When will I feel normal again? Trajectories and predictors of persistent symptoms and poor wellbeing after primary chemotherapy for ovarian cancer

• Published in: Gynecologic oncology Vol. 159; no. 1; pp. 179 - 186
• Main Authors: Beesley, Vanessa L., Webber, Kate, Nagle, Christina M., DeFazio, Anna, Obermair, Andreas, Williams, Merran, Friedlander, Michael, Webb, Penelope M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2020
• Subjects: Age Factors; Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Anxiety; Anxiety - chemically induced; Anxiety - diagnosis; Anxiety - epidemiology; Anxiety - psychology; Depression; Depression - chemically induced; Depression - diagnosis; Depression - epidemiology; Depression - psychology; Fatigue; Fatigue - chemically induced; Fatigue - diagnosis; Fatigue - epidemiology; Fatigue - psychology; Female; Humans; Insomnia; Middle Aged; Ovarian cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - psychology; Patient Health Questionnaire - statistics & numerical data; Patient Reported Outcome Measures; Prospective Studies; Quality of Life; Risk Factors; Severity of Illness Index; Sleep Initiation and Maintenance Disorders - chemically induced; Sleep Initiation and Maintenance Disorders - diagnosis; Sleep Initiation and Maintenance Disorders - epidemiology; Sleep Initiation and Maintenance Disorders - psychology; Time Factors; Depression; Fatigue; Anxiety; Insomnia; Ovarian cancer; Quality of life
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2020.07.029

After treatment for ovarian cancer, women want to know when they will feel ‘normal’ again. Our objective was to document the proportions of women with high levels of physical and emotional symptoms at the end of treatment, determine if/when they return to normal and identify groups at risk of persistent symptoms/delayed recovery. Women in the OPAL (Ovarian cancer Prognosis And Lifestyle) study who received ≥3 cycles of first-line chemotherapy and completed patient-reported outcome (PRO) questionnaires on or < 6 weeks after completing chemotherapy (baseline) were included in this analysis (n = 527). PRO measures included anxiety, depression, insomnia, fatigue and wellbeing (quality-of-life) at baseline, 3, 6, 9 and 18 months post-baseline. Group-based trajectory models identified clusters of individuals who followed similar patterns. Logistic and Cox regression identified factors associated with persistent symptoms and delayed recovery, respectively. At baseline, 57% of women reported moderate-to-severe fatigue, 22% anxiety, 20% depression, 14% clinical insomnia and 45% had quality-of-life scores significantly lower than the general population. Between 50 and 75% of individual PRO scores normalised within six months, with the exception of emotional wellbeing (42%), but approximately two-in-five women still had at least one persistently poor PRO at 18 months. Women with more severe symptoms at baseline, who were younger, or had a history of anxiety/depression were more likely to have persistent symptoms or delayed recovery. Two-in-five women might never fully return to ‘normal’ after completing primary treatment for ovarian cancer. Those with risk factors should be triaged for early supportive interventions. •Fatigue (57%), insomnia (14%), anxiety (22%) and depression (20%) are common in women completing ovarian cancer treatment.•Almost half (45%) had quality of life scores significantly lower than the general population at the end of treatment.•For 50–75%, individual symptoms resolved and wellbeing (except emotional) normalised within 6 months.•Two-in-five never fully returned to normal with one or more persistently poor symptom or wellbeing domain at 18 months.•Young age and more severe symptoms or prior anxiety or depression increased risk of delayed recovery.