Quality of life and coping in ovarian cancer: The last year of life. — ASN Events
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Quality of life and coping in ovarian cancer: The last year of life. (#869)

Dirkje W Sommeijer 1 , Melanie A Price 2 3 , Melanie Bell 2 , Michael Friedlander 1 , Martin Stockler 1 , Anna deFazio 4 , Penelope M Webb 5 , The Australian Ovarian Cancer Study Group 4 5 6 , The Australian Ovarian Cancer Study - Quality of Life Study Investigators , Phyllis N Butow 2 3
  1. ANZGOG, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
  2. Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, University of Sydney, Sydney, NSW, Australia
  3. Psycho-oncology Co-operative Research Group, University of Sydney, Sydney, NSW, Australia
  4. Department of Gynaecological Oncology, Westmead Hospital and Westmead Institute for Cancer Research, University of Sydney at the Westmead Millenium Institute, Westmead, NSW, Australia
  5. Gynaecological Cancers Group, Queensland Institute of Medical Research, Brisbane, QLD, Australia
  6. Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Background
The major treatment goal at the end of life of patients with recurrent ovarian cancer is palliation and improving quality of life (QoL). The aim of this study was to determine important symptoms and changes in QoL during the last 12 months of patients’ lives, and the possible effects of preferred coping strategies.
Patients and Methods
QoL, specific symptoms and coping strategies (optimism, minimisation, hopelessness/helplessness) were assessed at three monthly intervals in 217 women recruited into the Australian Ovarian Cancer Study-QoL sub-study between 2002-2007 and who completed at least one follow-up assessment during their last year of life.
Results
The 217 women completed a total of 502 assessments during their last year of life. Overall QoL as well as the functional, physical and emotional sub-scales significantly worsened over time, with a more rapid decline commencing 6-8 months before death. Lack of energy (78%) was the most prevalent and severe symptom 4-6 months before death. Other major symptoms included abdominal swelling (46%), pain (43%), nausea (38%) and loss of appetite (37%), all increasing in prevalence and severity towards the end of life. Forty eight percent of patients were receiving chemotherapy at 4-6 months before death, decreasing to 39% within 0-3 months before death. QoL was positively predicted by optimism (β 0.6 (0.2, 1.1); p = 0.009) and minimisation (β 1.1 (0.4, 1.8); p = 0.003) and negatively predicted by helplessness/hopelessness (β -0.8 (-1.5,-0.1); p = 0.03).
Conclusion
Fatigue, abdominal distension, pain, nausea and anorexia are the major symptoms reported by patients in the last year of life. Many of these could potentially be improved by early referral to palliative care. This is the first study in patients with ovarian cancer showing that coping strategies are strongly associated with QoL at the end of life. Whether interventions targeting coping strategies might improve QoL in patients with advanced cancer needs further study.