Quality of life evaluations in patients with ovarian cancer during chemotherapy treatment

Older ovarian cancer survivors report lower long-term health-related quality of life than younger survivors: A study from the population-based profiles registry

OBJECTIVE

To assess long-term differences in health-related quality of life (HRQoL) of older ovarian cancer survivors compared to both an age-matched normative population and to younger survivors. In addition, the differential effect of chemotherapy on HRQoL between older and younger survivors was compared.

METHODS

Ovarian cancer survivors (n = 348) diagnosed between 2000 and 2010, as registered by the Dutch population-based Eindhoven Cancer Registry, were invited to complete the EORTC QLQ-C30 HRQoL questionnaire in 2012. HRQoL outcomes of survivors were compared with an age-matched normative population and older survivors (≥70 years) were compared with younger survivors.

RESULTS

The questionnaire was returned by 191 ovarian cancer survivors (55%), 31% were aged ≥70 years (n = 59). Compared to the normative population, survivors ≥70 years scored lower on global health status and all functioning subscales except emotional functioning, and they reported more symptoms. Survivors aged <70 years only reported worse physical and cognitive functioning in comparison with the normative population. Most differences were of medium to small clinical relevance. Age appeared to moderate the effect of chemotherapy on HRQoL. Older survivors who had received chemotherapy experienced better physical functioning and less pain and insomnia while the opposite was found in younger survivors.

CONCLUSION

In comparison with an age-matched normative population, older ovarian cancer survivors report lower HRQoL scores than younger survivors. As this represents a selection of long-term survivors, future research should focus on the trajectory of HRQoL from diagnosis throughout treatment and follow-up to identify which factors are related to worse HRQoL in the entire older ovarian cancer population and whether timely interventions are able to improve HRQoL.

Caregiver Burden in End-Stage Ovarian Cancer

BACKGROUND

Caregiver burden associated with caring for women with ovarian cancer has received limited focus. However, these patients often have complex needs, requiring a high level of care at home and imposing substantial burdens on caregivers.

OBJECTIVES

This pilot study assessed the level of caregiver burden experienced by the primary caregivers of patients with end-stage ovarian cancer and identified variables associated with caregiver burden.

METHODS

Caregiver burden was assessed using the Caregiver Reaction Assessment. Fifty caregivers completed an anonymous and voluntary survey. Pearson correlations and independent samples t tests were used to analyze data.

FINDINGS

Most participants were Caucasian, married or living with a partner, and college graduates, with an annual household income of less than $90,000. Caregiver ages ranged from 29-81 years. Participants agreed most with the self-esteem scale, indicating they had pride in caring for their loved ones. Disrupted schedules and financial problems were the most burdensome factors in providing care. Because financial issues affected caregiver burden, nurses should facilitate interdisciplinary support. Future research is needed to determine the impact of nurse-led interventions to reduce caregiver burden.

Quality of life of women undergoing chemotherapy for a gynaecological oncological disease in Turkey

AIM

Studies have shown effects of surgery, radiation and chemotherapy on quality of life in cases of gynaecological cancer. Very few studies are available examining the quality of life of individuals in Turkey who have been diagnosed with gynaecological cancer and undergoing treatment.

METHOD

This study was performed to evaluate the quality of life of such patients using the EORTC-QLQ-C30 Quality of Life Index. Chi-square Yates, Mann-Whitney-U tests and variance analysis used for statistical analizing.

RESULTS

The EORTC-QLQ-C30 Quality of Life Index mean points for "general well-being and quality of life" of the patients were found to be 60.5 ± 25.0. In the sub-groups of the Quality of Life Index determined fatigue (60.1 ± 24.8), economic difficulties (46.9 ± 33.3), pain and loss of appetite (42.9 ± 27.8; 42.9 ± 34.0) and insomnia (40.1 ± 34.0) were the symptoms most reported to have a negative effect on quality of life. Statistical significance was noted for marital status and income status (p<0.05) but not educational level.

CONCLUSION

Determination of quality of life of women with a diagnosis of gynaecological oncological disease who are undergoing chemotherapy enables provision of a more comprehensive and higher quality of care.

Clinical trials and decision-making strategies for optimal treatment of relapsed ovarian cancer

The proportion of patients with advanced ovarian cancer who relapse has remained high and fairly constant over the last decade. Choosing treatment for recurrent ovarian cancer is complex. Many active therapeutic agents are available, and there are challenges in defining the optimal timing and sequencing of treatments. Furthermore, the explosion in the number of biological agents presents additional challenges in identifying their activity and place in the pathway of treatment. Establishing optimal treatment as monotherapy, or in combination with chemotherapy, or as maintenance treatment requires new approaches to trial design, selecting meaningful endpoints and conducting carefully conducted trials with translational studies. Patients with relapsed ovarian cancer can now survive several years; the aim is to increase this further.

Quality of life, lifestyle behavior and employment experience: a comparison between young and midlife survivors of gynecology early stage cancers

GOALS

To evaluate differences and changes in quality of life (QoL), lifestyle behavior and employment experience of young in comparison to midlife adults in response to early stage gynecologic cancer diagnoses.

METHODS

263 patients, divided into two age groups (Group A: ≤ 45 and Group B: >45 years), were interviewed on their QoL, lifestyle behavior (dietary habits, tobacco and alcohol use, physical activity) and employment experience (employment status and working time) at diagnosis and within 4 years from the treatment. The QoL was evaluated by European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30) and its specific modules for each cancer type (in particular endometrium, cervix, ovarian and breast).

RESULTS

Global health status was significantly different between the two groups. In the younger age group a more relevant cancer interference on family life and social activities and a greater impact on perception of health status have been observed. Young women were more affected by fatigue, constipation, gastrointestinal symptoms, lymphedema, poor body image and impaired sexuality. Cancer diagnosis had a major negative impact on employment of younger patients. Conversely, younger patients had overall better health behavior. They reported a higher daily intake of fruits and vegetables, along with lower alcohol consumption, furthermore they were a little more physically active than midlife adults.

CONCLUSIONS

To enhance quality of life and to promote healthy lifestyle behavior of female cancer patients, particularly in younger age, it is essential to assure multidisciplinary approaches with specific medical intervention and psychosocial supports. Indeed, midlife adults seem to have a more rapid adaptive tendency to return towards levels of well-being, following cancer diagnosis and treatment, than younger patients.

Prospective assessment of quality of life in long-term ovarian cancer survivors

The objective of our study was to compare prospectively the QoL in long-term ovarian cancer survivors with short-term survivors and to explore discriminating variables between short-term and long-term survival. Thirty-three patients were included, 22 died within 5 years post diagnosis and 11 survived beyond 10 years. QoL data were collected pre-treatment (baseline), 1-year post diagnoses and for long-term survivors 10 years post-treatment using the EORTC QLQ-C30. At baseline, there was no difference in terms of FIGO stage, residual tumor and adjuvant chemotherapy. Significantly, more short-term survivors (96%) had intra operative ascites as compared to long-term survivors (55%) (p = 0.01). Before treatment, short-term survivors had clinically significantly lower QoL scores on the physical functioning (mean 75.45) and role functioning scale (mean 68.94) compared to long-term survivors (mean 68.94 and 84.85, respectively). They also reported higher levels of symptoms. One year post-diagnosis, QoL scores were comparable in most domains. Long-term survivors had a significantly better global QoL but more insomnia. Emotional functioning and global QoL/health status improved significantly from baseline to 1-year post-diagnosis and remained relatively stable at the 10-year follow-up. The presence of intra operative ascites and a supporting social network were identified as significant variables that discriminated between short-term and long-term survival. Compared to a reference sample, long-term survivors showed similar QoL scores but more dyspnoea. Although ovarian cancer patients do not belong to the most prevalent survivor populations, we found that long-term survivors have QoL scores similar to females without a history of cancer.

Assessment and significance of quality of life in women with gynecologic cancer

In the design of randomized clinical trials, quality of life (QOL) has become an important component across multiple cancer types. QOL includes the measurement of patient-reported outcomes, mostly described as the physical, social, emotional and functional wellbeing of the patient. These realms of wellbeing are reported by the patient themself and are thought to be a subjective measurement of response to treatment and/or treatment outcomes. Therapeutic interventions such as chemotherapy and/or radiation can thus be monitored from a patient perspective. In addition, while researchers and oncologists may recognize the futility of advanced and/or recurrent cancer therapy in the setting of reduced QOL, patients may have difficulty with discontinuing therapy. QOL research adds to the literature by introducing a patient perspective into the decision to treat aggressively. Specifically, in gynecologic cancers, there is a wide range of outcomes and patient characteristics to be considered. All three cancer settings – endometrial, cervical and ovarian – are remarkable in the QOL literature as this is a relatively new field with room to create interventions targeted towards improving QOL in often challenging clinical and life situations.

Prospective evaluation of weekly topotecan in recurrent platinum-resistant epithelial ovarian cancer

Topotecan administered on a weekly basis has been reported to possess antineoplastic activities with lower toxicities than the standard 5-day regimen every 3 weeks. We studied the activity of weekly topotecan regimen in recurrent platinum-resistant epithelial ovarian cancer patients. Ovarian cancer patients with documented platinum-resistant recurrences were treated with weekly intravenous topotecan (4 mg/m2) on days 1, 8, and 15 on a 28-day cycle. Prospective data collection included patients' demographics together with disease- and treatment-related toxicities. Responses were evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) and CA125 criteria. Progression-free survival and overall survival time from commencement of weekly treatment were estimated using the Kaplan–Meier method. All P values less than 0.05 were considered to be statistically significant. Twenty-two patients were treated. Weekly topotecan was used most commonly as third-line chemotherapy (range 1–5). A total of 244 weekly treatments were administered, with a median of 12 weekly treatments per patient. Two patients (9%) reported grade 3/4 gastrointestinal and two had grade 3/4 hematologic toxicities respectively. No dose reduction or treatment delay was required. Partial response was observed in two patients (9.1%) and another seven patients (31.8%) showed stable disease. No significant association was observed between best clinical response and patients' initial platinum sensitivity status. The estimated median progression-free survival was 20.9 weeks (95% CI 11.2–30.5) from the start of the weekly regimen. Weekly topotecan is well tolerated in patients with recurrent platinum-resistant ovarian cancer with modest activity.

Cytoreductive surgery for recurrent ovarian cancer

PURPOSE OF REVIEW

The issue facing clinicians managing ovarian cancer has evolved over the past three decades from treatment for cure and subsequently palliation, to prolongation of survival for most patients. The purpose of this paper is to review the data, rationale, and issues surrounding cytoreductive surgery in recurrent ovarian cancer and its potential role in this new paradigm shift.

RECENT FINDINGS

Abundant retrospective series report prolongation of survival with secondary cytoreductive surgery in recurrent ovarian cancer. Selection bias, publication bias, and subsequent therapies, however, are confounding factors for survival. As management of ovarian cancer has recently evolved to a treatment of a 'chronic disease', surgery (which has a definite role in primary therapy) should be considered.

SUMMARY

No prospective randomized studies have been performed to date, and therefore adoption of this method of management has been limited. The absence of good data leaves clinicians without clear direction on how to best manage patients. Patients with favorable characteristics such as a long disease-free interval, good performance status, a single or few small intra-abdominal recurrences may benefit from secondary cytoreduction. A prospective randomized study is needed.

Quality of Life Considerations in Gynecologic Cancer

Quality of life (QOL) is a fundamental consideration for patients with life threatening diseases. Major evolving paradigms are discussed: improved QOL with laparoscopic surgery, the impact on QOL of intraperitoneal chemotherapy for optimally cytoreduced ovarian cancer, combination therapy, sexuality, and survivorship. The goals of treatment for many patients with gynecologic tumors remain largely palliative, and patient reported QOL is the primary outcome determining the utility of treatment. Particularly in this area, QOL endpoints are increasingly important in clinical trials. The QOL issues facing gynecologic cancer patients, the use of validated QOL instruments, recent advances in the evaluation of interventions, and changes in concepts related to QOL are reviewed.

Proteomic tracking of serum protein isoforms as screening biomarkers of ovarian cancer

Epithelial ovarian cancer is the fourth leading cause of cancer death among women. Due to the asymptomatic nature and poor survival characteristic of the disease, screening for specific biomarkers for ovarian cancer is a major health priority. Differentially expressed proteins in the serum of ovarian cancer patients have the potential to be used as cancer-specific biomarkers. In this study, proteomic methods were used to screen 24 serum samples from women with high-grade ovarian cancer and compared to a control group of 11 healthy women. Affigel-Blue treated serum samples were processed either by linear (pH 4-7) or narrow range (pH 5.5-6.7) IEF strips for the first dimension. Proteins separated in first dimension were resolved by 8-16% gradient SDS-PAGE. Protein spots were visualized by SYPRO Ruby staining, imaged by FX-imager and compared and analyzed by PDQuest software. Twenty-two protein spots were consistently differentially expressed between normal and ovarian cancer patients by resolving proteins in a linear pH strip of 4-7 for the first dimension. Six of the protein spots, significantly up-regulated in grade 3 ovarian cancer patients (p < 0.05), were identified by MALDI-TOF MS and Western blotting as the isoforms of haptoglobin precursor. When serum proteins were resolved on narrow pH range strips (5.5-6.7), 23 spots were consistently differentially expressed between normal and grade 3 ovarian cancer patients. Of these, 4 protein spots significantly down regulated in grade 3 ovarian cancer patients (p < 0.05) were identified by MALDI-TOF MS and Western blotting, as isoforms of transferrin precursor. Increased expression of serum haptoglobin and transferrin was also identified in peritoneal tumor fluid obtained from women diagnosed with grade 2/3 ovarian cancer (n = 7). Changes in the expression of haptoglobin and transferrin in the serum of women with different pathological grades of ovarian cancer was examined by one-dimensional Western blotting method. Serum samples collected from women suffering from benign, borderline, grade 1, grade 2 and grade 3 cancer (n = 4 for haptoglobin and n = 5 for transferrin in each group) were analyzed and compared to the serum of normal healthy women. The mean serum haptoglobin expression in grade 3 ovarian cancer patients was fourfold higher than in the control subjects (p < 0.05). On the other hand, transferrin expression in grade 3 ovarian cancer patients was decreased by twofold than in normal healthy women (p < 0.05). Haptoglobin expression in the serum of cancer patients (n = 7) decreased following chemotherapy (six cycles of taxol/carboplatin). Concomitant with the decrease of haptoglobin, transferrin expression remained constant in four patients, but increased in three out of seven patients included in the study. Changes in serum expression of haptoglobin correlated with the change of CA 125 levels before and after chemotherapy. In conclusion, proteomic profiling of differentially expressed proteins in the sera of normal women compared to women with ovarian cancer can greatly facilitate the discovery of a panel of biomarkers that may aid in the detection of ovarian cancer with greater specificity.

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.

Prospective evaluations of continuous weekly paclitaxel regimen in recurrent platinum-resistant epithelial ovarian cancer

BACKGROUND

Paclitaxel administered on a weekly basis has been reported to possess both anti-angiogenic and apoptotic-inducing effects. We investigated the activity of a weekly continuous paclitaxel regimen in patients with recurrent platinum-resistant ovarian cancer.

METHODS

Patients with recurrent ovarian cancer and documented platinum-resistant disease were treated with weekly intravenous paclitaxel (60-80 mg/m(2)) continuously for up to 24 weeks over an 18-month period. Prospective data collection included: information on patients' demographics together with disease- and treatment-related toxicities. Response was evaluated using radiographic and Ca125 criteria. Chi-square tests were used to test for significant associations between categorical variables. Progression-free survival and overall survival time from commencement of weekly treatment were estimated using the Kaplan-Meier method. All P values less than 0.05 were considered to be statistically significant.

RESULTS

Thirty-four patients were treated on protocol. Five patients (15%) reported grade 3/4 neurotoxicity at the end of 12 weeks. No dose reduction or treatment delay was required. No significant hematologic toxicity was observed. Responses were evaluable in thirty-two patients. Complete response was observed in three patients (9%), and another 14 patients showed a partial response (44%). Seven patients (22%) had disease stabilization. The estimated median progression-free survival and overall survival were 6.10 months (95% CI:3.81-8.39) and 10.43 months (95% CI: 8.49-12.38) respectively from the start of the regimen.

CONCLUSION

Continuous weekly paclitaxel is a well-tolerated and active regimen in patients with recurrent platinum-resistant ovarian cancer.

Quality of life and gynecologic malignancies

In 2005, an estimated 79,480 new cases of gynecologic malignancies will be diagnosed, and almost 29,000 women will die. Treatment of gynecologic malignancies involves a combination of surgery, chemotherapy, and/or radiotherapy, all of which may affect a woman's physical, social, and emotional well-being. Although specific effects on quality of life (QOL) depend on disease site, treatment-, and patient-specific factors, common QOL issues include changes in physical functioning due to side effects of treatment, psychological distress due to fear and anxiety of recurrence, sexual dysfunction associated with anatomic and physiologic changes of treatment, and, for younger women, loss of childbearing potential. As new diagnostic and treatment strategies for gynecologic malignancies are developed, research efforts should include QOL consequences. Further studies are needed to develop strategies for identifying women at risk for serious QOL disruption so that effective interventions to assist these women can be designed.

Quality of life assessment during adjuvant and salvage chemotherapy for advance stage epithelial ovarian cancer

OBJECTIVES

This report assessed the quality of life of ovarian cancer patients undergoing adjuvant and salvage chemotherapy treatment.

METHODS

All epithelial ovarian cancer patients requiring chemotherapy to manage their disease were recruited from university based gynecologic oncology clinics. Quality of life was measured using the FACT-O (Functional Assessment of Cancer Therapy-Ovarian module version 4) questionnaire. Descriptive statistics and two-way analysis of variance were used to compare the effect on the mean quality of life scores with respect to the indications of chemotherapy and best radiologic response. Any P value of less than 0.10 was considered worthy of interest.

RESULTS

Ninety-three patients participated. In the adjuvant setting, there was a trend towards better quality of life with better response to therapy. In patients with a first recurrence, complete response to therapy clearly had a beneficial effect on overall quality of life compared to stable or partial response. There was no significant quality of life difference between those with partial response versus stable disease in a first recurrent setting. In patients with more than one recurrence, no large change in overall quality of life was observed across the range of tumor responses.

CONCLUSION

Chemotherapy is beneficial to improve quality of life of ovarian cancer patients. Differential effect of tumor response status on quality of life at different treatment phases requires further investigations.