Recent improvements in treatment for ovarian cancer are helping women to live longer with a disease which has traditionally been called ‘the silent killer.’ However, this means that many women undergo repeated and prolonged courses of debilitating treatment for a disease that remains the leading cause of death from gynaecologic cancers, with around 152,000 deaths per year worldwide.1
While women with ovarian cancer undergo extensive treatment to help them live longer, they are also concerned about being bald, feeling unsexy, and overcoming the fatigue related to their disease and its therapy. They are faced with tough decisions about whether to have additional treatment following clinical remission, or to turn it down in order to enjoy quality time with family and friends and risk their cancer coming back. Getting to grips with quality of life issues as part of ovarian cancer management is an important priority for clinicians, patients and their families.
What does maintaining QoL mean for patients?
Good quality of life and, more specifically, health-related quality of life (HRQoL), has long been included as a key goal of ovarian cancer management. HRQoL addresses important health-rated aspects of a patient's life, including physical, social, psychological, financial, and sexual issues, as well as the side effects of the anti-cancer medications that are currently used as the standard of care.2 Every effort is made to reduce adverse effects through provision of supportive health and social care.
HRQoL is important because, for many women, ovarian cancer is a long, ongoing battle that can negatively impact on their lives in so many ways. Maintaining and improving HRQoL means being able to preserve well-being, being able to perform every day activities and being in control of disease and/or treatment-related symptoms.
The challenge of preserving health-related QoL during chemotherapy
It is well known that ovarian cancer and its current management interventions can significantly impair a woman’s HRQoL. Despite advances in diagnostic techniques, 85% of women present with advanced-stage disease3 which means that HRQoL is compromised at diagnosis.
Surgery with chemotherapy is current standard of care primary treatment for most women with late-stage ovarian cancer. Fortunately, recent advances have improved overall survival, with 45% of women with all types of disease surviving five years or longer.3 Yet, the improvement in survivorship often comes at the price of considerably reduced quality of life, due to the known side effects of traditional chemotherapy medicines for ovarian cancer. In addition, as patients have as high as a 60% - 70% chance of developing recurrent disease within two years after 1st-line chemotherapy,4 they often need to continue to undergo multiple rounds of chemotherapy which further diminish HRQoL.
As well as the adverse effects of prolonged exposure to the toxicity of chemotherapy, the related burden of time lost from work and family life can cause social and financial difficulties.2 Other factors come into play including physical impairment and mobility issues, psychological and emotional problems, such as anxiety, depression, and marital/partner difficulties and sexual issues.2 All of these effects contribute to disrupted HRQoL which may result in poor adherence to treatment.
The impact of maintenance treatment on QoL
The recurrence rate for ovarian cancer is high, and even amongst women who achieve a complete response to initial treatment over 50% will relapse within 18 to 24 months.5 One strategy to forestall recurrence is maintenance therapy – an extension of treatment following a complete response in the hope of prolonging time to recurrence or inducing a lasting remission.5
However, this is a difficult choice for women who have already undergone such challenging treatment. It’s not surprising that many want a ‘treatment holiday’ after achieving clinical remission despite of the fear of further deterioration on HRQoL due to possible relapse of the disease. Although it is widely acknowledged that the question of HRQoL must be answered when considering extended treatments for women in clinical remission, the lack of data addressing the impact of maintenance chemotherapy on HRQoL has made this difficult.5
New scientific discoveries have not only pointed the way to more targeted therapies that offer prolonged progression-free survival for women with advanced and recurrent ovarian cancer, such treatments have also shown less toxicity, and HRQoL has been maintained compared to conventional chemotherapy. These findings paint a promising picture in this setting for a future where more women can confidently decide to continue treatment after remission for potential survival benefits, without having to compromise their ability to work and enjoy everyday life with family and friends.
- Cancer Research UK. Ovarian cancer mortality statistics. Available at: http://www.cancerresearchuk.org/cancer-info/cancerstats/types/ovary/mortality/ Last accessed May 2017.
- Grzankowski KS, MD; Carney M, MD. Quality of life in Ovarian Cancer. Cancer Control. 2011;18(1):52-58. Available at: http://www.medscape.com/viewarticle/738385
- Survival rates for ovarian cancer, by stage. American Cancer Society. Available at: https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/survival-rates.html. Last accessed May 2017.
- Robert L. Coleman, MD. Maintenance Therapy in Ovarian Cancer: What’s at Stake? ASCO Post. November 15, 2014. Available at: http://www.ascopost.com/issues/november-15-2014/maintenance-therapy-in-ovarian-cancer-what-s-at-stake/
- Joanie Mayer Hope, Stephanie V Blank. Current status of maintenance therapy for advanced ovarian cancer. Int J Womens Health. 2009;1:173-180. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971701/