Helplessness/hopelessness, minimization and optimism predict survival in women with invasive ovarian cancer: a role for targeted support during initial treatment decision-making?
Women with advanced ovarian cancer generally have a poor prognosis but there is significant variability in survival despite similar disease characteristics and treatment regimens. The aim of this study was to determine whether psychosocial factors predict survival in women with ovarian cancer, controlling for potential confounders.
The sample comprised 798 women with invasive ovarian cancer recruited into the Australian Ovarian Cancer Study and a subsequent quality of life study. Validated measures of depression, optimism, minimization, helplessness/hopelessness, and social support were completed 3–6 monthly for up to 2 years. Four hundred nineteen women (52.5 %) died over the follow-up period. Associations between time-varying psychosocial variables and survival were tested using adjusted Cox proportional hazard models.
There was a significant interaction of psychosocial variables measured prior to first progression and overall survival, with higher optimism (adjusted hazard ratio per 1 standard deviation (HR) = 0.80, 95 % confidence interval (CI) 0.65–0.97), higher minimization (HR = 0.79, CI 0.66–0.94), and lower helplessness/hopelessness (HR = 1.40, CI 1.15–1.71) associated with longer survival. After disease progression, these variables were not associated with survival (optimism HR = 1.10, CI 0.95–1.27; minimization HR = 1.12, CI 0.95–1.31; and helplessness/hopelessness HR = 0.86, CI 0.74–1.00). Depression and social support were not associated with survival.
In women with invasive ovarian cancer, psychosocial variables prior to disease progression appear to impact on overall survival, suggesting a preventive rather than modifying role. Addressing psychosocial responses to cancer and their potential impact on treatment decision-making early in the disease trajectory may benefit survival and quality of life.
KeywordsOvarian cancer Oncology Psychological factors Survival Predictors
- 1.Australian Institute of Health and Welfare & National Breast and Ovarian Cancer Centre. Ovarian Cancer in Australia: an overview, 2010. Canberra.Google Scholar
- 2.Coleman MP, Forman D, Bryant H, et al. (2011) Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet 377(9760):127–138. doi:10.1016/S0140-6736(10)62231-3 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Antoni MH. Psychosocial intervention effects on adaptation, disease course and biobehavioral processes in cancer. Brain Behav Immun. 2013; 30(SI):S88-S98. doi:10.1016/j.bbi. 2012.05.009Google Scholar
- 31.Rustin GJS, Vergote I, Eisenhauer E, et al. (2011) Definitions for response and progression in ovarian cancer clinical trials incorporating RECIST 1.1 and CA 125 agreed by the Gynecological Cancer Intergroup (GCIG). Int J Gynecol Cancer 21(2):419–423. doi:10.1097/IGC.0b013e3182070f17 CrossRefPubMedGoogle Scholar
- 35.Scheier MF, Carver CS, Bridges MW (1994) Distinguishing optimism from neuroticism (and trait anxiety, self mastery, and self esteem): a reevaluation of the life orientation test. J Pers Soc Psychol 67(6):1063–78. doi:10.1037/0022-35188.8.131.523
- 40.Australian Cancer Network and National Breast Cancer Centre. Clinical practice guidelines for the management of women with epithelial ovarian cancer. Camperdown, Sydney, Australia: National Breast Cancer Centre; 2004.Google Scholar