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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Similar content being viewed by others
Tracey EA, Roder D, Francis J, Zorbas HM, Hacker NF, Bishop J (2009) Reasons for improved survival from ovarian cancer in New South Wales, Australia, between 1980 and 2003: implication for cancer control. Int J Gynecol Cancer 19:591–599
Lockwood-Rayermann S (2006) Survivorship issues in ovarian cancer: a review. Oncol Nurs Forum 33:553–562
Price MA, Butow PN, Costa DSJ, King MT, Aldridge LJ, Fardell JE, DeFazio A, Webb PM (2010) Prevalence and predictors of anxiety and depression in women with invasive ovarian cancer and their caregivers. Med J Aust 193:S52–S57
Power J, Brown L, Ritvo P (2008) A qualitative study examining psychosocial distress, coping, and social support across the stages and phases of epithelial ovarian cancer. Health Care Women Int 29:366–383
Mizrahi I, Kaplan G, Milshtein E, Reshef BP, Baruch GB (2008) Coping simultaneously with 2 stressors: immigrants with ovarian cancer. Cancer Nurs 31:126–133
Tuncay T (2014) Coping and quality of life in Turkish women living with ovarian cancer. Asian Pac J Cancer Prev 15:4005–4012
Gilbertson-White S, Campbell G, Ward S, Sherwood P, Donovan H (2017) Coping with pain severity, distress, and consequences in women with ovarian cancer. Cancer Nurs 40:117–123
Canada AL, Parker PA, Basen-Engquist K, de Moor JS, Ramondetta LM (2005) Active coping mediates the association between religion/spirituality and functional well-being in ovarian cancer. Gynecol Oncol 99:S125–S125
Hill EM (2016) Quality of life and mental health among women with ovarian cancer: examining the role of emotional and instrumental social support seeking. Psychol Health Med 21:551-61
Price MA, Bell ML, Sommeijer DW, Friedlander M, Stockler MR, Defazio A, Webb PM, Butow PN (2013) Physical symptoms, coping styles and quality of life in recurrent ovarian cancer: a prospective population-based study over the last year of life. Gynecol Oncol 130:162–168
Seibaek L, Blaakaer J, Petersen LK, Hounsgaard L (2013) Ovarian cancer surgery: health and coping during the perioperative period supportive care in cancer. Support Care Cancer 21:575–582
Lazarus RS, Folkman S (1984) Stress appraisal and coping. Springer, New York
Carver CS, Connor-Smith J (2010) Personality and coping. Annu Rev Psychol 61:679–704
Carver CS, Scheier MF, Weintraub JK (1989) Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol 56:267–283
Dunkel-Schetter C, Feinstein LG, Taylor SE, Falke RL (1992) Patterns of coping with cancer. Health Psychol 11:79–87
Bury M (1982) Chronic illness as biographical disruption. Sociol Health Illn 4:167–182
Folkman S, Greer S (2000) Promoting psychological well-being in the face of serious illness: when theory, research and practice inform each other. Psycho-Oncology 9:11–19
Roberts D, Calman L, Large P, Appleton L, Grande G, Lloyd-Williams M, Walshe C (2018) A revised model for coping with advanced cancer. Mapping concepts from a longitudinal qualitative study of patients and carers coping with advanced cancer onto Folkman and Greer’s theoretical model of appraisal and coping. Psycho-Oncology 27:229-235
Carver CS (1997) You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med 4:92–100
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370
Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J et al (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579
King MT, Stockler MR, Butow P, O’Connell R, Voysey M, Oza AM, Gillies K, Donovan HS, Mercieca-Bebber R, Martyn J, Sjoquist K, Friedlander ML (2014) Development of the measure of ovarian symptoms and treatment concerns: aiming for optimal measurement of patient-reported symptom benefit with chemotherapy for symptomatic ovarian cancer. Int J Gynecol Cancer 24:865–873
Basen-Engquist K, Bodurka-Bevers D, Fitzgerald M, Webster K, Cella D, Hu S, Gershenson D (2001) Reliability and validity of the functional assessment of cancer therapy-ovarian. J Clin Oncol 19:1809–1817
Matsunaga M (2010) How to factor-analyze your data right: do’s, don’ts and how-To’s. Int J Psychol Res (Medellin) 3:97–110
Nagin DS, Odgers CL (2010) Group-based trajectory modeling in clinical research. Annu Rev Clin Psychol 6:109–138
Jones BL, Nagin DS (2007) Advances in group-based trajectory modeling and an SAS procedure for estimating them. Sociol Methods Res 35:542–571
Jones BL, Nagin DS, Roeder K (2001) A SAS procedure based on mixture models for estimating developmental trajectories. Sociol Methods Res 29:374–393
Christ GH (1991) A model for the development of psychosocial interventions recent results in cancer research Fortschritte Der Krebsforschung Progrès Dans les Recherches Sur Le. Cancer 121:301–312
Carver CS, Pozo C, Harris SD, Noriega V, Scheier MF, Robinson DS, Ketcham AS, Moffat FL Jr, Clark KC (1993) How coping mediates the effect of optimism on distress: a study of women with early stage breast cancer. J Pers Soc Psychol 65:375–390
Courtens AM, Stevens FC, Crebolder HF, Philipsen H (1996) Longitudinal study on quality of life and social support in cancer patients. Cancer Nurs 19:162–169
Price MA, Butow PN, Bell ML, deFazio A, Friedlander M, Fardell JE, Protani MM, Webb PM (2016) 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 24:2627-34
Manne S (2007) Coping with cancer: findings of research and intervention studies. In: Martz E, Livneh H (eds) Coping with chronic illness and disability. Springer Science and Business Media, New York, pp 191–293
Osborn RL, Demoncada AC, Feuerstein M (2006) Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 36:13–34
Hulbert-Williams N, Owen R (2015) Acceptance and commitment therapy (ACT) for cancer patients. In: Holland JC, Breitbart WS, Butow PN, Jacobsen PB, Loscalzo MJ, McCorkle R, Holland JC, Breitbart WS, Butow PN, Jacobsen PB, Loscalzo MJ, McCorkle R (eds) Psycho-oncology, 3rd edn. Oxford University Press, New York, pp 521–525
Australian Institute of Health and Welfare (2012) Gynaecological cancers in Australia: an overview. Australian Institute of Health and Welfare, Canberra
Australian Cancer Network and the National Breast Cancer Centre (2004) Clinical Practice Guidelines for the Management of Women with Epithelial Ovarian Cancer. Camperdown, NSW
We acknowledge the OPAL Study team and all the clinicians and participating institutions who helped make this study possible (see opalstudy.qimrberghofer.edu.au 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.
Conflict of interest
The authors declare that they have no conflicts of interest.
Electronic supplementary material
About this article
Cite this article
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). https://doi.org/10.1007/s00520-018-4284-0