The Burden of Ovarian Cancer Affects Multiple Dimensions of Women's Lives

For women with ovarian cancer (OC), the burden of disease encompasses the physical disease symptoms, its comorbidities, the burden of treatment (primarily chemotherapeutic toxicity), mental health, the financial cost, and the effects on overall quality of life (QOL). The foremost OC burden for a patient, though, is its poor prognosis and high mortality rate.¹

The burden of OC often entails complications of the disease as well as secondary disease processes. As OC tends to affect older women and be diagnosed in its later stages, comorbidities, particularly those associated with aging, may exacerbate the physiologic course of the disease. Complications of OC can compound its effects as well, as in the cases wherein the oncogenes BRCA1, BRCA2, and TP53 associated with OC result in higher rates of coagulopathies because of the coagulation pathways affected by these mutations.¹

Malignant bowel obstruction, another complication, has been reported by OC patients to be one of the more disruptive events in the course of the disease in terms of their QOL, since it is accompanied by vomiting, inappetence, and abdominal pain. Malignant bowel obstruction is additionally devastating for its associated median 5-month survival rate and its limited treatment options.  Another comorbidity of OC is depression, the rates of which have been found to be higher in women with gynecologic cancers, particularly in those women with OC.³

Symptoms experienced by patients with OC as part of the course of the disease and because of its indicated treatments (ie, surgery and chemotherapy) also decrease the patient’s health-related QOL (HRQOL). The treatment of OC itself rivals some of the other OC-associated symptoms for its toxicity-related adverse effects, particularly when treatment follows a likely relapse.¹ In a recent survey of patients with OC, chemotherapy-induced peripheral neuropathy was reported as the most commonly experienced symptom associated with treatment of patients with OC. This symptom was followed in patient reporting by sexual dysfunction, depression, and sleep disturbance. The same study found that every one of its enrolled OC patents experienced at least 2 symptoms simultaneously.⁴

One of the most-reported symptoms in that study, sexual dysfunction, was the focus of another study that explored patients’ HRQOL as, in part, a function of sexual health. Fischer and colleagues noted that in prior studies more than half of women with gynecologic cancers had reported persistent and worsening sexual dysfunction 2 years following treatment.⁵ In a more recent study, OC patients scored lower than the general population and also lower than other cancer survivors on a sexual function questionnaire.⁵

In addition to physiologic burdens, the financial burden of OC is considerable. A 2017 study of the cost of OC in its first year of treatment investigated a select OC patient group, covered by employee insurance plans, who underwent surgical treatment within 90 days of diagnosis and who also received chemotherapy.⁶ This study’s primary outcomes were overall annual cost of care and out-of-pocket expense to the patient, the former of which was $93,632, and the latter, $2988.⁶ Previous investigation of Medicare beneficiaries found the annual per-patient out-of-pocket expense to be $4727 over a 2-year period, whereas another study found that Medicare recipients with no supplemental insurance paid $8115.⁶ Hence, in addition to the multivariate physiologic burden of OC, financial costs can exacerbate the burden of the patient with OC.

References

1. Chandra A, Pius C, Nabeel M, et al. Ovarian cancer: current status and strategies for improving therapeutic outcomes. Cancer Med. 2019;8(16):7018-7031.
2. Lheureux S, Gourley C, Vergote I, Oza AM. Epithelial ovarian cancer. Lancet. 2019;393(10177):1240-1253.
3. Klapheke AK, Keegan THM, Ruskin R, Cress RD. Depressive symptoms and health-related quality of life in older women with gynecologic cancers [published online October 25, 2019]. J Geriatr Oncol. pii: S1879-4068(19)30292-9.
4. Nho J-H, Kim SR, Nam J-H. Symptom clustering and quality of life in patients with ovarian cancer undergoing chemotherapy. Eur J Oncol Nurs. 2017;30:8-14.
5. Fischer OJ, Marguerie M, Brotto LA. Sexual function, quality of life, and experiences of women with ovarian cancer: a mixed-methods study [published online September 6, 2019]. Sex Med. pii: S2050-1161(19)30094-7.
6. Bercow AS, Chen L, Chatterjee S, et al. Cost of care for the initial management of ovarian cancer. Obstet Gynecol. 2017;130(6):1269-1275.