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



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.

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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.


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.

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Correspondence to Vanessa L. Beesley.

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Beesley, V.L., Smith, D.D., Nagle, C.M. et al. Coping strategies, trajectories, and their associations with patient-reported outcomes among women with ovarian cancer. Support Care Cancer 26, 4133–4142 (2018).

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