Supportive Care in Cancer

, Volume 26, Issue 12, pp 4133–4142 | Cite as

Coping strategies, trajectories, and their associations with patient-reported outcomes among women with ovarian cancer

  • Vanessa L. BeesleyEmail author
  • David D. Smith
  • Christina M. Nagle
  • Michael Friedlander
  • Peter Grant
  • Anna DeFazio
  • Penelope M. Webb
  • on behalf of the OPAL Study Group
Original Article



Most women with ovarian cancer present with advanced stage disease and face aggressive treatments, recurrence, and possible death, yet little is known about how they cope. Our objective was to identify coping strategies used by women with ovarian cancer and their trajectories of use after diagnosis and to assess if coping trajectories are associated with subsequent anxiety, depression, or quality of life.


Women with ovarian cancer completed questionnaires including the Brief-COPE, HADS, and FACT at 3, 6, and 9 months after diagnosis and the HADS and FACT at 12 months. Using data from 634 women who completed the 3-month questionnaire, factor analysis was conducted to identify coping strategy clusters. Trajectory modeling was used to assess patterns of coping over time. Associations between coping trajectory from 3 to 9 months and patient-reported outcomes at 12 months were investigated using general linear models.


Three coping strategy clusters were identified. Use of “taking action/positive framing” followed four distinct trajectories over time: low-stable (44%), medium-stable (32%), medium-decreasing (11%), high-stable (12%). Use of “social/emotional support” had four trajectories: low-increasing (7%), low-decreasing (44%), medium-decreasing (40%), and high-stable (8%). Women either “accepted their reality” (26%) or “used some denial” (74%). Women who accepted reality reported significantly less anxiety and depression and better quality of life at 12 months. Women with high-stable use of taking action/positive framing reported less depression. Women with high-stable use of social/emotional support reported better quality of life.


Strategies to assist women with acceptance, action-planning, positive-framing, and maintaining psychosocial support should be considered.


Ovarian cancer Coping Anxiety Depression Quality of life 



We acknowledge the OPAL Study team and all the clinicians and participating institutions who helped make this study possible (see for a complete list). We also thank consumer representatives Karen Livingstone, Hélène O’Neill, and Merran Williams and all the women who took part.

Funding information

The OPAL study was funded by the National Health and Medical Research Council (NHMRC) of Australia (GNT1025142, GNT1073898). Collection of additional MOST data was funded by BUPA Health Foundation and the QIMR Berghofer Weekend to End Women’s Cancers 2014. PM Webb was supported by an NHMRC Fellowship (GNT1043134) and A DeFazio is supported by the University of Sydney Cancer Research Fund and the Cancer Institute NSW through the Sydney West Translational Cancer Research Centre.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

520_2018_4284_MOESM1_ESM.docx (220 kb)
Supplementary Table 1 (DOCX 219 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Vanessa L. Beesley
    • 1
    Email author
  • David D. Smith
    • 2
  • Christina M. Nagle
    • 1
    • 3
  • Michael Friedlander
    • 4
  • Peter Grant
    • 5
  • Anna DeFazio
    • 6
    • 7
  • Penelope M. Webb
    • 1
  • on behalf of the OPAL Study Group
  1. 1.Gynaecological Cancers Group, QIMR Berghofer Medical Research InstituteBrisbaneAustralia
  2. 2.Statistics Unit, QIMR Berghofer Medical Research InstituteBrisbaneAustralia
  3. 3.School of Public HealthThe University of QueenslandBrisbaneAustralia
  4. 4.Department of Medical OncologyPrince of Wales HospitalSydneyAustralia
  5. 5.Gynaecological Oncology UnitMercy Hospital for WomenMelbourneAustralia
  6. 6.The Westmead Institute for Medical ResearchThe University of SydneySydneyAustralia
  7. 7.Department of Gynaecological OncologyWestmead HospitalSydneyAustralia

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