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Ranked importance of outcomes of first-line versus repeated chemotherapy among ovarian cancer patients

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Abstract

Purpose

To examine the importance of possible outcomes of first-line versus repeated chemotherapy to ovarian cancer patients and to compare doctors' treatment intentions with patients' beliefs about cure.

Methods

Women with newly diagnosed (74) or relapsed (48) ovarian cancer were prospectively followed over 2 years. The level of importance they ascribed to four chemotherapy outcomes and their beliefs about cure were assessed. Their doctors independently specified intent of successive treatments.

Results

Approximately half (54%) of newly diagnosed ovarian cancer patients (65% with residual disease >2 cm and 49% with no or ≤2 cm residual disease) ranked ‘tumour shrinkage (or decrease in blood levels of CA125)’ as ‘most important’ during first-line chemotherapy. Approximately two thirds (65–70%) of all women whose disease had relapsed also ranked ‘tumour shrinkage’ as ‘most important’ during repeated chemotherapy. Few women (<8%) rated symptom relief or absence of side-effects as most important. While both patients' and doctors' belief about cure decreased over successive treatments, patients grew more optimistic relative to doctors over time. Women's reports of advice by doctors about cure were consistent with doctors' stated intents for repeat chemotherapy. However, discordance between doctors' actual treatment intent and patients' beliefs about cure increased from 24% at first-line to 83% by fourth-line chemotherapy.

Conclusions

Women prioritise tumour response as the most important outcome of chemotherapy for ovarian cancer. This priority predominates in women with residual and relapsed disease despite declining likelihood of cure. Women may still hope for a cure while acknowledging their doctor's advice that their disease is incurable.

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Acknowledgments

This study was funded by The Cancer Council Queensland, and Penelope Webb was funded by a Senior Research Fellowship from The Cancer Council Queensland. Alexandra Clavarino was funded by an NHMRC Capacity Building Grant No. 252834. We thank Mrs. Ann Ward for all her help with the project, Dr. Christina Nagle and Dr. Catherine Olsen for their helpful comments on the manuscript and the women who gave their time to participate.

Conflict of interest statement

The authors declare that there are no conflicts of interest.

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Authors and Affiliations

  1. Queensland Institute of Medical Research, Genetics and Population Health Division, PO Royal Brisbane Hospital, Herston, QLD, Australia, 4029

    Vanessa L. Beesley, Alexandra M. Clavarino, Penelope M. Webb, James D. Doecke, Colleen A. Loos & Adele C. Green

  2. School of Pharmacy, University of Queensland, St. Lucia, Australia, 4072

    Alexandra M. Clavarino

  3. Department of Medical Oncology, Royal Brisbane and Women’s Hospital, Level 5 West Block, Butterfield Street, Herston, QLD, Australia, 4029

    David K. Wyld & Alessandra B. Francesconi

  4. Greenslopes Specialist Centre, Greenslopes Private Hospital, Suite 11, Newdegate Street, Greenslopes, QLD, Australia, 4120

    Keith R. Horwood

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  1. Vanessa L. Beesley
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Correspondence to Vanessa L. Beesley.

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Beesley, V.L., Clavarino, A.M., Webb, P.M. et al. Ranked importance of outcomes of first-line versus repeated chemotherapy among ovarian cancer patients. Support Care Cancer 18, 943–949 (2010). https://doi.org/10.1007/s00520-009-0734-z

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  • DOI: https://doi.org/10.1007/s00520-009-0734-z

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