Psychosocial predictors of survival in women with invasive ovarian cancer: a population-based prospective study (#105)
Background: Women with advanced ovarian cancer generally have a poor prognosis but there is significant variability in survival despite similar disease characteristics and treatment regimens. The aim of this study was to determine whether psychosocial factors predict survival time in women with ovarian cancer, controlling for other potential confounders.
Patients and Methods: The sample consisted of 798 women with invasive ovarian cancer recruited into the Australian Ovarian Cancer Study (AOCS) through major treatment centres and cancer-registries, and a subsequent Quality of Life (QoL) study. Validated measures of depression (HADS), optimism (LOT–R), minimisation, helplessness/hopelessness (Mental Adjustment to Cancer) and social support (Duke-UNC) were completed at three to six monthly intervals for up to two years. Detailed epidemiological, pathology, treatment and clinical outcome data were accessed through AOCS and 419 (52.5%) died within the follow-up period. The associations between time-varying psychosocial variables and survival were tested using adjusted Cox proportional hazard models.
Results: Depression and social support were not associated with survival. However, in women whose disease had not yet progressed, 1 standard deviation differences on the psychosocial variables had the following Hazard Ratios (HRs) for survival: optimism (HR=0.80, CI: 0.65-0.97), minimisation (HR=0.79, CI: 0.66-0.93) and helplessness/hopelessness (HR=1.40, CI: 1.15-1.71). In contrast, for women whose disease had progressed, optimism (HR=1.10, CI: 0.95-1.27), minimisation (HR=1.12, CI: 0.95-1.31) and helplessness/hopelessness (HR=0.86, CI: 0.74-1.00) were not associated with survival.
Conclusions: In women with invasive ovarian cancer without disease progression, greater optimism, less helplessness/hopelessness, and coping by minimising the impact of their illness were associated with longer survival. In women with disease progression, there was no evidence of these psychosocial variables impacting on survival. These results highlight the importance of addressing psychosocial responses to cancer early in the disease trajectory, as they may benefit survival as well as quality of life.