Skip to main content

Advertisement

SpringerLink
Log in

Helplessness/hopelessness, minimization and optimism predict survival in women with invasive ovarian cancer: a role for targeted support during initial treatment decision-making?

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Australian Institute of Health and Welfare & National Breast and Ovarian Cancer Centre. Ovarian Cancer in Australia: an overview, 2010. Canberra.

  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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Parker PA, Baile WF, deMoor C, Cohen L (2003) Psychosocial and demographic predictors of quality of life in a large sample of cancer patients. Psycho-Oncology 12(2):183–193

    Article  PubMed  Google Scholar 

  4. Punnen S, Cowan JE, Dunn LB, Shumay DM, Carroll PR, Cooperberg MR (2013) A longitudinal study of anxiety, depression and distress as predictors of sexual and urinary quality of life in men with prostate cancer. BJU International. 112(2):E67–E75. doi:10.1111/bju.12209

    Article  PubMed  Google Scholar 

  5. Antoni MH, Lechner S, Diaz A, et al. (2009) Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer. Brain Behav Immun 23(5):580–591. doi:10.1016/j.bbi. 2008.09.005

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Irwin ML, Mayne ST (2008) Impact of nutrition and exercise on cancer survival. Cancer J 14(6):435–441. doi:10.1097/PPO.0b013e31818daeee

    Article  PubMed  Google Scholar 

  7. Watson M, Homewood J, Haviland J (2012) Coping response and survival in breast cancer patients: a new analysis. Stress Health 28(5):376–380. doi:10.1002/smi.2459

    Article  CAS  PubMed  Google Scholar 

  8. Carver CS, Scheier MF, Segerstrom SC (2010) Optimism. Clin Psychol Rev 30(7):879–889

    Article  PubMed  PubMed Central  Google Scholar 

  9. Antoni MH, Lutgendorf SK, Cole SW, et al. (2006) The influence of bio-behavioural factors on tumour biology: pathways and mechanisms. Nat Rev Cancer 6(3):240–248. doi:10.1038/nrc1820

    Article  CAS  PubMed  PubMed Central  Google 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. 2012.05.009

  11. Butow P, Coates AS, Dunn SM (1999) Psychosocial predictors of survival in metastatic melanoma. J Clin Oncol 17(7):2256–2263. doi:10.1054/bjoc. 2000.1471

    CAS  PubMed  Google Scholar 

  12. Brown JE, Butow PN, Culjak G, Coates AS, Dunn SM (2000) Psychosocial predictors of outcome: time to relapse and survival in patients with early stage melanoma. Br J Cancer 83(11):1448–1453. doi:10.1054/bjoc. 2000.1471

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Butow P, Coates AS, Dunn SM (2000) Psychosocial predictors of survival: metastatic breast cancer. Ann Oncol 11(4):469–474. doi:10.1038/sj.bjc.6603091

    Article  CAS  PubMed  Google Scholar 

  14. Butow PN, Brown JE, Coates AS, Dunn SM (2001) Psychosocial predictors of outcome IV: patients with early-stage breast cancer. Breast 10(Suppl 3):182–189

    Article  Google Scholar 

  15. Petticrew M, Bell R, Hunter D (2002) Influence of psychological coping on survival and recurrence in people with cancer: systematic review. BMJ 325(7372):1066. doi:10.1136/bmj.325.7372.1066

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kroenke CH, Kubzansky LD, Schernhammer ES, Holmes MD, Kawachi I (2006) Social networks, social support, and survival after breast cancer diagnosis. J Clin Oncol 24(7):1105–1111. doi:10.1200/JCO. 2005.04.2846

    Article  PubMed  Google Scholar 

  17. Chida Y, Hamer M, Wardle J, Steptoe A (2008) Do stress-related psychosocial factors contribute to cancer incidence and survival? Nat Rev Clin Oncol 5:466–475. doi:10.1038/ncponc1134

    Article  Google Scholar 

  18. Satin JR, Linden W, Phillips MJ (2009) Depression as a predictor of disease progression and mortality in cancer patients. Cancer 115(22):5349–5361. doi:10.1002/cncr.24561

    Article  PubMed  Google Scholar 

  19. Dahl AA (2010) Link between personality and cancer. Future Oncol 6(5):691–707. doi:10.2217/fon.10.31

    Article  PubMed  Google Scholar 

  20. Martin Pinquarta M, Dubersteinb PR (2010) Associations of social networks with cancer mortality: a meta-analysis. Crit Rev Oncol Hematol 75(2):122–137. doi:10.1016/j.critrevonc. 2009.06.003

    Article  Google Scholar 

  21. Lutgendorf SK, De Geest K, Bender D, et al. (2012) Social influences on clinical outcomes of patients with ovarian cancer. J Clin Oncol 30(23):2885–2890. doi:10.1200/JCO. 2011.39.4411

    Article  PubMed  PubMed Central  Google Scholar 

  22. Spiegel D, Butler LD, Giese-Davis J, et al. (2007) Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer: a randomized prospective trial. Cancer 110(5):1130–1138. doi:10.1002/cncr.22890

    Article  PubMed  Google Scholar 

  23. Kissane D, Li Y (2008) Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer: a randomized prospective trial. Cancer 112(2):443–444. doi:10.1002/cncr.23179

    Article  PubMed  Google Scholar 

  24. Kissane D (2009) Beyond the psychotherapy and survival debate: the challenge of social disparity, depression and treatment adherence in psychosocial cancer care. Psycho-Oncology 18(1):1–5. doi:10.1002/pon.1493

    Article  PubMed  Google Scholar 

  25. Spiegel D (2012) Mind matters in cancer survival. Psycho-Oncology 21(6):588–593. doi:10.1002/pon.3067

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lutgendorf SK, Sood AK, Anderson B, et al. (2005) Social support, psychological distress, and natural killer cell activity in ovarian cancer. J Clin Oncol 23(28):7105–7113. doi:10.1200/JCO. 2011.39.4411

    Article  PubMed  Google Scholar 

  27. Costanzo ES, Lutgendorf SK, Sood AK, Anderson B, Sorosky J, Lubaroff DM (2005) Psychosocial factors and interleukin-6 among women with advanced ovarian cancer. Cancer 104(2):305–313. doi:10.1002/cncr.21147

    Article  PubMed  Google Scholar 

  28. Jordan SJ, Green AC, Whiteman DC, et al. (2008) Serous ovarian, fallopian tube and primary peritoneal cancers: a comparative epidemiological analysis. Int J Cancer 122:1598–1603. doi:10.1002/ijc.23287

    Article  CAS  PubMed  Google Scholar 

  29. Price MA, Zachariae R, Butow PN, et al. (2009) Prevalence and predictors of insomnia in women with invasive ovarian cancer: anxiety a major factor. Eur J Cancer 45(18):3262–3270. doi:10.1016/j.ejca. 2009.05.030

    Article  PubMed  Google Scholar 

  30. Price MA, Butow PN, Costa DS, et al. (2010) Prevalence and predictors of anxiety and depression in women with invasive ovarian cancer and their carers. Med J Aust 193(5 Suppl):S52–S57

    PubMed  Google 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

    Article  PubMed  Google Scholar 

  32. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica. 67(6):361–370. doi:10.1111/j.1600-0447.1983.tb09716.x

    Article  CAS  PubMed  Google Scholar 

  33. Osborne RH, Elsworth GR, Kissane DW, Burke SA, Hopper JL (1999) The Mental Adjustment to Cancer (MAC) scale: replication and refinement in 632 breast cancer patients. Psychol Med 29(6):1335–1145. doi:10.1200/JCO. 2014.57.6801

    Article  CAS  PubMed  Google Scholar 

  34. Watson M, Greer S, Young J, Inayat Q, Burgess C, Robertson B (1988) Development of a questionnaire measure of adjustment to cancer: the MAC scale. Psychol Med 18(1):203–209. doi:10.1017/S0033291700002026

    Article  CAS  PubMed  Google 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:10.1037/0022-3514.67.6.1063

  36. Broadhead WE, Gehbach SH, de Gruy FV, Kaplan BH (1988) The Duke-UNC Functional Social Support Questionnaire. Measurement of social support in family medicine patients. Med Care 26(7):709–723

    Article  CAS  PubMed  Google Scholar 

  37. Garssen B (2004) Psychological factors and cancer development: evidence after 30 years of research. Clin Psychol Rev 24(3):315–338. doi:10.1016/j.cpr. 2004.01.002

    Article  PubMed  Google Scholar 

  38. Danhauer SC, Crawford SL, Farmer DF, Avis NE (2009) A longitudinal investigation of coping strategies and quality of life among younger women with breast cancer. J Behav Med 32(4):371–379. doi:10.1007/s10865-009-9211-x

    Article  PubMed  Google Scholar 

  39. Goncalves V, Jayson G, Tarrier N (2008) A longitudinal investigation of psychological morbidity in patients with ovarian cancer. Br J Cancer 99(11):1794–1801. doi:10.1038/sj.bjc.6604770

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

Download references

Acknowledgments

The following are acknowledged: study participants, nurses, and research assistants, including Lynley Aldridge, Diana Grivas, Naomi McGowan, Colleen Loos, and Rebekah Cicero; institutions and investigators represented within AOCS www.aocstudy.org; clinical and scientific collaborators and New South Wales Hospitals John Hunter, North Shore Private, Royal Hospital for Women, Royal North Shore, Royal Prince Alfred, Westmead, and the NSW Cancer Registry; Queensland Hospitals Mater Misericordiae, Royal Brisbane and Women’s, Townsville, Wesley, and the Queensland Cancer Registry; South Australian Hospitals Flinders Medical Centre, Queen Elizabeth, Royal Adelaide, Burnside War Memorial, and the South Australian Cancer Registry; Tasmania Royal Hobart Hospital; Victorian Hospitals Freemasons, Mercy Hospital for Women, Royal Women’s, and the Victorian Cancer Registry; Western Australian Hospitals King Edward Memorial, St. John of God (Subiaco), Sir Charles Gairdner; and Western Australia Research Tissue Network (WARTN), Western Australian Cancer Registry.

Author information

Authors and Affiliations

  1. Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia

    Melanie A. Price & Phyllis N. Butow

  2. Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, Australia

    Melanie A. Price, Phyllis N. Butow, Melanie L. Bell & Joanna E. Fardell

  3. Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA

    Melanie L. Bell

  4. Department of Gynaecological Oncology, Westmead Hospital and Westmead Institute for Cancer Research, The University of Sydney at Westmead Millennium Institute, Westmead, Australia

    Anna deFazio

  5. Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia

    Michael Friedlander

  6. Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia

    Michael Friedlander

  7. Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia

    Melinda M. Protani & Penelope M. Webb

Authors
  1. Melanie A. Price
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Phyllis N. Butow
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Melanie L. Bell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna deFazio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Friedlander
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joanna E. Fardell
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Melinda M. Protani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Penelope M. Webb
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

AOCS—Quality of Life Study Investigators on behalf of the Australian Ovarian Cancer Study Group

Corresponding author

Correspondence to Melanie A. Price.

Ethics declarations

The study was approved and conducted in accordance with the Human Research Ethics Committees of The University of Sydney, QIMR Berghofer Medical Research Institute, and all participating sites across Australia.

Conflict of interest

The authors declare that they have no competing interests.

Research support

This study was funded by The Cancer Councils of New South Wales and Queensland (RG 36/05). Financial support for the parent study was provided by the U.S. Army Medical Research and Materiel Command under DAMD17-01-1-0729; National Health and Medical Research Council (NHMRC) grants 400413, 400281; and Cancer Councils of New South Wales, Queensland, South Australia, Tasmania, Victoria and Western Australia. Additional recruitment was conducted under the Australian Cancer Study (Ovarian Cancer) NHMRC (199600). P Butow is supported by NHMRC Principal Research Fellowship (211199, 457093). P Webb is supported by NHMRC Senior Research Fellowship (1043134).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Price, M.A., Butow, P.N., Bell, M.L. et al. Helplessness/hopelessness, minimization and optimism predict survival in women with invasive ovarian cancer: a role for targeted support during initial treatment decision-making?. Support Care Cancer 24, 2627–2634 (2016). https://doi.org/10.1007/s00520-015-3070-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-015-3070-5

Keywords

Search

Navigation