Skip to main content

Advertisement

SpringerLink
Log in

Quality-of-Life Issues in the Management of Epithelial Ovarian Cancer

  • Gynecologic Tumors
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

The importance of quality-of-life (QOL) measurements in cancer management is being increasingly appreciated. This is especially important in patients with advanced cancers. Over 80% of women with epithelial ovarian cancer (EOC) will present with disease outside the ovary as there are no accurate screening tests, and symptoms usually do not develop until EOC has spread. Standard treatment includes debulking surgery followed by chemotherapy to which most women will have a complete response but only a minority of women with advanced disease will be cured. Fortunately, advances in surgical and chemotherapeutic management have improved overall survival with 45% of women of all stages living 5 years or longer. EOC may in many cases be considered a “chronic cancer,” which highlights the importance of QOL in management decisions. QOL may be affected by the disease itself as well as by surgical and chemotherapeutic treatments. Future studies of the care and treatment of EOC patients should include well-designed QOL evaluations.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest have been highlighted as: •Of importance ••Of major importance

  1. Jemal A, Siegel R, Ward E, et al.: Cancer statistics 2007. CA Cancer J Clin 2007, 57:43–66

    Article  PubMed  Google Scholar 

  2. Morgan RJ Jr, Alvarez RD, Armstrong DK, et al.: Ovarian cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 2006, 4:912–939

    CAS  PubMed  Google Scholar 

  3. Armstrong DK, Bundy B, Wenzel L, et al.: Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 2006, 354:34–43

    Article  CAS  PubMed  Google Scholar 

Third and most recent large phase III randomized study showing superiority of combination IV and IP chemotherapy over IV chemotherapy alone.

  1. Lowe T, Morgan RJ Jr: Intraperitoneal chemotherapy in ovarian cancer. Future Med-Women’s Health 2007, 3:433–440

    CAS  Google Scholar 

  2. Cannistra SA: Cancer of the ovary. N Engl J Med 2004, 351:2519–2529

    Article  CAS  PubMed  Google Scholar 

  3. Ferrell BR, Dow KH, Grant M: Measurement of the quality of life in cancer survivors. Qual Life Res 1995, 4:523–531

    Article  CAS  PubMed  Google Scholar 

  4. Ferrell B, Smith SL, Cullinane CA, Melancon C: Psychological well being and quality of life in ovarian cancer survivors. Cancer 2003, 98:1061–1071

    Article  PubMed  Google Scholar 

Qualitative data analysis from more than 21,806 items of␣natural correspondence over 7 years between EOC survivors and an ovarian cancer newsletter-“Conversations-The International Newsletter for those Fighting Ovarian Cancer”

  1. Penson RT, Wenzel LB, Vergote I, Cella D: Quality of life considerations in gynecologic cancer. FIGO 6th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet 2006, 95:S247–S257

    Article  PubMed  Google Scholar 

  2. Bottomley A: The cancer patient and quality of life. Oncologist 2002, 7:120–125

    Article  PubMed  Google Scholar 

  3. Sanders C, Egger M, Donovan J, et al.: Reporting on quality of life in randomised controlled trials: bibliographic study. BMJ 1998, 317:1191–1194

    CAS  PubMed  Google Scholar 

  4. Kornblith AB, Thaler HT, Wong G, et al.: Quality of life of women with ovarian cancer. Gynecol Oncol 1995, 59:231–242

    Article  CAS  PubMed  Google Scholar 

  5. Bodurka-Bevers D, Basen-Engquist K, Carmack CL, et al.: Quality of life of women with ovarian cancer. Gynecol Oncol 1995, 59:231–242

    Article  Google Scholar 

  6. Wenzel LB, Donnelly JP, Fowler JM, et al.: Resilience, reflection, and residual stress in ovarian cancer survivorship: a gynecologic oncology group study. Psychooncology 2002, 11:142–153

    Article  PubMed  Google Scholar 

  7. Norton TR, Manne SL, Rubin S, et al.: Prevalence and predictors of psychological distress among women with ovarian cancer. J Clin Oncol 2004, 22:919–926

    Article  PubMed  Google Scholar 

  8. Efficace F, Osoba D, Gotay C, et al.: Has the quality of health-related quality of life reporting in cancer clinical trials improved over time? Towards bridging the gap with clinical decision making. Ann Oncol 2007, 18:775–781

    Article  CAS  PubMed  Google Scholar 

  9. Joly F, Vardy J, Pintilie M, Tannock I: Quality of life and/or symptom control in randomized clinical trials for patients with advanced cancer. Ann Oncol 2007, Aug 13 [Epub ahead of print]

  10. Cella DF, Tulsky DS, Gray G: The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 1993, 11:570–579

    CAS  PubMed  Google Scholar 

  11. Butler L, Bacon M, Carey M, et al.: Determining the relationship between toxicity and quality of life in an ovarian cancer chemotherapy clinical trial. J Clin Oncol 2004, 22:2461–2468

    Article  PubMed  Google Scholar 

  12. Basen-Engquist K, Bodurka-Bevers D, Fitzgerald MA, et al.: Reliability and validity of the functional assessment of cancer therapy-ovarian. J Clin Oncol 2001, 19:1809–1817

    CAS  PubMed  Google Scholar 

  13. Fitch M, Gray RE, Franssen E: Perspectives on living with ovarian cancer: young women’s views. Can Oncol Nurs J 2000, 10:101–108

    CAS  PubMed  Google Scholar 

  14. Aletti GD, Dowdy SC, Gostout BS, et al.: Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. Obstet Gynecol 2006, 107:77–85

    PubMed  Google Scholar 

  15. Fader AN, Rose PG: Role of surgery in ovarian carcinoma. J Clin Oncol 2007, 25:2873–2883

    Article  PubMed  Google Scholar 

  16. Panici PB, Maggioni A, Hacker N, et al.: Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomized clinical trial. J Natl Cancer Inst 2005, 97:560–566

    PubMed  Google Scholar 

  17. Maggioni A, Benedetti Panici P, Dell’Anna T, et al.: Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer 2006, 95:699–704

    Article  CAS  PubMed  Google Scholar 

  18. Crawford SC, Vasey PA, Paul J, et al.: Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from an international comparison within the SCOTROC-1 Trial. J Clin Oncol 2005, 23:8802–8811

    Article  PubMed  Google Scholar 

  19. Schilder JM, Thompson AM, DePriest PD, et al.: Outcome of reproductive age women with stage IA or IC invasive epithelial ovarian cancer treated with fertility-sparing therapy. Gynecol Oncol 2002, 87:1–7

    Article  PubMed  Google Scholar 

  20. Colombo N, Parma G, Lapresa MT, et al.: Role of conservative surgery in ovarian cancer: the European experience. Int J Gynecol Cancer 2005, 15:206–211

    Article  PubMed  Google Scholar 

  21. Schlaerth AC, Abu-Rustum NR: Role of minimally invasive surgery in gynecologic cancers. Oncologist 2006, 11:895–901

    Article  PubMed  Google Scholar 

  22. Ozols RF, Fisher RI, Anderson T, et al.: Peritoneoscopy in the management of ovarian cancer. Am J Obstet Gynecol 1981, 140:611–619

    CAS  PubMed  Google Scholar 

  23. van der Burg ME, van Lent M, Buyse M, et al.: The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. Gynecological cancer cooperative group of the European organization for research and treatment of cancer. N Engl J Med 1995, 332:629–634

    Article  PubMed  Google Scholar 

  24. Redman CW, Warwick J, Luesley DM, et al.: Intervention debulking surgery in advanced epithelial ovarian cancer. Brit J Obstet Gynaecol 1994, 101:142–146

    CAS  Google Scholar 

  25. Rose PG, Nerenstone S, Brady MF, et al.: Secondary surgical cytoreduction for advanced ovarian carcinoma. N Engl J Med 2004, 351:2489–2497

    Article  CAS  PubMed  Google Scholar 

  26. Wenzel L, Huang HQ, Monk BJ, et al.: Quality-of-life comparisons in a randomized trial of interval secondary cytoreduction in advanced ovarian carcinoma: a Gynecologic Oncology Group study. J Clin Oncol 2005, 23:5605–5612

    Article  PubMed  Google Scholar 

  27. Kumar L, Hariprasad R, Kumar S, et al.: Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery versus upfront surgery followed by chemotherapy (CT) in advanced epithelial ovarian carcinoma (EOC): a prospective randomized study—Interim results [abstract]. Proc ASCO 2007, 25:5531. http://www.asco.org

  28. Alberts DS, Liu PY, Hannigan EV, et al.: Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N Engl J Med 1996, 335:1950–1955

    Article  CAS  PubMed  Google Scholar 

First large randomized phase III study of intraperitoneal chemotherapy.

  1. Markman M, Bundy BN, Alberts DS, et al.: Phase III trial of standard-dose intravenous Cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the gynecologic oncology group, southwestern oncology group, and eastern cooperative oncology group. J Clin Oncol 2001, 19:1001–1007

    CAS  PubMed  Google Scholar 

Second large randomized phase III study of intraperitoneal chemotherapy.

  1. Kyrgiou M, Salanti G, Pavlidis N, et al.: Survival benefits with diverse chemotherapy regimens for ovarian cancer: meta-analysis of multiple treatments. J Natl Cancer Inst 2006, 98:1655–1663

    CAS  PubMed  Google Scholar 

  2. Bezjak A, Tu D, Bacon M, et al.: Quality of life in ovarian cancer patients: comparison of paclitaxel plus cisplatin, with cyclophosphamide plus cisplatin in a randomized study. J Clin Oncol 2004, 22:4595–4603

    Article  CAS  PubMed  Google Scholar 

  3. Neijt JP, Engelholm SA, Tuxen MK, et al.: Exploratory phase III study of paclitaxel and cisplatin versus paclitaxel and carboplatin in advanced ovarian cancer. J Clin Oncol 2000, 18:3084–3092

    CAS  PubMed  Google Scholar 

  4. Ozols RF, Bundy BN, Greer BE, et al.: Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 2003, 21:3194–3200

    Article  CAS  PubMed  Google Scholar 

Established carboplatin and paclitaxel as standard of care for primary postoperative therapy for EOC.

  1. du Bois A, Lück HJ, Meier W, et al.: A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. J Natl Cancer Inst 2003, 95:1320–1329

    CAS  PubMed  Google Scholar 

Established carboplatin and paclitaxel as standard of care for primary postoperative therapy for EOC.

  1. Greimel ER, Bjelic-Radisic V, Pfisterer J, et al.: Randomized study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group comparing quality of life in patients with ovarian cancer treated with cisplatin/paclitaxel versus carboplatin/paclitaxel. J Clin Oncol 2006, 24:579–586

    Article  CAS  PubMed  Google Scholar 

  2. Vasey PA, Jayson GC, Gordon A, et al.: Phase III randomized trial of docetaxel-carboplatin versus paclitaxel-carboplatin as first-line chemotherapy for ovarian carcinoma. J Natl Cancer Inst 2004, 96:1682–1691

    Article  CAS  PubMed  Google Scholar 

Randomized phase III study comparing docetaxel versus paclitaxel in combination with carboplatin. Global QOL was similar many symptom scores favored docetaxel. The current primary postoperative chemotherapy recommendation is for paclitaxel or docetaxel in combination with carboplatin.

  1. Wenzel LB, Huang HQ, Armstrong DK, et al.: Health-related quality of life during and after intraperitoneal versus intravenous chemotherapy for optimally debulked ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol 2007, 25:437–443

    Article  CAS  PubMed  Google Scholar 

  2. Wenzel LB, Huang HQ, Armstrong DK, et al.: Baseline quality of life (QOL) as a predictor of tolerance to intraperitoneal (IP) chemotherapy for advanced epithelial ovarian cancer (EOC): A Gynecologic Oncology Group (GOG) study [abstract]. Proc ASCO 2006, 24:5007. http://www.asco.org

  3. Sun CC, Ramirez PT, Bodurka DC: Quality of life for patients with epithelial ovarian cancer. Nat Clin Pract Oncol 2007, 4:18–29

    Article  PubMed  Google Scholar 

  4. Sun CC, Bodurka DC, Weaver CB, et al.: Rankings and symptom assessments of side effects from chemotherapy: insights from experienced patients with ovarian cancer. Support Care Cancer 2005, 13:219–227

    Article  PubMed  Google Scholar 

  5. Ettinger DS, Bierman PJ, Bradbury B, et al.: Antiemesis. J Natl Compr Canc Netw 2007, 5:12–33

    CAS  PubMed  Google Scholar 

  6. Hesketh PJ, Batchelor D, Golant M, et al.: Chemotherapy-induced alopecia: psychosocial impact and therapeutic approaches. Support Care Cancer 2004, 12:543–549

    PubMed  Google Scholar 

  7. Holzner B, Kemmler G, Meraner V, et al.: Fatigue in ovarian carcinoma patients: a neglected issue? Cancer 2003, 97:1564–1572

    Article  PubMed  Google Scholar 

  8. Hensley ML, Correa DD, Thaler H, et al.: Phase I/II study of weekly paclitaxel plus carboplatin and gemcitabine as first-line treatment of advanced-stage ovarian cancer: pathologic complete response and longitudinal assessment of impact on cognitive functioning. Gynecol Oncol 2006, 102:270–277

    Article  CAS  PubMed  Google Scholar 

  9. Liavaag AH, Dørum A, Fosså SD, et al.: Controlled study of fatigue, quality of life, and somatic and mental morbidity in epithelial ovarian cancer survivors: how lucky are the lucky ones? J Clin Oncol 2007, 25:2049–2056

    Article  PubMed  Google Scholar 

  10. Narod SA: Ovarian cancer and HRT in the Million Women Study. Lancet 2007, 369:1667–1668

    Article  PubMed  Google Scholar 

  11. Guidozzi F, Daponte A: Estrogen replacement therapy for ovarian carcinoma survivors. Cancer 1999, 86:1013–1018

    Article  CAS  PubMed  Google Scholar 

  12. Carmack Taylor CL, Basen-Engquist K, Shinn EH, Bodurka DC: Predictors of sexual functioning in ovarian cancer patients. J Clin Oncol 2004, 22:881–889

    Article  PubMed  Google Scholar 

  13. Parmar MK, Ledermann JA, Colombo N, et al.: ICON and AGO Collaborators. Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet 2003, 361:2099–2106

    Article  CAS  PubMed  Google Scholar 

  14. Donovan KA, Green PG, Shuster EE, et al.: Treatment Preferences in Recurrent Ovarian Cancer. Gynecol Oncol 2002, 86:200–211

    Article  PubMed  Google Scholar 

  15. Mercadante S, Casuccio A, Mangione S: Medical treatment for inoperable malignant bowel obstruction: a qualitative systematic review. J Pain Symptom Manage 2007, 33:217–223

    Article  CAS  PubMed  Google Scholar 

  16. Brooks RA, Herzog TJ: Long-term semi-permanent catheter use for the palliation of malignant ascites. Gynecol Oncol 2006, 101:360–362

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, USA

    Thomas Lowe, Betty Ferrell & Lucille Leong

Authors
  1. Thomas Lowe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Betty Ferrell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lucille Leong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Betty Ferrell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lowe, T., Ferrell, B. & Leong, L. Quality-of-Life Issues in the Management of Epithelial Ovarian Cancer. Curr. Treat. Options in Oncol. 8, 402–416 (2007). https://doi.org/10.1007/s11864-007-0049-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-007-0049-6

Keywords

Search

Navigation