Hope, Quality of Life, and Benefit From Treatment in Women Having Chemotherapy for Platinum-Resistant/Refractory Recurrent Ovarian Cancer: The Gynecologic Cancer Intergroup Symptom Benefit Study

Abstract

Purpose. Chemotherapy for platinum-resistant/refractory ovarian cancer is motivated by the hope of benefit. We sought to determine the relationships between: (a) trait hope, expectation of symptom benefit from chemotherapy, and anxiety and depression; (b) hope and perceived efficacy of chemotherapy; and (c) unfulfilled hope (where expectations for benefit are not fulfilled) and depression. Methods. Adult patients enrolled within stage 1 of the Gynecologic Cancer Intergroup Symptom Benefit Study were included. Patient. Reported outcomes were collected from 126 women with predominantly platinum-resistant ovarian cancer at baseline, prior to the first four treatment cycles (12-16 weeks), and four weeks after completing chemotherapy or at disease progression, whichever came first. Associations were assessed with Spearman rank correlation coefficient (r) and odds ratio.Results. Trait hope and expectation of symptom benefit from chemotherapy were weakly correlated with each other (r ϭ 0.25). Trait hope, but not expectation of symptom benefit, was negatively correlated with anxiety (r ϭ Ϫ0.43) and depression (r ϭ Ϫ0.50). The smaller the discrepancy between perceived and expected symptom benefit, the less likely the patient was to have scores indicative of depression (odds ratio: 0.68; 95% confidence interval: 0.49 -0.96; p ϭ .026). Conclusion. Trait hope and expectation of symptom benefit fromchemotherapyappeartobedistinctandindependentofthe aspects of quality of life and scores for depression. Hope did not appear to affect perceived efficacy of chemotherapy in alleviating symptoms, but women whose expectation of symptom benefitfromchemotherapywasnotfulfilledweremorelikelytohave scores indicative of depression. It may be preferable to encourage hope toward achievable goals rather than toward benefits from chemotherapy. The Oncologist 2013;18:1221-1228 Implications for Practice: Many women with platinum resistant ovarian cancer decide to continue chemotherapy out of hope, even if their prognosis is very poor. They hope the chemotherapy will reduce the size of the cancer, give them more time, or reduce their symptoms. While most clinicians would agree that hope is a positive attribute, this study showed that if women's hopes were not fulfilled, they were more likely to become depressed. This suggests that clinicians should be careful to communicate in a way that encourages realistic hope, targeted toward achievable goals, as this may protect women from depression. INTRODUCTIONOvarian cancer is the leading cause of death in women with gynecological malignancies in the Western world. Most women present with advanced disease and following surgery receive platinum-based chemotherapy. Although many women initially respond to treatment, the majority will have relapse within 12 to 18 months [1]. Patients who have relapse within

Esperança de vida de pacientes com câncer submetidos à quimioterapia

“…Health professionals, especially those working in this area should try to accept and deal with this range of feelings, based on realistic perspectives about the treatment and prognosis, encouraging patients to maintain hope whenever possible. (13) Emphasis is also given to pain intensity, as the findings of this study show that patients with lesser degrees of pain have greater hope, a similar result to the findings of another study, using a different scale, conducted with patients suffering from lung cancer. (14) Despite such comparisons, the authors of a study conducted in Canada, with patients with newly diagnosed cancer, affirm that the findings in the literature cannot provide a clear relationship when it comes to pain and maintaining hope, and more research in this direction is needed.…”

Attentes des patientes atteintes d’un cancer de l’ovaire. Résultats de l’enquête européenne EXPRESSION III chez les patientes françaises du groupe GINECO (Groupe d’investigateurs nationaux pour l’étude des cancers ovariens et du sein)

“…Ceci tient probablement à l'âge des patientes qui n'appartiennent pas à la « génération internet » : dans la cohorte allemande, on retrouve la même tendance. [10]. Ainsi, les patientes surévaluent l'efficacité de la chimiothérapie en dépit des informations données (ou de l'absence d'information demandée/reçue).…”

“…Ceci est retrouvé dans d'autres études où même si le taux de réponse objective à la chimiothérapie est faible, l'amélioration de l'humeur et de la qualité de vie traduit l'effet palliatif de la chimiothérapie [14]. Concernant l'évolution de leur maladie, les patientes souhaitent une information précise et juste (franche) de la part de leur oncologue, alors que, paradoxalement, 20 % ne souhaitent pas entendre un pronostic défavorable (tout comme l'oncologue peut hésiter à le formuler) et souhaitent entretenir, ce-faisant, un espoir de guérison [10,15]. Les patientes émettent en majorité le souhait d'avoir un support écrit, type « carnet de santé » pour suivre l'évolution de leur maladie et de leur traitement.…”

Do all patients with recurrent ovarian cancer need systemic therapy?

“…There is a subset of women with PR-ROC who have a particularly short survival, and administering systemic therapies to patients in their final weeks of life should be discouraged. 34 It is unclear whether the decision to recommend systemic therapy in patients with a low likelihood of benefit reflects inadequate physician-patient communication and/or a failure to recognize the limitations of systemic therapy in patients on a terminal disease trajectory. 33 The provocative title of the article questions the uncertainty of the cost benefit of systemic therapy in a subset of patients with ROC and the human costs of futile treatments, although the financial costs cannot be ignored either.…”