceptions concerning this affect patient counseling and physicians' ability to overcome patient fears. In the present systematic review, we sought to accumulate current evidence in the field in order to help establish robust information that will help physicians answer patients' questions.

METHODS

The present systematic review is based on the PRISMA guidelines. Studies that evaluated patient QoL pre-, during, and post-chemotherapy with the use of the QLQC-30 were selected for inclusion. Their methodological quality was assessed with the before-after studies tool that is proposed by the National Institute of Health (NIH).

RESULTS

Ten studies that involved 5181 patients were included in the present systematic review. The risk of bias and methodological quality of included studies was of good and fair overall quality. Retrieved data suggest there is substantial evidence that points toward improved global QoL among ovarian cancer patients treated with taxanes-platinum combination therapy. Individual outcomes evaluated with the QLQ-C30 also provide positive results, although underreporting was noted.

CONCLUSION

Despite the significant heterogeneity in outcome reporting, the findings of this study reveal the significant benefit of combined platinum taxane chemotherapy on the QoL of ovarian cancer patients and can be used for patients counseling in order to reduce refusals that arise from fear of adverse effects that may negatively affect QoL. Graphical abstract.

Quality of Life in Patients with Gynecological Cancers: A Web-Based Study

Introduction:

Gynecological cancers are common in adult women. One of the most important goals in the management of these patients is to improve quality of life, along with survival as a traditional outcome. The aim of this study was to evaluate quality of life in gynecological cancers in Iran.

Methods:

This cross-sectional study was performed on a sample of patients with gynecological cancers including uterine, ovarian, cervical, and vulvovaginal attending a teaching hospital affiliated to Tehran University of Medical Sciences between 2014 and 2019. The data was collected by a web-based platform with validated self-administered questionnaires including demographic information, the EORTC QLQ-C30 and the Hospital Anxiety and Depression (HADS). The data were analyzed using appropriate tests.

Results:

In all 251 patients were studied. The mean age of patients was 52.8±12.4 years and 43% had uterine, 30% had ovarian, 25% had cervical, and 2% had vulvovaginal cancer. The mean global quality of life score as measured by the EORTC QLQ-C30 was 59.8 ± 24.9. Women with ovarian cancer had the highest and women with cervical cancer had the lowest global quality of life score. There were significant differences in emotional, cognitive and global quality of life by cancer diagnosis (p <0.05). Although not significant, overall physical, role, cognitive and social functioning was found to be better in women who had been treated with surgery. The mean anxiety and depression score were 8.7± 5.0 and 7.1 ± 5.2, respectively.

Conclusion:

The results demonstrated that patients with gynecological cancers had a low quality of life, and experience higher anxiety and depression.

Patient-Reported Outcomes in Surgical Oncology: An Overview of Instruments and Scores

Traditional measures of quality and effectiveness in surgical oncology have focused on morbidity, mortality, and when available, recurrence rates. Measuring patient-reported outcomes (PROs) has become more widely accepted during the last decade. This article reviews instruments commonly used in the surgical treatment of cancer patients to evaluate PROs. In addition, it discusses the linkage of PROs and health-related quality of life measures with traditional surgical complications and highlights future directions related to the expanding use of PROs in the surgical care of cancer patients.

State of the Science in Ovarian Cancer Quality of Life Research: A Systematic Review

Introduction

Health-related quality of life (HRQOL) has become an increasingly important focus of outcomes in cancer care with the movement toward more patient-oriented research. Quality-of-life outcomes are important in ovarian cancer, which has not yet benefitted from improved survival outcomes as have other diseases. This study was designed to systematically assess and summarize HRQOL in ovarian cancer.

Methods

A systematic search strategy was initiated to identify published literature measuring HRQOL of women with a diagnosis of ovarian cancer (OC). Data were synthesized to evaluate HRQOL and patient-reported outcome data at various time points: before, during, and after chemotherapy. Data were pooled and summary statistics compared across published studies. Comparisons of means were conducted using analysis of variance.

Results

There were 170 publications meeting all eligibility criteria, representing 139 unique studies of patients with ovarian cancer, where QOL data were collected. Within this literature, more than 90 different patient-reported outcome (PRO) instruments were administered. The most common HRQOL instruments included the European Organisation for Research and Treatment of Cancer QLQ-C30 and the Functional Assessment of Cancer Therapy. Few studies alone demonstrated significant differences in QOL between the experimental and comparison arm or throughout the treatment period. Pooled data, however, show that baseline QOL may significantly improve, particularly after completion of chemotherapy treatment.

Discussion

Despite the increase in assessment and reporting of QOL in ovarian cancer research studies during the past 15 years, there remains little consistency in the types and format of data collected. There is a need to enhance the standardized collection and reporting of HRQOL data from research involving women with ovarian cancer so that research can build on the cumulative knowledge base to improve outcomes in this patient population.

Improving care for women after gynecological cancer: the development of a sexuality clinic

The impact of a gynecological cancer diagnosis and the subsequent treatment on women is profound, both physically and psychologically, in particular with respect to sexual function and sexuality. We describe our experience creating a specialized clinic to address concerns about sexual health and rehabilitation. We used a case study approach to describe the clinic's inception and first 2 years of operation. Fifty-six survivors of gynecological cancer were seen at the clinic in the first 2 years. These patients had a significant symptom burden, many related to menopause, as well as those aftereffects of radiation therapy, chemotherapy, and surgical operation as well as psychological and emotional responses to cancer. The most common interventions were education and counseling. Patients reported high levels of satisfaction with their experience at the clinic. We hope our experience may be of assistance to others considering a similar endeavor.

Pretreatment malnutrition and quality of life - association with prolonged length of hospital stay among patients with gynecological cancer: a cohort study

Background

Length of hospital stay (LOS) is a surrogate marker for patients' well-being during hospital treatment and is associated with health care costs. Identifying pretreatment factors associated with LOS in surgical patients may enable early intervention in order to reduce postoperative LOS.

Methods

This cohort study enrolled 157 patients with suspected or proven gynecological cancer at a tertiary cancer centre (2004-2006). Before commencing treatment, the scored Patient Generated - Subjective Global Assessment (PG-SGA) measuring nutritional status and the Functional Assessment of Cancer Therapy-General (FACT-G) scale measuring quality of life (QOL) were completed. Clinical and demographic patient characteristics were prospectively obtained. Patients were grouped into those with prolonged LOS if their hospital stay was greater than the median LOS and those with average or below average LOS.

Results

Patients' mean age was 58 years (SD 14 years). Preoperatively, 81 (52%) patients presented with suspected benign disease/pelvic mass, 23 (15%) with suspected advanced ovarian cancer, 36 (23%) patients with suspected endometrial and 17 (11%) with cervical cancer, respectively. In univariate models prolonged LOS was associated with low serum albumin or hemoglobin, malnutrition (PG-SGA score and PG-SGA group B or C), low pretreatment FACT-G score, and suspected diagnosis of cancer. In multivariable models, PG-SGA group B or C, FACT-G score and suspected diagnosis of advanced ovarian cancer independently predicted LOS.

Conclusions

Malnutrition, low quality of life scores and being diagnosed with advanced ovarian cancer are the major determinants of prolonged LOS amongst gynecological cancer patients. Interventions addressing malnutrition and poor QOL may decrease LOS in gynecological cancer patients.

Can subjective global assessment of nutritional status predict survival in ovarian cancer?

Background

Malnutrition is a significant problem in patients with ovarian cancer. The goal of this study was to investigate the prognostic role of Subjective Global Assessment (SGA) in patients with ovarian cancer treated in an integrative cancer treatment setting.

Methods

We evaluated a case series of 132 ovarian cancer patients treated at Cancer Treatment Centers of America^® from Jan 2001 to May 2006. SGA was used to assess nutritional status at baseline. Using SGA, patients were classified as well nourished (SGA A), moderately malnourished (SGA B) or severely malnourished (SGA C). Kaplan Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of SGA independent of other factors.

Results

Of 132 patients, 24 were newly diagnosed while 108 had received prior treatment. 15 had stage I disease at diagnosis, 8 stage II, 85 stage III and 17 stage IV. The median age at presentation was 54.4 years (range 25.5 – 82.5 years). 66 patients were well-nourished (SGA A), 35 moderately malnourished (SGA B) and 31 severely malnourished (SGA C). Well nourished patients had a median survival of 19.3 months (95% CI: 14.1 to 24.5), moderately malnourished 15.5 months (95% CI: 5.8 to 25.1), and severely malnourished 6.7 months (95% CI: 4.1 to 9.3); the difference being statistically significant (p = 0.0003). Multivariate Cox modeling, after adjusting for stage at diagnosis and prior treatment history found that moderately malnourished and severely malnourished status were associated with a relative risk of 2.1 (95% CI: 1.2 to 3.6, p = 0.008) and 3.4 (95% CI: 1.9 to 5.8, p < 0.001) respectively as compared to well nourished status.

Conclusion

Univariate and multivariate survival analyses found that low SGA scores (i.e. well-nourished status) are associated with better survival outcomes. This study lends support to the role of aggressive nutritional intervention in improving patient outcomes in cancer care.

Quality of life among women after surgery for ovarian cancer

OBJECTIVES

Difficulties with diagnosis and aggressive, long-term treatment may result in lower quality of life (QOL), including high levels of anxiety, depression, and uncertainty, greater symptom distress, and lower overall QOL among women with ovarian cancer. The purpose of this study was to describe demographic, clinical, and other risk factors associated with compromised QOL among women who have undergone surgery for ovarian malignancies.

METHODS

Subjects were recruited to participate in a clinical trial that tested a specialized nursing intervention addressing psychological and physical care among women post-surgical for ovarian cancer. QOL was measured using five standardized self-report measures: the State-Trait Anxiety Scale (SAS), the Center for Epidemiological Studies Depression Scale (CES-D), the Mishel Uncertainty in Illness Scale (MUIS), the Symptom Distress Scale (SDS), and the Short-Form Health Survey (SF-12). Baseline data were collected while women were hospitalized following surgery.

RESULTS

The sample (n=145) included women with ovarian cancer (58%) and other cancers metastasized to the ovaries and abdomen (42%). Mean scores on the measures were consistent with or higher than previously reported means for similar populations. Women reporting the lowest QOL were more likely to be younger, more educated, and have early stage disease.

SIGNIFICANCE OF RESULTS

Women who have undergone surgery for ovarian malignancies have psychological needs that are often considered secondary to physical needs. Interventions should include routine screening for distress and referral to appropriate psychological and social services, thereby facilitating quality cancer care.

Quality of life in obese postmenopausal women

The aim of this review was to identify the ways in which obesity affects the health-related quality of life (HRQoL) of postmenopausal women. This was considered important because a growing body of literature has identified obesity as a significant predictor for a poor psychological wellbeing and negative HRQoL, particularly in women, and because during the transition through the menopause women tend to accumulate more body weight. After searching eight electronic databases, only nine papers appeared meaningful. Although a meta-analysis was not possible, we found that a body mass index (BMI) >30 kg/m2 was associated with a poor HRQoL in postmenopausal women; particularly in the areas associated with physical functioning, energy and vitality, and health perceptions. Thus, clinical management of obese postmenopausal women should focus on weight reduction and exercise in an attempt to improve wellbeing in these areas. However, the paucity of research, the different instruments chosen to measure HRQoL and the methodological limitations of the studies identified, prevented firm conclusions being made about whether the relationship between BMI and HRQoL is linear in postmenopausal women. Further research is needed to explore this relationship; particularly in comparison with underweight postmenopausal women and obese premenopausal women, where a few papers have identified these women as having a worse HRQoL than their obese postmenopausal counterparts. Other measures of central adiposity, including waist circumference and waist-hip ratio are recommended as useful supplemental measures to BMI in future studies.

Review of quality of life: menorrhagia in women with or without inherited bleeding disorders

The objectives of this study were to identify the impact of menorrhagia on the health-related quality of life (HRQOL) of women in general and those with inherited bleeding disorders and to identify the commonly used tools in assessing quality of life. A review of studies evaluating quality of life in women suffering from menorrhagia was conducted. Data sources used included electronic databases Medline and Embase. Reference lists and bibliographies of the relevant papers and books were hand-searched for additional studies. Eighteen of the 53 studies identified measured quality of life prior to treatment of menorrhagia. Ten of the studies used a validated measure of quality of life. Five studies involving a total of 1171 women with menorrhagia in general and using SF-36 were considered for further review. The mean SF-36 scores in women with menorrhagia were worse in all the eight scales when compared with normative scores from a general population of women. Three studies, involving 187 women, assessed the quality of life in women with menorrhagia and inherited bleeding disorders. None of these studies used a validated HRQOL score making it difficult for comparison. However, all reported poorer scores in study women compared to the controls. In conclusion, HRQOL is adversely affected in women with menorrhagia in general and in those with inherited bleeding disorders. HRQOL evaluation is useful in the management of women with menorrhagia for assessment of treatment efficacy.

Survivorship Issues in Ovarian Cancer: A Review

PURPOSE/OBJECTIVES

To review what is known about survivorship issues for women after ovarian cancer treatment while identifying gaps and controversies.

DATA SOURCES

MEDLINE, CINAHL, and CancerLit database searches using the key words ovarian cancer, quality of life (QOL), chronic care, coping, uncertainty, and survivor separately and in combination.

DATA SYNTHESIS

Data were categorized into psychosocial, QOL, and physical symptoms and reviewed for design, sample size, method, and outcome.

CONCLUSIONS

Ovarian cancer studies focus on women's symptoms and concerns during treatment. Needs and issues of long-term survivors lack exploration. The relationship of ovarian cancer survivorship and physical side effects of treatment or recurrence is insufficient given increasing survival rates.

IMPLICATIONS FOR NURSING

The nature and management of physical symptoms, beyond pain, in ovarian cancer survivors need further study. Specifically, QOL and psychosocial issues for long-term survivors require study. Consequences for women who undergo major tissue debulking or multiple and aggressive courses of cytotoxic treatments must be understood to facilitate intervention.

The impact of treatment for gynecological cancer on health-related quality of life (HRQoL): a systematic review

Gynecologic cancers are major sources of mortality and morbidity. Although many review articles have reported on the impact of these diseases on health-related quality of life (HRQoL), none have reviewed the evidence in specific relation to the effect of treatment on HRQoL. Consequently, we systematically searched 4 electronic databases and hand-searched relevant reference lists and bibliographies to identify literature on this subject. Only 47 studies used a validated questionnaire to measure HRQoL. Although a meta-analysis was not possible, we found HRQoL rarely included as a treatment outcome, and when included assessment was often methodologically flawed. Seldom were pretreatment and posttreatment data collected or treatment regimes documented. Except for a few studies, analysis of HRQoL was conducted on small samples, excluding the cancer site and stage. Consequently, no definitive conclusions could be drawn and therefore we conclude with recommendations for the future reporting of HRQoL in gynecologic oncology studies.

Development of ovarian cancer surgery quality indicators using a modified Delphi approach

OBJECTIVE

Little performance measurement has been undertaken in the area of oncology, particularly for surgery which is a pivotal event in the continuum of cancer care. This work was conducted to develop indicators of quality ovarian cancer surgery using a modified three-step Delphi approach.

METHODS

A multidisciplinary panel, comprised of surgical and methodologic co-chairs, nine surgeons, one medical oncologist, one radiation oncologist, a nurse, and a pathologist, reviewed potential indicators extracted from the medical literature through two consecutive rounds of rating followed by consensus discussion. The panel then prioritized the indicators selected in the previous two rounds.

RESULTS

Of 33 possible indicators that emerged from 41 selected articles, 14 were prioritized by the panel as benchmarks for assessing the quality of surgical care. The 14 indicators represent three levels of measurement (provincial/regional, hospital, individual provider) across several phases of care (diagnosis, surgery, pathology, and adjuvant therapy), as well as broad measures of access and outcomes. Some of the indicators selected by the panel were also recommended as standards of care by national initiatives in other countries.

CONCLUSIONS

A systematic evidence- and consensus-based approach was used to develop quality indicators of ovarian cancer care, with a focus on pre-, peri-, and postoperative care as well as outcomes, that are applicable in any jurisdiction.

Quality of life in ovarian cancer patients: comparison of paclitaxel plus cisplatin, with cyclophosphamide plus cisplatin in a randomized study

PURPOSE

Formal quality-of-life (QOL) assessments may contribute important information on patient symptoms. Despite many trials of systemic chemotherapy in ovarian cancer, reports of its effect on QOL are few.

PATIENTS AND METHODS

QOL was assessed in an Intergroup randomized trial comparing paclitaxel plus cisplatin to cyclophosphamide plus cisplatin in women with advanced ovarian cancer. One hundred fifty-two eligible patients accrued in Canada completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and a trial-specific checklist at baseline (after surgical debulking) and at regular intervals during and after chemotherapy. Mean change scores over time in the two arms were calculated.

RESULTS

Compliance with QOL questionnaire completion was excellent (81% to 93%). In general, deterioration was seen in the QOL domains immediately after chemotherapy (day 8 of cycle 1), followed by clinically meaningful improvements compared with baseline (change scores > or = 10) in both arms during the treatment period in a number of domains and items, including global QOL, emotional function, social function, fatigue, pain, sleep, constipation, appetite, abdominal swelling, and abdominal cramps. Improvements in global QOL persisted for the duration of follow-up. More neurosensory effects and myalgia were documented in the paclitaxel arm; however, this did not adversely affect global or other domains of QOL and improved once chemotherapy was completed.

CONCLUSION

Improvement from baseline in QOL measures was seen in both treatment arms. The greater neurologic and muscle toxicity of paclitaxel did not adversely influence QOL. QOL data can contribute useful information on the experience of symptoms and their time course, which may assist patients and physicians in their discussion about the anticipated effects of therapy.

EMEA and the evaluation of health-related quality of life data in the drug regulatory process

Objectives:This study reviewed the European guidelines of the Committee for Proprietary Medicinal Products (CPMP) on how health-related quality of life (HRQOL) research should be conducted in clinical trials. Published product-level information was also reviewed to investigate the actual role of HRQOL data in the European regulatory process.

Methods:All disease-specific notes for guidance and concept papers on clinical investigations, development and evaluation of human medicinal products, as well as the European Public Assessment Reports (EPAR) of all approved drugs published on the European Agency for the Evaluation of Medicinal Products (EMEA) Web site were evaluated for their HRQOL recommendations.

Results:Only twenty of the fifty CPMP guidance notes for clinical investigation of pharmaceutical products in specific disease areas included a reference to HRQOL. Most of the recommendations were generic and vague, and the terminology used was inconsistent across documents. The EPAR provided nonspecific information about HRQOL and contradictory conclusions on the effect of a drug on HRQOL sometimes occurred in different documents. The criteria used by the CPMP to assess the HRQOL data could not be identified due to an ad hoc approach to the inclusion of data in the EPAR.

Conclusions:A more systematic approach is needed on the way health outcomes data are considered, reviewed, and interpreted by the regulatory authorities. For this to be achieved, CPMP should develop general guidelines on the importance of HRQOL and how research should be conducted if data are to be included in the registration process.

Determining the relationship between toxicity and quality of life in an ovarian cancer chemotherapy clinical trial

PURPOSE

This analysis of data from a randomized trial of chemotherapy in epithelial ovarian cancer sought to determine whether a relationship exists between the presence and severity of the most commonly observed toxic effects and the corresponding quality of life (QOL) items.

PATIENTS AND METHODS

One hundred fifty-two eligible patients accrued from Canada by the National Cancer Institute of Canada Clinical Trials Group on a randomized trial of paclitaxel and cisplatin versus cyclophosphamide/cisplatin were included in the analysis. Toxicity to the chemotherapeutic treatments was subjectively evaluated using a trial-specific checklist for ovarian cancer and the European Organization for Research and Treatment of Cancer QLQ C30+3 questionnaire. Assessments were conducted at baseline, before each cycle of treatment (3 weeks), and at each 3-month follow-up during the next 2 years (or until progression).

RESULTS

The most frequently observed symptoms experienced during or shortly following chemotherapy were neurosensory loss, lethargy, nausea, vomiting, and alopecia. Regression analyses revealed that change scores of QOL items related to motor weakness and gastrointestinal pain were common predictors for the change global QOL score during protocol treatment; and change scores of QOL items related to lethargy or fatigue and change toxicity grade of mood predicted the change global QOL score after patients were off treatment.

CONCLUSION

The use of the European Organization for Research and Treatment of Cancer QLQ C30+3 and trial-specific checklist was able to assess the effect of expected toxicities on patient' s QOL during and following treatment, and so may be useful in addressing the concerns regarding methodological issues that have limited the acquisition of prospective, longitudinal treatment-related toxicity data.

Quality of life for women living with a gynecologic cancer

The purpose of this research study was to enhance understanding about quality of life from the perspective of women living with a gynecologic cancer. Parse's human becoming theory provided the theoretical perspective and guided the descriptive exploratory methodology that was used. Participants were 14 women diagnosed with a gynecologic cancer. Through analysis-synthesis processes, four themes were identified, which provide the following unified description: Quality of life is treasuring loving expressions while affirming personal worth, as consoling immersions amid torment emerge with expanding fortitude for enduring. The findings suggest implications for quality care that honors persons' experiences.

Quality-of-life issues in patients with ovarian cancer and their caregivers: a review

Significant progress has been made towards the treatment of ovarian cancer resulting in longer median survival despite a persistent low cure rate. Relatively few studies have examined the impact of the cancer and its treatment on the patients and their caregivers due to the difficulty in the definition and measurement of the Quality of Life (QOL) concept. A review of the literature revealed significant alterations in the quality of life of ovarian cancer patients during treatment and long term follow ups. For the caregivers, it is important for health care providers to realize that: 1) caregivers are being asked to assume an increasing number of complex care giving tasks at home, 2) there exists a high proportion of unmet caregiver needs, 3) the care giving experience includes both positive and negative elements and, 4) perception of caregivers' burden is positively linked to negative reactions to care giving. Supportive programs for patients and caregivers should be designed with these needs in mind. Future research should study the best way to incorporate results of quality of life assessments into routine treatment decision-making.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader should be able to outline the current data on QOL issues in patients with ovarian cancer, and to describe potential working definitions of QOL.

The taxanes: toxicity and quality of life considerations in advanced ovarian cancer

The taxanes paclitaxel and docetaxel show good activity in the management of advanced ovarian cancer when used in conjunction with platinum agents. Accumulating evidence from clinical studies, particularly the latest results from the phase III comparative SCOTROC study, indicates that the two drugs confer similar rates of tumour response and survival in women with this condition. However, it is clear that paclitaxel and docetaxel differ in their tolerability profiles and in other respects, and cannot be regarded as directly equivalent drugs. In particular, paclitaxel is associated with significant neurotoxicity; peripheral neuropathy has also been reported with docetaxel, but to a lesser extent. Neutropenia appears more prevalent with docetaxel than with paclitaxel, although clinical trial data show that this adverse effect is manageable and need not compromise dose delivery. Docetaxel is also associated with potential benefits accruing from shorter infusion times and lack of need for premedication with intravenous histamine H(1) and H(2) antagonists. Emerging quality of life data are expected to shed further light on the overall benefit of chemotherapy in women with advanced ovarian cancer in general, and on taxane-platinum combinations in particular.

The silent killer: psychological issues in ovarian cancer

Ovarian cancer represents about 4% of all cancers in women and is the fifth leading cause of death in the United States each year. Ovarian cancer is associated with uncertainty, anxiety, and depression. Many women present with advanced disease at diagnosis and are faced with aggressive surgical and medical protocols to treat them. To meet the needs of women with ovarian cancer, the effects of their physical problems on psychological adjustment must be identified. Health care professionals must closely monitor women with ovarian cancer to identify those who may require ongoing psychological care or psychiatric intervention. This article presents an overview of ovarian cancer, focusing on the psychological effects, and an intervention by oncology nurse specialists to address both the physical and emotional distress that accompanies ovarian cancer. The importance of screening for psychological distress is emphasized.

Psychosocial management of patients with recurrent ovarian cancer: treating the whole patient to improve quality of life

OBJECTIVES

To describe the psychosocial issues affecting women with recurrent ovarian cancer and provide suggestions for screening to provide appropriate referrals.

DATA SOURCES

Research articles and textbooks.

CONCLUSION

Nursing care may involve practical, informational, and emotional support. Screening patients for psychosocial distress can be conducted quickly and is important to identify patients requiring additional interventions.

IMPLICATIONS FOR NURSING PRACTICE

Nurses should be familiar with the National Comprehensive Cancer Network guidelines regarding distress management. Psychosocial support requires a commitment to addressing the individual psychosocial needs of each patient. Nurses play an invaluable role in helping to improve the quality of life for women with recurrent ovarian cancer.

An international field study of the reliability and validity of a disease-specific questionnaire module (the QLQ-OV28) in assessing the quality of life of patients with ovarian cancer

This study defines the psychometric properties of the European Organisation for Research and Treatment of Cancer (EORTC) quality of life (QOL) questionnaire designed to measure the QOL of patients with ovarian cancer. The ovarian cancer module (EORTC QLQ-OV28) was developed to supplement the EORTC QLQ-C30. The core questionnaire and the QLQ-OV28 were prospectively administered to 368 ovarian cancer patients after they had been treated with radical or debulking surgery followed by chemotherapy. The QLQ-OV28 module assesses abdominal/gastrointestinal symptoms, peripheral neuropathy, other chemotherapy side-effects, hormonal/menopausal symptoms, body image, attitude to disease/treatment and sexual functioning. Questionnaires were well accepted by patients, baseline compliance rates were 86%, 72% provided a second assessment, less than 3% of the items had missing data. Multi-trait scaling analyses confirmed the hypothesised scales. All hypothesised scales exhibited good psychometric properties. These results support the clinical and psychometric validity of the EORTC QLQ-OV28 module as a supplement to the EORTC QLQ-C30.

Impact of ovarian cancer perceived by women

Ovarian cancer may be particularly challenging for women, both physically and psychologically, because of the advanced nature of the disease at the time of diagnosis, the side effects of the disease, the repetitive cycles of aggressive therapy, and the perceived loss of femininity from the removal of reproductive organs. In addition, women with this disease rarely have an opportunity for cure. Most will face the very real possibility of dying. This qualitative study examined the perspectives of women living with ovarian cancer. Eighteen women participated in interviews, in which they described their experiences living with the disease. Women reported the myriad day-to-day changes in their lives, the major challenges they had to face, and the sources to which they turned for support. Implications for the practice of oncology nurses involve assessment, an understanding of the profound impact that this illness has on both the woman and her family, and the need to access a variety of supportive care programs.

Health-related quality of life measurement in women with common benign gynecologic conditions: a systematic review

Endometriosis, menorrhagia, chronic pelvic pain, and polycystic ovary syndrome are major sources of psychologic morbidity and can negatively affect quality of life. Although comparative studies have been published on the measurement of health-related quality of life for gynecologic malignancies, a similar review for these benign gynecologic conditions has not been conducted. Consequently, we searched the literature systematically to identify the impact of symptoms and treatments for these conditions on health status and to report on the types and psychometric properties of the instruments used. Papers were retrieved by systematically searching 6 electronic databases and hand-searching relevant reference lists and bibliographies. Forty-six studies used a questionnaire to measure health status: 34 studies (74%) used standardized instruments; of these, 23 studies (68%) used generic tools. Although a meta analysis was not possible, it appears that women with chronic pelvic pain and conditions that are associated with pelvic pain (such as endometriosis) report worse health-related quality of life. Despite the development of disease-specific questionnaires, only 2 questionnaires were generated from interviews of patients with the condition of interest, and few questionnaires are being used to evaluate the outcomes of treatment on subjective health status.

Quality of life: gynaecological cancers

The clinical management of gynaecological cancer patients has been mainly focused on prolonging the survival of the patients. Thus, research on MEDLINE using as keywords 'Quality of Life' (QoL) allowed us to identify few papers which reported data on QoL in gynecological oncology. However, the assessment of QoL is becoming one of the most important issues in gynecological oncology, and there is a growing interest in including quality of life measurements in clinical trials. In fact, in several randomised trials on ovarian cancer now ongoing in Europe, the evaluation of QoL has been planned. The one underlying this article focuses on the symptoms and problems particular to gynecologic cancer and the treatments of them that could affect quality of life evaluations. These include limitations of sexual activity and fertility, early menopause, chemotherapy induced toxicity, and loss of body image. In this report, we will discuss the aspects affecting the QoL in gynaecological cancer in relation to surgical treatment, medical therapy, and follow-up.

Ovarian cancer patients: are their informational and emotional needs being met?

A study was undertaken to assess if the informational and emotional needs of ovarian cancer patients were being met according to their individual requirements. In the study, a gynaecology oncology specialist nurse provided hospital nursing support through individual care and a patients' support group. A questionnaire was completed by 24 patients using an integrated qualitative and quantitative data collection. This study showed that respondents evaluated positively the care provided in these two ways. Further research into the needs of gynaecological cancer patients should be undertaken.

Quality of life in ovarian cancer patients receiving chemotherapy

OBJECTIVE

A descriptive study was performed to evaluate the variables which influence the quality of life of women with ovarian cancer undergoing chemotherapy treatment.

METHODS

The study involved a chart review of 60 women with ovarian cancer and analysis of their compiled EORTC QLQ-C30 Quality of Life (QoL) questionnaires. Analyses were performed using SPSS software to test the relationship of a number of biomedical variables with QoL outcomes.

RESULTS

In comparing QoL scores between newly diagnosed women receiving first-line (cisplatin) chemotherapy and women receiving palliative (carboplatin) therapy for recurrent disease, those receiving first-line therapy had more appetite disturbance, diarrhea, and nausea than women in the latter group. Over time, global QoL declined for newly diagnosed patients, while it improved for those with recurrent disease. A third finding was that younger women reported more fatigue over the course of their treatment than older women. Finally, lower QoL was found to be able to predict death within 12 months after starting treatment.

CONCLUSIONS

The EORTC QLQ-C30 can be used to test clinical assumptions and to influence treatment programs of women with ovarian cancer undergoing chemotherapy. The results confirmed the assumption that carboplatin has less of an impact on QoL than cisplatin. Also, the finding of improvements in QoL over time, for the women with recurrent disease, supports the use of carboplatin as palliative treatment. The differences observed in QoL between survivors and nonsurvivors 12 months after starting treatment may help identify high-risk patients for closer monitoring. Brief, structured QoL assessments before clinic appointments may be useful for improving the overall care of ovarian cancer patients.

Development of a European Organization for Research and Treatment of Cancer questionnaire module to assess the quality of life of ovarian cancer patients in clinical trials: a progress report

A questionnaire was developed, according to the European Organization for Research and Treatment of Cancer (EORTC) published guidelines, to supplement the EORTC quality of life questionnaire-core 30 (QLQ-C30) to assess the quality of life (QL) of women with ovarian cancer treated in clinical trials. The provisional 28-item module, OV28, assesses abdominal symptoms; peripheral neuropathy; other chemotherapy side-effects; hormonal symptoms; body image; attitude to disease and treatment; and sexual functioning. The first 24 items of the module (excluding sexual functioning) were included in a UK multicentre trial (SCOTROC). The trial data were used for preliminary scaling analysis. Two problematic items were identified. When these were treated as single items along with the 'other chemotherapy side-effects' the instrument showed excellent scale properties. Mean scale scores discriminated between trial patients pre- and on chemotherapy. This is a promising tool for assessing the QL of women with ovarian cancer. The EORTC international field study (Protocol 15982) to assess more fully the psychometric properties of the OV28 is well underway.

Women's perspectives regarding the impact of ovarian cancer: implications for nursing

Ovarian cancer is the fourth leading cause of cancer-related death in women. Ovarian cancer and its treatment have a considerable effect on the quality of life of women diagnosed with the disease. Currently, little is known about the perspectives of women regarding their experiences of living with ovarian cancer or the impact of recurrent disease. This article presents data from a national study of Canadian women living with ovarian cancer and describes the impact of the disease and its treatment. In this study, 93 women had recurrent disease, and 170 had not experienced recurrent disease. Women in both groups were similar, ranging in age from 21 to 61 years. Two-thirds of the women were married, and all were white. A greater proportion of the women with recurrent disease reported bowel problems; fears of dying, pain, getting around; and feelings of self-blame. On the average, women with recurrent disease reported experiencing more problems since diagnosis than those without recurrent disease (p = 0.01). The proportion of women who perceived that they received adequate help for their problems ranged from 20% to 85%. Implications for oncology nurses regarding assessment, referral for assistance, and patient education are apparent from the study findings.

A phase I/II study of hypofractionated whole abdominal radiation therapy in patients with chemoresistant ovarian carcinoma: Karnofsky score determines treatment outcome

PURPOSE

Radiation therapy can provide useful palliation in chemorefractory ovarian cancer patients. The purpose of this study was to prospectively study the palliative effect of a hypofractionated radiation treatment regimen. Change in quality-of-life scores (Functional Assessment of Cancer Therapy [FACT], Karnofsky scale), pain score, and tolerance to therapy were also assessed.

METHODS AND MATERIALS

A single-institution Phase I/II trial was initiated in patients with chemoresistant recurrent or progressive ovarian cancer. All patients had symptomatic and measurable intra-abdominal disease. Patients were treated with a single radiation fraction (700 cGy) or two fractions (300 cGy twice a day) to the whole abdomen over 1 day. Quality-of-life scale (FACT G version 2) was assessed at baseline and 1 and 3 months following treatment. Karnofsky scale and pain score were also evaluated in the same time frame.

RESULTS

Sixteen patients were prospectively entered into this protocol between February 1996 and September 1998. Twelve patients received a single 700 cGy fraction and four 300 cGy twice a day. All were heavily pretreated and 9 (56%) had a poor performance status prior to treatment. Symptoms needing palliation included pain (14), ascites (10), and bleeding (2). Symptomatic improvement occurred in all patients with pain (5 complete response [CR] and 7 partial response [PR], all patients with bleeding (CR 2), and two (20%) with ascites. Five patients (31%) had a reduction in lesion size documented radiologically in three. The mean duration of response was 22 weeks in patients with a Karnofsky score >70. Thirteen patients developed transient nausea and vomiting which resolved in 48 hours in all. All patients developed a transient lymphopenia. Thirteen patients completed a follow-up quality-of-life scale. There was an improvement in the physical and functional components of the scale in patients with Karnofsky score of 90-100. There was no improvement in quality of life in patients with Karnofsky score <90 despite symptomatic response. Median survival was 3 months from the date of treatment.

CONCLUSION

Hypofractionated radiation therapy is an effective palliative treatment for end-stage ovarian cancer patients. Karnofsky score can help determine the duration of response and survival for this high-risk population.

Pharmacoeconomic considerations in treating ovarian cancer

Ovarian cancer is the leading cause of death in women with gynaecological cancers. The most common type of ovarian cancer is epithelial ovarian cancer. Referred to as the 'silent' killer, this disease is difficult to detect because of the lack of specific symptoms. The majority of women who have ovarian cancer are diagnosed in the advanced stages. While the exact cause of ovarian cancer remains elusive, it is believed that the events relating to incessant ovulatory function play a major role in the development of this disease. Long term prognosis of women with ovarian cancer remains grim. Although ovarian cancer is highly responsive to chemotherapy, most women will develop persistent or recurrent disease after primary treatment. The standard front-line treatment is paclitaxel in combination with a platinum-based agent; however, toxicities associated with paclitaxel must be weighed against the clinical benefit. The economic issues associated with the treatment of ovarian cancer involve costs of chemotherapy agents and management of supportive care. Patient preferences and quality-of-life issues are also of major importance because of the short survival benefit for most patients. Therefore, quality of life must be maximised alongside efforts to prolong survival. More research is necessary to determine what trade-offs (e.g. adverse effects of treatment) patients are willing to make for modest gains in survival.

Quality of Life in Advanced Ovarian Cancer: Identifying Specific Concerns

PURPOSE

To identify issues affecting the quality of life (QoL) in women receiving palliative therapy for ovarian cancer.

METHODS

Twenty women with advanced recurrent ovarian cancer were interviewed to establish what issues affect QoL. All patients were receiving palliative chemotherapy or other palliative therapy in the department of Gynecologic Oncology at the Massachusetts General Hospital, and were felt to have a life expectancy of 1 year or less by best clinical estimate.

RESULTS

Twenty patients with an average age of 56.7 years participated. Psychosocial issues were more common than physical ones, and patients were more likely to mention issues that positively impact on QoL rather than those with a negative effect. Most patients noted that a sense of hope, enhanced appreciation for day to day life, and a strong support system had a significantly positive effect on QoL. Issues negatively impacting QoL included fear of their disease (90%) and concern for family and friends (100%), particularly children. Most common physical symptoms impacting QoL included fatigue (100%) and anorexia (55%).

CONCLUSIONS

Little research has been done into QoL issues for ovarian cancer patients receiving palliative care. Available QoL studies tend to focus on the physical aspects of a disease or its treatment. This pilot study suggests that women with advanced, recurrent ovarian cancer feel that psychosocial issues play a greater role in determining QoL than do physical issues. Further QoL studies for these patients should include assessment of psychosocial realms. This information can then be used to design interventions to improve QoL.

Spanish version of the Rotterdam Symptom Check List: cross-cultural adaptation and preliminary validity in a sample of terminal cancer patients

We report on the process of adaptation into Spanish of the Rotterdam Symptom Check List (RSCL). The original version was translated and back-translated by professional bilingual translators. A quantitative rating method was used to select the items to include in the final Spanish version. Validity (discriminant and construction) and reliability were test in 118 terminal cancer patients. In addition to the RSCL the Nottingham Health Profile (NHP) and the Karnofsky Performance Status (KPS) were used. The RSCL showed different ratings on all scales according to the functional level of the patients. The scales were moderately to highly correlated with the NHP (from 0.48 to 0.71). Internal consistency, measured by Cronbach's alpha coefficient ranged from 0.74 (physical) to 0.90 (activity). Twenty-four hours test-retest intraclass correlation coefficient ranged from 0.71 to 0.88. The results of this study suggest that the Spanish version of the RSCL is conceptually equivalent to the original. More research is needed to assess the responsiveness of the version before using it in clinical trials.

Quality of life in patients with lung cancer: a review of literature from 1970 to 1995

A review of the literature was carried out covering the last 25 years (1970 to 1995) by searching through the MEDLINE and manually. The review consists of two companion parts. The first includes studies of quality of life in lung cancer patients in general, while the second part is restricted to defined samples of small and non-small cell lung cancer patients. Excluding non-English and review articles, in total 151 citations were identified and all have been reviewed. Over 50 instruments were used to measure quality of life in lung cancer studies. Of these, the European Organisation for Research and Treatment of Cancer Quality of Life Lung Cancer Questionnaire (EORTC QLQ-LC13) in conjunction with the core cancer questionnaire (QLQ-C30) was found to be the best developed instrument, although there were two other lung cancer-specific measures with good reliability and validity. Several topics in this chapter have been highlighted, including the importance of regularly measuring quality of life in lung cancer patients. Progress and achievements in areas such as performance status as a proxy of quality of life measure, psychological morbidity and symptom distress as predictive factors of quality of survival, and communication problems in quality of life studies of lung cancer patients have been emphasized and their implications in lung cancer care discussed. It is argued that palliation of symptoms, psychosocial interventions, and understanding patients' feelings and concerns all contribute to improving quality of life in lung cancer patients. It is concluded that the future challenge in treatment of lung cancer lies not only in improving the survival, but mainly the patients' quality of life regardless of cell type. Clinical trial and epidemiologic population-based outcome studies are recommended to provide this and to allow a better understanding of the contribution of the socioeconomic characteristics of the patients to their pretreatment and posttreatment quality of life.

Measuring quality of life in oncology: is it worthwhile? II. Experiences from the treatment of cancer

This is the second part of the paper on quality of life in cancer patients which appeared in this journal (Montazeri et al., 1996a). In this part experiences from the treatment of cancer are given and relevant literature is reviewed. Several topics have been covered, including new directions and methods in assessing quality of life. It is argued that in a chronic condition, adding life to years instead of years to life is an important task. Adding years to life may prolong survival, but whether this is to the benefit of patients is debatable. Considering patients' views, their values and preferences may improve the quality of care and at the same time, reduce the psychological distress and physical discomfort in patients with cancer. It is concluded that quality of life measures have considerable potential in this challenging issue.