Patient reported outcomes after risk-reducing surgery in patients at increased risk of ovarian cancer

Gynecol Oncol. 2022 Feb;164(2):421-427. doi: 10.1016/j.ygyno.2021.12.017. Epub 2021 Dec 23.

Abstract

Objective: To describe the quality of life of women at an increased risk of ovarian cancer undergoing risk-reducing bilateral salpingo-oophorectomy (RRBSO).

Methods: Patients evaluated in our gynecologic oncology ambulatory practice between January 2018-December 2019 for an increased risk of ovarian cancer were included. Patients received the EORTC QLQ-C30 and PROMIS emotional and instrumental support questionnaires along with a disease-specific measure (PROM). First and last and pre- and post-surgical PROM responses in each group were compared as were PROMs between at-risk patients and patients with other ovarian diseases.

Results: 195 patients with an increased risk of ovarian cancer were identified, 155 completed PROMs (79.5%). BRCA1 or BRCA2 mutations were noted in 52.8%. Also included were 469 patients with benign ovarian disease and 455 with ovarian neoplasms. Seventy-two at-risk patients (46.5%) had surgery and 36 had both pre- and post-operative PROMs. Post-operatively, these patients reported significantly less tension (p = 0.011) and health-related worry (p = 0.021) but also decreased levels of health (p = 0.018) and quality of life <7d (0.001), less interest in sex (p = 0.014) and feeling less physically attractive (p = 0.046). No differences in body image or physical/sexual health were noted in at-risk patients who did not have surgery. When compared to patients with ovarian neoplasms, at-risk patients reported lower levels of disease-related life interference and treatment burden, less worry, and better overall health.

Conclusions: In patients with an increased risk of ovarian cancer, RRBSO is associated with decreased health-related worry and tension, increased sexual dysfunction and poorer short-term quality of life. Patients with ovarian neoplasms suffer to a greater extent than at-risk patients and report higher levels of treatment burden and disease-related anxiety.

Keywords: Outcome measures; Ovarian cancer; Patient reported; Patient reported outcomes; Quality improvement; Risk-reducing surgery.

MeSH terms

  • Adult
  • Aged
  • Anxiety / psychology*
  • Body Dissatisfaction / psychology*
  • Carcinoma, Ovarian Epithelial / genetics
  • Carcinoma, Ovarian Epithelial / prevention & control*
  • Carcinoma, Ovarian Epithelial / psychology
  • Carcinoma, Ovarian Epithelial / surgery
  • Colorectal Neoplasms, Hereditary Nonpolyposis / genetics
  • Colorectal Neoplasms, Hereditary Nonpolyposis / psychology
  • Colorectal Neoplasms, Hereditary Nonpolyposis / surgery
  • Female
  • Hereditary Breast and Ovarian Cancer Syndrome / genetics
  • Hereditary Breast and Ovarian Cancer Syndrome / psychology
  • Hereditary Breast and Ovarian Cancer Syndrome / surgery
  • Humans
  • Middle Aged
  • Ovarian Neoplasms / genetics
  • Ovarian Neoplasms / prevention & control*
  • Ovarian Neoplasms / psychology
  • Ovarian Neoplasms / surgery
  • Patient Reported Outcome Measures*
  • Prophylactic Surgical Procedures*
  • Quality of Life
  • Salpingo-oophorectomy*
  • Sexual Dysfunction, Physiological / physiopathology*
  • Young Adult