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Follow up of women with epithelial ovarian cancer

Survivorship/Psychosocial issues

Some women who survive ovarian cancer, or who are living with ovarian cancer, have reported positive changes such as a new appreciation of life, a strengthening of relationships or family ties, or a more “live for the moment” philosophy.9 However, many women report issues related to survival. A study of 18 Canadian women living with ovarian cancer found that the most significant challenges faced by women with ovarian cancer could be grouped into three main themes: living with uncertainty, the stigma of cancer, and facing death.10

The members of the treatment team should be aware that follow-up visits are a source of anxiety for women,8 with concerns about the testing involved and the possibility of a recurrence being diagnosed.  Consideration should be given as to how anxiety might be lessened, such as scheduling tests before the visit so that test results are available for discussion at the time of the follow-up visit.11 A pilot study of nurse-led follow-up found providing information, practical advice and coping strategies improved women’s wellbeing.12

Women surveyed about their experiences of recurrent disease have described the experience of waiting for a recurrence as frightening, and the follow-up appointments were anticipated with fear that their ovarian cancer had recurred. Tumour markers such as CA125 were a signal that their cancer was recurring and they found the periods of waiting difficult.  A rising CA125 had significant meaning, and women reported profound fear and devastation knowing it meant a recurrence of the cancer.10

In a study of women with stage I and II ovarian cancer who had survived 5 years or more after completion of treatment, survivors reported significant amounts of distress related to fear of a second cancer, recurrence of the cancer, and future diagnostic tests.  In relation to specific survivorship stressors, 18% reported continuing distress since the completion of treatment, and distress related to changes in their appearance as a result of the cancer and/or treatment.13

Key point:

  • Clinicians should be aware that follow-up appointments are a cause for concern and anxiety for women, and that consideration should be given to strategies to lessen anxiety

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