Ovarian Cancer Survivors Research Articles

Sexual dysfunction among gynecologic cancer survivors in a population-based cohort study.

Treatment for gynecologic cancer is associated with sexual dysfunction, which may present during and/or after treatment. The aim of this study was to investigate the risk of sexual dysfunction among gynecologic cancer survivors compared to cancer-free women in a population-based cohort study. We identified a cohort of 4863 endometrial, ovarian, and cervical cancer survivors diagnosed between 1997 and 2012 in the Utah Cancer Registry. Up to five cancer-free women were matched to cancer survivors (N = 22,693). We used ICD-9 codes to identify sexual dysfunction. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for sexual dysfunction with adjustment for potential confounders. Approximately 6.6% of gynecologic cancer survivors had sexual dysfunction diagnoses 1-5years after cancer diagnosis. Gynecologic cancer survivors had higher risks of overall sexual dysfunction (HR: 2.51, 95% CI: 2.16, 2.93), dyspareunia (HR: 3.27, 95% CI: 2.63, 4.06), and vaginal dryness (HR: 2.63, 95% CI: 2.21, 3.12) compared to a general population of women, 1-5years after cancer diagnosis. Sexual dysfunction was associated with advance cancer stage (HRRegional vs. Localized: 1.61, 95% CI: 1.19, 2.31), radiation therapy (HR: 1.73, 95% CI: 1.29, 2.31), and chemotherapy (HR: 1.80, 95% CI: 1.30, 2.50). This large cohort study confirms that there is an increased risk of sexual dysfunction among gynecologic cancer survivors when compared to the general population. Further investigation is needed to address the risk factors for sexual dysfunction and to improve patient-provider communication, diagnosis, documentation, and treatment of sexual dysfunction among gynecologic cancer survivors.

Understanding cancer genetic risk assessment motivations in a remote tailored risk communication and navigation intervention randomized controlled trial

ABSTRACT Background National guidelines recommend cancer genetic risk assessment (CGRA) (i.e. genetic counseling prior to genetic testing) for women at increased risk for hereditary breast and ovarian cancer (HBOC). Less than one-half of eligible women obtain CGRA, leaving thousands of women and their family members without access to potentially life-saving cancer prevention interventions. Purpose The Genetic Risk Assessment for Cancer Education and Empowerment Project (GRACE) addressed this translational gap, testing the efficacy of a tailored counseling and navigation (TCN) intervention vs. a targeted print brochure vs. usual care on CGRA intentions. Selected behavioral variables were theorized to mediate CGRA intentions. Methods Breast and ovarian cancer survivors meeting criteria for guideline-based CGRA were recruited from three state cancer registries (N = 654), completed a baseline survey, and were randomized. TCN and targeted print arms received the brochure; TCN also participated in a tailored, telephone-based decision coaching and navigation session grounded in the Extended Parallel Process Model and Ottawa Decision Support Framework. Participants completed a one-month assessment. Logistic regression was used to compare the rate of CGRA intentions. CGRA intentions and theorized mediator scores (continuous level variables) were calculated using mixed model analysis. Results CGRA intentions increased for TCN (53.2%) vs. targeted print (26.7%) (OR = 3.129; 95% CI: 2.028, 4.827, p < .0001) and TCN vs. usual care (23.1%) (OR = 3.778, CI: 2.422, 5.894, p < .0001). Perceived risk (p = 0.023) and self-efficacy (p = 0.035) mediated CGRA intentions in TCN. Conclusions Improvements in CGRA intentions and theorized mediators support the use of a tailored communication intervention among women at increased HBOC risk. (Clinicaltrials.gov: NCT03326713.) Trial registration: ClinicalTrials.gov identifier: NCT03326713.

The genomic and immune landscape of long-term survivors of high-grade serous ovarian cancer.

Fewer than half of all patients with advanced-stage high-grade serous ovarian cancers (HGSCs) survive more than five years after diagnosis, but those who have an exceptionally long survival could provide insights into tumor biology and therapeutic approaches. We analyzed 60 patients with advanced-stage HGSC who survived more than 10 years after diagnosis using whole-genome sequencing, transcriptome and methylome profiling of their primary tumor samples, comparing this data to 66 short- or moderate-term survivors. Tumors of long-term survivors were more likely to have multiple alterations in genes associated with DNA repair and more frequent somatic variants resulting in an increased predicted neoantigen load. Patients clustered into survival groups based on genomic and immune cell signatures, including three subsets of patients with BRCA1 alterations with distinctly different outcomes. Specific combinations of germline and somatic gene alterations, tumor cell phenotypes and differential immune responses appear to contribute to long-term survival in HGSC.

Beating the odds: molecular characteristics of long-term survivors of ovarian cancer.

Beating the odds: molecular characteristics of long-term survivors of ovarian cancer.

Pre-Diagnosis Sleep Status and Survival after a Diagnosis of Ovarian Cancer: A Prospective Cohort Study.

Objective: To explore if pre-diagnosis sleep status is associated with overall survival (OS) of ovarian cancer (OC). Methods: This is a prospective cohort study of 853 OC patients newly diagnosed between 2015 and 2020. Sleep status was measured by the Pittsburgh Sleep Quality Index (PSQI). Vital status of patients was obtained through active follow-up and linkage to medical records and cancer registry. The Cox proportional hazards regression model was utilized to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for aforementioned associations. Results: During the follow-up period (median: 37.57 months, interquartile: 25.00 to 50.17 months), 123 (18.39%) OC patients died. The HR (95%CI) for OS of OC was 2.13 (1.42−3.18) for sleeping after 22:00, compared with sleeping before 22:00; 2.43 (1.64−3.62) for poor sleep quality, compared to good sleep quality; 2.26 (1.37−3.72) for late bed-early rise and 1.93 (1.09−3.42) for late bed-late rise, compared with early bed-early rise; 0.40 (0.24−0.67) for night sleep duration of ≥7.5 h/day, compared with 7−7.5 h/day; 0.53 (0.29−0.98) for total sleep duration of ≥8 h/day, compared with 7.5−8 h/day. Further, the interaction effects were significant between residual lesions and wake-up time, night bedtime, sleep pattern, and between total sleep duration and menopausal status, parity. Additionally, there was a significant curvilinear association between PSQI score and OS (p nonlinear <0.05). Conclusions: Pre-diagnosis longer total and night sleep duration were associated with better OS, whereas later sleeping time, poor sleep quality, and bad sleep patterns were associated with poor OS among OC survivors.

Long-term risks of coronary heart disease and cerebrovascular disease in ovarian, uterine and cervical cancer survivors: a nationwide study in Korea

Only few studies have evaluated the incidence of coronary heart disease (CHD) and cerebrovascular disease (CVD) among gynaecologic cancer survivors. We selected 26,880 gynaecologic cancer patients who underwent health check-ups within 2 years after diagnosis using the Korean National Health Insurance Service Database. They were compared with 79,830 non-cancer controls. Cox regression models were used to estimate hazard ratios (HRs). There was no significant relationship between gynaecologic cancer survivors and CHD or CVD events. However, 10 years after diagnosing cancers, the risk of angina increased in cancer survivors (adjusted HR = 1.193, 95% CI: 1.013–1.406). After 1 year of diagnosis, cancer patients with no initial comorbidities showed an increased risk of all CHD and CVD events (adjusted HR = 1.101, 95% CI: 1.020–1.189) and CHD alone (adjusted HR = 1.168, 95% CI: 1.055–1.293) compared with controls. CHD risk was also higher in the cancer group with no comorbidities after 10 years of diagnosis (adjusted HR = 1.284, 95% CI: 1.020–1.615). Overall, the risk of CHD or CVD did not increase in gynaecologic cancer survivors. However, cancer patients without any comorbidities showed a higher risk of CHD compared with control, the risk persisting until 10 years after cancer diagnosis. Impact Statement What is already known on this subject? Cardiovascular risk and the incidence of stroke increase after cancer diagnosis. What do the results of this study add? The risk of coronary heart disease (CHD) and cerebrovascular disease did not increase in Asian (especially Korean) gynaecologic cancer survivors compared with the general population. However, cancer patients without any comorbidities showed a higher risk of CHD compared with the non-cancer population. What are the implications of these findings for clinical practice and/or further research? Our results imply the importance of surveillance of cardiovascular risks among patients with gynaecologic cancer without comorbidities.

Pathways to ovarian cancer diagnosis: a qualitative study

BackgroundOvarian cancer is often diagnosed at a late stage, when survival is poor. Qualitative narratives of patients’ pathways to ovarian cancer diagnoses may identify opportunities for earlier cancer detection and, consequently, earlier stage at diagnosis.MethodsWe conducted semi-structured interviews of ovarian cancer patients and survivors (n = 14) and healthcare providers (n = 11) between 10/2019 and 10/2021. Interviews focused on the time leading up to an ovarian cancer diagnosis. Thematic analysis was conducted by two independent reviewers using a two-phase deductive and inductive coding approach. Deductive coding used a priori time intervals from the validated Model of Pathways to Treatment (MPT), including self-appraisal and management of symptoms, medical help-seeking, diagnosis, and pre-treatment. Inductive coding identified common themes within each stage of the MPT across patient and provider interviews.ResultsThe median age at ovarian cancer diagnosis was 61.5 years (range, 29–78 years), and the majority of participants (11/14) were diagnosed with advanced-stage disease. The median time from first symptom to initiation of treatment was 2.8 months (range, 19 days to 4.7 years). The appraisal and help-seeking intervals contributed the greatest delays in time-to-diagnosis for ovarian cancer. Nonspecific symptoms, perceptions of health and aging, avoidant coping strategies, symptom embarrassment, and concerns about potential judgment from providers prolonged the appraisal and help-seeking intervals. Patients and providers also emphasized access to care, including financial access, as critical to a timely diagnosis.ConclusionInterventions are urgently needed to reduce ovarian cancer morbidity and mortality. Population-level screening remains unlikely to improve ovarian cancer survival, but findings from our study suggest that developing interventions to improve self-appraisal of symptoms and reduce barriers to help-seeking could reduce time-to-diagnosis for ovarian cancer. Affordability of care and insurance may be particularly important for ovarian cancer patients diagnosed in the United States.

Bibliometric analysis of hotspots and frontiers in cancer-related fatigue among ovarian cancer survivors.

To explore and analyze research hotspots and frontiers in CRF in ovarian cancer patients to provide an evidence-based basis for scholars and policymakers. Ovarian cancer is one of the most common and lethal gynecological malignancies. Cancer-related fatigue (CRF) is an annoying and pervasive side-effect that seriously affects the activities of daily living and decreases the quality of life (QoL) of cancer survivors. The literature was retrieved from the Web of Science Core Collection (WOSCC) from inception to 2021-12-31. CiteSpace was used to discuss research countries, institutions, authors, and keywords. This study ultimately included 755 valid publications, and the number of publications showed a gradual upward trend. The countries, institutions, authors, and journals that have published the most articles and cited the most frequently were the United States, the University of Texas MD Anderson Cancer Center, Michael Friedlander and Amit M Oza, Gynecologic Oncology, and Journal of Clinical Oncology. The top three high-frequency keywords were Ovarian cancer, chemotherapy, and clinical trial. The top three keywords with the strongest citation bursts were cyclophosphamide, double-blind, and open-label. Conducting multi-center, large-sample, randomized controlled clinical trials to determine whether chemotherapeutic agents have severe adverse effects and to discuss the relationship between CRF and QoL and overall survival in cancer survivors are hotspots in this field. The new trends may be applying double-blind, randomized controlled trials to clarify the causes of CRF and open-label, randomized trials to determine the efficacy, safety, and tolerability of chemotherapeutic agents.

P01.18.B Structural abnormalities related to chemotherapy in cancer survivors: an ALE meta-analysis of neuroimaging studies

Abstract Background Chemotherapy induced cognitive impairment (CICI) is a term used for the cognitive dysfunction reported with non-central nervous system cancer patients during or after chemotherapy. Recent neuroimaging studies have shown decreased activation in cancer patients during cognitive tasks post-chemotherapy. Structural changes are sought to be associated with cognitive decline in cancer survivors after chemotherapy. Here we aim to investigate the neuroimaging findings of structural abnormalities and gray matter alterations associated with chemotherapy in cancer survivors. Material and Methods A systematic search through PubMed database for peer-reviewed English-language studies yielded a total of 302 studies. Eligible studies were included in the activation likelihood estimation (ALE) meta-analysis if they reported coordinates in a stereotactic format (MNI or Talairach space) for voxel-based morphometric (VBM) studies on gray matter volume and post-chemotherapy cancer survivors compared to matched healthy controls. GingerALE (3.0.2) software from Brainmap.org was used to perform the ALE meta-analysis with threshold settings of uncorrected P-value &amp;lt; 0.001 for multiple comparisons. Results The study sample included 299 patients comprised of breast cancer survivors (BCS), childhood acute lymphocytic leukemia (ALL) survivors, ovarian cancer survivors (OCS) and lung cancer with 279 matched healthy controls from 12 studies and 21 experiments. ALE-maps for post-chemotherapy cancer survivors showed reduced gray matter volume in comparison to healthy controls in the left inferior frontal gyrus, right thalamus, right superior frontal gyrus, right medial frontal gyrus and right cerebellum (peak coordinates: [-43,40,-6], [23,-29,2], [14,30,55], [9,57,-16], [9,-78,-41] respectively, and cluster size of 544 mm3, 312 mm3 and 257 mm3, 296 mm3, 297 mm3 respectively). Conclusion This is the first ALE meta-analysis that studied the converged areas of reduced gray matter volume in post-chemotherapy cancer survivors. Our findings of reduced gray matter volume in frontal regions and cerebellum might be responsible for the cognitive dysfunction in executive function, attention, and memory observed in cancer survivors. Further studies are needed to assess the impact of different chemotherapeutic regimens related to CICI .

CN83 Interventions to alleviate depression and anxiety in women with ovarian cancer to improve mental health and health-related quality of life

Patients with ovarian cancer, who also deal with depression and/or anxiety, are at a significantly greater risk of higher mortality rates, increased hospital stays, poorer mental health and, reduced health-related quality of life (HRQoL). This structured review aims to critically appraise and synthesise up to date evidence on the effectiveness of psychosocial interventions to combat anxiety and depression, to improve mental health and HRQoL in women with ovarian cancer at any point in the cancer trajectory. We explored the effectiveness of diverse interventions to combat depression and/or anxiety in adult women with a confirmed ovarian cancer diagnosis, offered at any point in the cancer trajectory. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines, peer reviewed publications of true and quasi-experimental studies were identified through a search of the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica Online (Embase), and medical Literature Online (MEDLINE) databases from 2008 to 2021. The Critical Appraisal Framework for Original Research (CAFFOR) was used to to assess methodological rigour. Findings were synthesised using quantitative grouping and a narrative critical analysis. Seven studies were selected for the analysis of the findings and methodology of each paper and the discussion. The interventions were grouped into three different types: nurse-led, CBT-based, and exercise. Irrespective of type, the reviewed supportive care interventions seem to be beneficial in reducing patients' distress and enhancing HRQoL among ovarian cancer survivors. Focusing on people living with ovarian cancer, particularly at the early stages of development, may help improve the mortality rate of the patient group. To improve mental health and HRQoL in this group of patients, more rigorous development of existing interventions is necessary, as well as early screening for mental health deficits. Nurses play an essential role in improving mental health and HRQoL for women with ovarian cancer by leading and/or supporting delivery of complex supportive care interventions.

535P Long term quality of life after chemotherapy among nonepithelial ovarian cancer survivors: The case-control vivrovaire rare tumours study

Treatments (ttt) of non-epithelial rare germ cell tumors (GCT) and sex cord stromal tumors (SCST) are associated with long survival. The standard treatment mainly includes conservative surgery combined with chemotherapy (CT) [bleomycin, etoposide and cisplatin (BEP)] depending on stage and prognostic factors. As reported in testicular cancer survivors, BEP may induce late side effects with negative impact on quality of life (QOL). The French Rare Malignant Gynecological Tumors (TMRG)/GINECO case-control VIVROVAIRE Rare tumors study assessed long term QOL among survivors treated with BEP as compared to age-matched healthy women (HW). Non-epithelial ovarian cancer survivors (nEOCS), cancer-free ≥2 years after end of treatment, were identified from the INCa French Network for TMRG. HW were issued from the ‘Seintinelles’ research platform. QOL (FACT-G and FACT-O), chronic fatigue (MFI), anxiety/depression (HADS), insomnia (ISI), neurotoxicity (FACT/GOG-NTX), cognition (FACT-COG) and sexuality items (from the FACT-O OCS) were compared between nEOCS and HW. A minimal 5% difference for the score between groups was considered as clinically relevant. 144 nEOCS were included with 144 age-matched HW (mean age at inclusion: 38 yrs; 60% aged below 40). Most nEOCS were treated for GCT (n=112). Median delay from the end of ttt to inclusion was 6 yrs. At inclusion, 42% of nEOCS were menopausal versus 17% of HW (p<0.001). General and ovarian QOL, fatigue, anxiety/depression and insomnia scores were similar between nEOCS and HW. nEOCS reported clinically significant (6%) better social functioning (p=0.006). However, nEOCS reported more perceived cognitive impairment than HW (31 vs 14%, p<0.001) and clinically significant (8%) neurotoxicity (p<0.001). In addition, nEOCS reported less interest in sex (35% vs 55%, p<0.001), felt less like a woman (67% vs 81%, p=0.012), and were more afraid of not having children (31% vs 13%, p=0.007) than HW, whatever the menopausal status. 6 yrs after BEP CT, most of nEOCS reported similar global QOL as HW, but experienced more risk of premature menopause, some late side effects on cognition, neurotoxicity and sexuality that may impact their daily life.

Disparities in Psychosocial Distress Screening and Management of Lung and Ovarian Cancer Survivors.

Since 2016, the American College of Surgeons' Commission on Cancer (CoC) has required routine distress screening (DS) of cancer survivors treated in their accredited facilities to facilitate early identification of survivors with psychosocial concerns. Lung and ovarian cancer survivors have relatively low 5-year survival rates and may experience high levels of distress. We examined the extent to which ovarian and lung cancer survivors received CoC-mandated DS and whether DS disparities exist on the basis of diagnosis, sociodemographic factors, or facility geography (urban/rural). This study included a quantitative review of DS documentation and follow-up services provided using existing electronic health records (EHRs). We worked with 21 CoC-accredited facilities across the United States and examined EHRs of 2,258 survivors from these facilities (1,618 lung cancer survivors and 640 ovarian cancer survivors) diagnosed in 2016 or 2017. Documentation of DS was found in half (54.8%) of the EHRs reviewed. Disparities existed across race/ethnicity, cancer type and stage, and facility characteristics. Hispanic/Latino and Asian/Pacific Islander survivors were screened at lower percentages than other survivors. Patients with ovarian cancer, those diagnosed at earlier stages, and survivors in urban facilities had relatively low percentages of DS. Non-Hispanic Black survivors were more likely than non-Hispanic White survivors to decline further psychosocial services. Despite the mandate for routine DS in CoC-accredited oncology programs, gaps remain in how many and which survivors are screened for distress. Improvements in DS processes to enhance access to DS and appropriate psychosocial care could benefit cancer survivors. Collaboration with CoC during this study led to improvement of their processes for collecting DS data for measuring standard adherence.

Utilization of an Electronic Patient-Reported Outcome Platform to Evaluate the Psychosocial and Quality-of-Life Experience Among a Community Sample of Ovarian Cancer Survivors.

Novel distress screening approaches using electronic patient-reported outcome (ePRO) measurements are critical for the provision of comprehensive quality community cancer care. Using an ePRO platform, the prevalence of psychosocial factors (distress, post-traumatic growth, resilience, and financial stress) affecting quality of life in ovarian cancer survivors (OCSs) was examined. A cross-sectional OCS sample from the National Ovarian Cancer Coalition-Illinois Chapter completed web-based clinical, sociodemographic, and psychosocial assessment using well-validated measures: Hospital Anxiety/Depression Scale-anxiety/depression, Post-traumatic Growth Inventory, Brief Resilience Scale, comprehensive score for financial toxicity, and Functional Assessment of Cancer Therapy-Ovarian (FACT-O/health-related quality of life [HRQOL]). Correlational analyses between variables were conducted. Fifty-eight percent (174 of 300) of OCS completed virtual assessment: median age 59 (range 32-83) years, 94.2% White, 60.3% married/in domestic partnership, 59.6% stage III-IV, 48.8% employed full-time/part-time, 55.2% had college/postgraduate education, 71.9% completed primary treatment, and median disease duration 6 (range < 1-34) years. On average, OCS endorsed normal levels of anxiety (mean ± standard deviation = 6.9 ± 3.8), depression (4.1 ± 3.6), mild total distress (10.9 ± 8.9), high post-traumatic growth (72.6 ± 21.5), normal resilience (3.7 ± 0.72), good FACT-O-HRQOL (112.6 ± 22.8), and mild financial stress (26 ± 10). Poor FACT-O emotional well-being was associated with greater participant distress (P < .001). Partial correlational analyses revealed negative correlations between FACT-O-HRQOL and anxiety (r = -0.65, P < .001), depression (r = -0.76, P < .001), and total distress (r = -0.92, P < .001). Yet, high FACT-O-HRQOL was positively correlated with post-traumatic coping (r = 0.27; P = .006) and resilience (r = 0.63; P < .001). ePRO assessment is feasible for identification of unique psychosocial factors, for example, financial toxicity and resilience, affecting HRQOL for OCS. Future investigation should explore large-scale, longitudinal ePRO assessment of the OCS psychosocial experience using innovative measures and community-based advocacy populations.

Long-Term Adaptation Among Adolescent and Young Adult Children to Familial Cancer Risk.

It is important to examine adolescent and young adult (AYA) children's long-term psychosocial and behavioral adaptation to disclosure of maternal BRCA-positive carrier status (BRCA+) to inform approaches for familial cancer risk communication, education, and counseling. Mothers underwent BRCA genetic testing 1 to 5 years earlier. Group differences in AYAs' self-reported outcomes were analyzed by maternal health and carrier status, and child age and sex. A total of N = 272 AYAs were enrolled: 76.1% of their mothers were breast or ovarian cancer survivors and 17.3% were BRCA+. AYAs' cancer risk behavior (tobacco and alcohol use, physical activity) and psychologic distress levels did not vary by maternal status. In bivariate analyses, AYAs of cancer-surviving mothers believed themselves to be at greater risk for, and were more knowledgeable about, cancer than AYAs of mothers without cancer. AYAs of BRCA+ mothers were more concerned about cancer, held stronger beliefs about genetic risk, and placed a higher value on learning about genetics. In adjusted models, maternal cancer history (not BRCA+) remained associated with AYAs' greater perceptions of cancer risk (P = .002), and knowledge about cancer (P = .03) and its causes (P = .002). Disclosing maternal BRCA+ status did not influence children's lifestyle behavior or adversely affect quality of life long term. AYAs of BRCA+ mothers were more aware of and interested in genetic risk information. Such families may benefit from support to promote open communication about genetic testing choices.

Factors Affecting the Occurrence of Mental Health Problems in Female Cancer Survivors: A Nationwide Cohort Study.

The purpose of this study is to determine the effect of cancer survivorship stage and health-related behaviors on the risk of developing mental health problems (depressive and anxiety disorders) in women who have experienced cancers that affect women (breast cancer, cervical cancer, ovarian cancer, endometrial cancer). Using the healthcare utilization and medical checkup data from 2010 to 2020 provided by the National Health Insurance Service, the occurrence of mental health problems since 2020 was tracked for 36,801 women diagnosed with cancer. The occurrence of mental health problems was defined as the cases in which the disease code was assigned to anxiety disorders (F40~F44, F48) and depressive disorders (F32~34, F41.2, F92) as presented in ICD-10. To evaluate the effect of cancer survivorship stage and health-related behaviors on the development of mental health problems, the hazard ratio (HR) and 95% confidence intervals (CI) were calculated using the Cox proportional hazard model. During the follow-up period of 5.6 years, anxiety disorder occurred in 14,698 (39.9%), and by cancer type, breast cancer survivors accounted for the most at 1.02 per 1000 person-years. The risk of anxiety disorders increased in those who experienced cervical cancer (AHR, 1.08, 95% CI, 1.03–1.13) and those in the acute survivorship stage (AHR, 1.38, 95% CI, 1.22–1.55). In terms of health-related behaviors, the risk of developing anxiety disorder was shown to be reduced in drinkers (AHR, 0.91, 95% CI, 0.87–0.96), former smokers (AHR, 0.86, 95% CI, 0.77–0.97), and current smokers (AHR, 0.80, 95% CI, 0.71–0.90). During the follow-up period of 5.6 years, depressive disorder occurred in 6168(16.8%), and by cancer type, ovarian cancer survivors accounted for the most at 1.30 per 1000 person-years. The risk of developing depressive disorders was highest in those who experienced ovarian cancer (AHR, 1.40, 95% CI, 1.27–1.53) and those in the acute survivorship stage (AHR, 2.99, 95% CI, 2.60–3.42). For health-related behaviors, the risk of developing depressive disorders was increased in former smokers (AHR, 1.32, 95% CI, 1.14–1.54), current smokers (AHR, 1.21, 95% CI, 1.04–1.41), and those with insufficient physical activity (AHR, 1.09, 95% CI, 1.02–1.15). It has been confirmed that cancer type, cancer survivorship stage, and health-related behaviors, such as smoking, drinking, and physical activity, are significantly related to the risk of mental health problems. Thus, it is necessary to develop strategies to cope with mental health problems at the individual and national levels and to develop interventions to promote a more active lifestyle.

Mental health disorders among ovarian cancer survivors in a population-based cohort.

Ovarian cancer is the fifth most common female cancer in the United States. There have been very few studies investigating mental health diagnoses among ovarian cancer survivors with long-term follow up. The aim of this study is to examine the incidence of mental illness among ovarian cancer survivors compared to a general population cohort. A secondary aim is to investigate risk factors for mental illnesses among ovarian cancer survivors. Cohorts of 1689 ovarian cancer patients diagnosed between 1996 and 2012 and 7038 women without cancer matched by age and birth state from the general population were identified. Mental health diagnoses were identified from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios (HRs). Ovarian cancer survivors experienced increased risks of mental illnesses within the first 2 years after cancer diagnosis (HR=3.55, 95% CI=3.04-4.14). The risks of depression among ovarian cancer survivors were nearly 3-fold within the first 2 years of cancer diagnosis (HR=2.59, 95% CI=1.94-3.47), and 1.69-fold at 2-5 years after cancer diagnosis (HR=1.69, 95% CI=1.18-2.42). Ovarian cancer survivors experienced an 80% increased risk of death with a mental illness diagnosis (HR=1.80, 95% CI=1.48-2.18) and a 94% increased risk of death with a depression diagnosis (HR=1.94, 95% CI=1.56-2.40). Higher risks of mental illnesses were observed among ovarian cancer survivors throughout the follow-up periods of 0-2 years and 2-5 years after cancer diagnosis. Multidisciplinary care is needed to monitor and treat mental illnesses among ovarian cancer survivors.

Pre-diagnosis and post-diagnosis dietary patterns and survival in women with ovarian cancer.

Evidence is limited on inflammation-related dietary patterns and mortality in ovarian cancer survivors. We examined the associations between pre- and post-diagnosis dietary patterns, including change in diet from before to after diagnosis, and mortality among 1003 ovarian cancer survivors in two prospective cohort studies. Dietary pattern scores for empirical dietary inflammatory pattern (EDIP) and Alternative Healthy Eating Index (AHEI) were calculated based on food frequency questionnaires. We used Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for ovarian cancer-specific and all-cause mortality. Pre-diagnosis EDIP score and AHEI were not associated with mortality. Among non-high grade serous cases, a higher post-diagnosis EDIP score was associated with increased risk of all-cause mortality (HR5th vs 1st quintile = 1.95, 95% CI = 1.04-3.67, p-trend = 0.06). Compared to survivors consuming a low EDIP score diet before and after diagnosis, high post-diagnosis EDIP was associated with increased risk of ovarian cancer specific mortality (pre-to-post diagnosis low/high, HR = 1.38, 95% CI = 0.99-1.92; high/high HR = 1.58, 95% CI = 1.09-2.30) and all-cause mortality (low/high HR = 1.44, 95% CI = 1.06-1.95; high/high HR = 1.55, 95% CI = 1.10-2.19). Consuming a more inflammatory dietary pattern post-diagnosis was associated with increased mortality in ovarian cancer survivors, suggesting limiting the inflammatory potential of diet post-diagnosis could lead to enhanced survivorship.

Abstract CT208: Feasibility, acceptability, and evaluation of a self-care app to enhance purposeful living among ovarian cancer patients (NCT04458168)

Abstract Background: Ovarian cancer is a devastating disease with a five-year survival rate of less than 50%. Identifying strategies to improve survival is imperative. Ovarian cancer survivors with higher quality of life (QoL) have better prognosis based on results from GOG-0218. Life purpose, defined as the meaning or direction a person has in life, emerged as an important theme in recent focus groups conducted among women who have lived five or more years with ovarian cancer. The participants felt that strong life purpose is a major contributor to their exceptional survival. Further, among people without cancer, strong life purpose has been shown to lead to improved QoL and longer survival. The Purposeful eHealth application (app) has been developed to improve life purpose. Preliminary data from non-cancer patients suggest that use of the app leads to increased life purpose. We hypothesized that among ovarian cancer survivors, greater life purpose is associated with higher QoL scores, and we initiated a clinical trial to test the feasibility and acceptability of ovarian cancer patients using the Purposeful app. Secondary outcomes include evaluation of whether use of this eHealth app improves life purpose and QoL. The app has potential as an accessible hands-on support system for ovarian cancer survivors to increase life purpose, QoL, and potentially survival if positive results are observed from the trial. Methods: In this single-arm interventional study (NCT04458168), eligible patients are age 18 or older, have ovarian cancer, and are under treatment through the University of Michigan Rogel Cancer Center Gynecologic Oncology clinic. As of January 2022, we have enrolled 45 women. We innovatively designed the study to enroll 25 women in each of three groups based on disease status to identify an optimal intervention period: Group 1: just completed treatment, Group 2: have not experienced a recurrence after one year since the initial diagnosis, Group 3: have experienced a recurrence after primary treatment. After providing informed consent, participants are provided with the Purposeful app and asked to fill out seven questionnaires in-person or remotely: 1) Demographics; 2) Life Purpose; 3) QoL; 4) Well-Being; 5) Fatigue; 6) Meaning in Life; and 7) Self-Care Assessment and Integrative Medicine Use. Participants’ CA125 measures and disease status are also collected from medical records. Participants are followed up at months 1, 3, and 6; at each visit, participants complete questionnaires 2-7 and the Acceptability questionnaire. Participants are asked to use the app daily until the end of 6 months. At the end of the study, overall and group-specific feasibility and acceptability will be assessed. Additionally, we will examine the associations between app usage, life purpose, and QoL through generalized linear/additive mixed models. Citation Format: Aliya Alimujiang, Bhramar Mukherjee, Maureen Metzger, R. Kevin Reynolds, Lisa Spratke, Shitanshu Uppal, Jean H. Siedel, Christine Willacker, Victor J. Strecher, Celeste Leigh Pearce, Karen McLean. Feasibility, acceptability, and evaluation of a self-care app to enhance purposeful living among ovarian cancer patients (NCT04458168) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT208.

Abstract 5906: Epidemiologic risk factors and survival trajectories among epithelial ovarian cancer survivors: A population-based cohort study

Abstract Background: Despite a poor 5-year survival rate of 45%, survival following a diagnosis of epithelial ovarian cancer stabilizes after 10 years. Although various clinical and tumor characteristics are established prognostic factors, the role of epidemiologic risk factors on short- versus long-term survival are unclear. The aim of this study was to evaluate the association between various hormonal, reproductive, and lifestyle risk factors on ovarian cancer mortality by survival trajectory time intervals across the survivorship phase. Methods: This population-based retrospective cohort study included 1,421 unselected women diagnosed with epithelial ovarian cancer from 1995 to 2004 in Ontario, Canada. Clinical information was obtained from medical records, risk factor information from telephone interview, and vital status was updated by linkage to the Ontario Cancer Registry up until 2020. We examined clinical risk factors, hormonal and reproductive related factors, lifestyle factors, and family history. Extended Cox proportional hazards models with Heaviside functions were used to estimate the association between risk factors and mortality by survival trajectory time interval (&amp;lt;3, 3-&amp;lt;6, 6-&amp;lt;10, and ≥10 years). Results: After a mean follow-up of 11.6 years, 65% (n=926) subjects died of which 51% (n=731) were due to ovarian cancer. Clinical factors such as late stage and presence of residual disease were strongly associated with short-term mortality, which attenuated over survival time. Stage IV disease significantly increased the risk of mortality compared to stage I disease for the survival interval within 3 years of diagnosis (HR 50.05; 95% CI 6.78, 369.57), however this association declined for survival beyond 10 years (HR 2.76; 95% CI 1.35, 5.65). Similarly, presence of residual disease increased the risk of mortality in the short-term (HR 2.47; 95% CI 1.40, 4.34), yet attenuated for long-term survival (HR 1.26; 95% CI 0.83, 1.93). Risk factors such as breastfeeding, smoking, and BMI were not associated with short-term survival, but significantly associated with long-term survival. History of breastfeeding decreased the risk of mortality (HR 0.65; 95% CI 0.46, 0.93), while a history of smoking (HR 1.75; 95% CI 1.27, 2.40) and obesity (HR 1.81; 95% CI 1.24, 2.65) increased the risk of mortality among long-term survivors. Conclusions: This study confirmed that clinical risk factors such as stage at ovarian cancer diagnosis and residual disease following debulking surgery are important prognostic factors in the short-term survival trajectory while breastfeeding, smoking, and BMI play a stronger role for long-term ovarian cancer survival. These findings suggest a role of modifiable factors in improving long-term outcomes across the survivorship phase. Citation Format: Shana Jean Kim, Barry Rosen, John R. McLaughlin, Harvey Risch, Shelly S. Tworoger, Steven A. Narod, Joanne Kotsopoulos. Epidemiologic risk factors and survival trajectories among epithelial ovarian cancer survivors: A population-based cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5906.

Abstract 3228: Body mass index and ovarian cancer: Changes after diagnosis and associations with overall survival

Abstract Background: While excess adiposity is positively associated with ovarian cancer risk, the relationship with patient prognosis remains to be fully elucidated, especially with regard to changes over time during survivorship. Methods: We assembled a retrospective cohort of tumor registry confirmed ovarian, fallopian tube, and primary peritoneal cancer cases and evaluated peri- and post-diagnosis (±30 days and up to 5 years after, respectively) body mass index (BMI) from electronic medical records (EMR) from the Vanderbilt University Medical Center. Associations with overall survival (OS) were quantified by Hazards Ratios (HRs) and corresponding 95% confidence intervals (CIs) from Cox proportional hazards regression; multivariable adjustment included age, stage, grade, histologic subtype, treatment, race, and year of diagnosis. Results: We evaluated 13,676 peri- and post-diagnosis BMI observations for 616 predominantly Caucasian (87.0%) cases; the majority had serous histology (62.5%), advanced stage (58.1% Stage III or IV), high grade (52.4% poorly or undifferentiated) disease. Compared to peri-diagnosis (median =29.0), BMI was lowest 6 months post-diagnosis (median=27.4) and then gradually increased over time among survivors. In multivariable adjusted models, each 5-unit increase in mean peri-diagnosis BMI corresponded with a nonsignificant increase (HR: 1.07, 95% CI: 0.97-1.18) while higher mean post-diagnosis BMI corresponded to a significantly decreased risk of death (HR: 0.92, 95% CI: 0.84-1.00). Adjusted models that incorporated all peri- and post-diagnosis BMI observations evaluated indicated that each 5-unit increase in BMI was associated with a 15% reduced risk of death (HR: 0.85, 95% CI: 0.77-0.94). Conclusions: Whereas lower adiposity may be beneficial in terms of risk, higher adiposity appears to benefit ovarian cancer survival. Factors including cancer cachexia, weight loss among ill patients, and weight gain among survivors may contribute to this seemingly protective association. Additional research to disentangle the influence of BMI on ovarian cancer outcomes and inform adiposity guidance for ovarian cancer survivors is needed. Citation Format: Alicia Beeghly-Fadiel, Sharon Phillips, George Bukenya, Pranoti Pradhan, Sara Duque, Nneka Anyanwu, Deok-Soo Son, Andrew J. Wilson, Demetra H. Hufnagel, Marta A. Crispens. Body mass index and ovarian cancer: Changes after diagnosis and associations with overall survival [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3228.