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Helplessness/hopelessness, minimization and optimism predict survival in women with invasive ovarian cancer: a role for targeted support during initial treatment decision-making?

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Abstract

Purpose

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 in women with ovarian cancer, controlling for potential confounders.

Methods

The sample comprised 798 women with invasive ovarian cancer recruited into the Australian Ovarian Cancer Study and a subsequent quality of life study. Validated measures of depression, optimism, minimization, helplessness/hopelessness, and social support were completed 3–6 monthly for up to 2 years. Four hundred nineteen women (52.5 %) died over the follow-up period. Associations between time-varying psychosocial variables and survival were tested using adjusted Cox proportional hazard models.

Results

There was a significant interaction of psychosocial variables measured prior to first progression and overall survival, with higher optimism (adjusted hazard ratio per 1 standard deviation (HR) = 0.80, 95 % confidence interval (CI) 0.65–0.97), higher minimization (HR = 0.79, CI 0.66–0.94), and lower helplessness/hopelessness (HR = 1.40, CI 1.15–1.71) associated with longer survival. After disease progression, these variables were not associated with survival (optimism HR = 1.10, CI 0.95–1.27; minimization HR = 1.12, CI 0.95–1.31; and helplessness/hopelessness HR = 0.86, CI 0.74–1.00). Depression and social support were not associated with survival.

Conclusions

In women with invasive ovarian cancer, psychosocial variables prior to disease progression appear to impact on overall survival, suggesting a preventive rather than modifying role. Addressing psychosocial responses to cancer and their potential impact on treatment decision-making early in the disease trajectory may benefit survival and quality of life.

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Acknowledgments

The following are acknowledged: study participants, nurses, and research assistants, including Lynley Aldridge, Diana Grivas, Naomi McGowan, Colleen Loos, and Rebekah Cicero; institutions and investigators represented within AOCS www.aocstudy.org; clinical and scientific collaborators and New South Wales Hospitals John Hunter, North Shore Private, Royal Hospital for Women, Royal North Shore, Royal Prince Alfred, Westmead, and the NSW Cancer Registry; Queensland Hospitals Mater Misericordiae, Royal Brisbane and Women’s, Townsville, Wesley, and the Queensland Cancer Registry; South Australian Hospitals Flinders Medical Centre, Queen Elizabeth, Royal Adelaide, Burnside War Memorial, and the South Australian Cancer Registry; Tasmania Royal Hobart Hospital; Victorian Hospitals Freemasons, Mercy Hospital for Women, Royal Women’s, and the Victorian Cancer Registry; Western Australian Hospitals King Edward Memorial, St. John of God (Subiaco), Sir Charles Gairdner; and Western Australia Research Tissue Network (WARTN), Western Australian Cancer Registry.

Author information

Authors and Affiliations

  1. Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia

    Melanie A. Price & Phyllis N. Butow

  2. Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, Australia

    Melanie A. Price, Phyllis N. Butow, Melanie L. Bell & Joanna E. Fardell

  3. Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA

    Melanie L. Bell

  4. Department of Gynaecological Oncology, Westmead Hospital and Westmead Institute for Cancer Research, The University of Sydney at Westmead Millennium Institute, Westmead, Australia

    Anna deFazio

  5. Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia

    Michael Friedlander

  6. Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia

    Michael Friedlander

  7. Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia

    Melinda M. Protani & Penelope M. Webb

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  1. Melanie A. Price
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Consortia

AOCS—Quality of Life Study Investigators on behalf of the Australian Ovarian Cancer Study Group

Corresponding author

Correspondence to Melanie A. Price.

Ethics declarations

The study was approved and conducted in accordance with the Human Research Ethics Committees of The University of Sydney, QIMR Berghofer Medical Research Institute, and all participating sites across Australia.

Conflict of interest

The authors declare that they have no competing interests.

Research support

This study was funded by The Cancer Councils of New South Wales and Queensland (RG 36/05). Financial support for the parent study was provided by the U.S. Army Medical Research and Materiel Command under DAMD17-01-1-0729; National Health and Medical Research Council (NHMRC) grants 400413, 400281; and Cancer Councils of New South Wales, Queensland, South Australia, Tasmania, Victoria and Western Australia. Additional recruitment was conducted under the Australian Cancer Study (Ovarian Cancer) NHMRC (199600). P Butow is supported by NHMRC Principal Research Fellowship (211199, 457093). P Webb is supported by NHMRC Senior Research Fellowship (1043134).

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Price, M.A., Butow, P.N., Bell, M.L. et al. 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, 2627–2634 (2016). https://doi.org/10.1007/s00520-015-3070-5

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  • DOI: https://doi.org/10.1007/s00520-015-3070-5

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