Psychological Support vs Standard of Care Following Chemotherapy for Ovarian Cancer

Conference Correspondent - ESMO 2018


Ovarian cancer treatment is associated with psychological morbidity.1 In this study, Blagden and colleagues prospectively studied the impact of a brief course of psychological support on self-reported depression, fear of progression (FoP), and quality of life (QOL) in patients following chemotherapy for primary or recurrent ovarian cancer.2

Patients were consented at their first post-chemotherapy appointment and were eligible if they scored from 5 to 19 on the PHQ9 questionnaire. They were then randomized 1:1 to the intervention or control group. Intervention was comprised of 3 standardized, 90-minute sessions of psychological support given 6 to 12 weeks after chemotherapy. Control was standard of care in which support was provided where indicated; unblinded block randomization was used for primary or recurrent ovarian cancer and 3 levels of PHQ9 as stratification factors. Patients completed PHQ9, FoP-Q-SF, EORTC QLQ C30, and OV28 questionnaires for up to 2 years, with the primary end point being change in PHQ9 score at 3 months compared with baseline.

Of the 182 patients registered, 107 were eligible and subsequently randomized: 54 to intervention and 53 to control groups. The mean age of enrolled women was 59 years. Seventy percent had primary disease and 30% had relapsed disease. Sixty-three patients completed baseline and 3-month questionnaires and were included in the analysis: 31 in the control and 32 in the intervention groups. At 3 months, there was an improvement in the PHQ9 and the Global Health Status/QOL scale for patients in both arms compared with baseline, but no significant difference was observed between the intervention and control groups. There was a significant improvement on FoP-Q-SF scores in the intervention arm; however, for patients in the control arm, FoP-Q-SF scores deteriorated at 3 months (intervention effect = –5.2; 95% confidence interval, –8.45 to 1.9; P = .003).

Overall, although symptoms of depression improved following completion of chemotherapy for patients in both arms of the study, fear of progression did not. The results presented here represent the first randomized trial of a survivorship intervention in ovarian cancer and demonstrates that fear of progression is a prominent concern for patients, which may be overcome with provision of psychological support immediately after chemotherapy.


References

  1. Gonçalves V, et al. Br J Cancer. 2008;99(11):1794-1801.
  2. Blagden S, et al. ESMO 2018. Abstract 940O.