title: Long-term survival from gynecologic cancer: psychosocial outcomes, supportive care needs and positive outcomes.
abstract: OBJECTIVE
  To assess the long-term psychosocial outcomes and supportive care needs of gynecologic cancer survivors.
  
  
  METHODS
  Women who had received care in a tertiary-based gynecologic cancer center 1-8 years earlier and who were disease-free were invited to complete a mailed self-report questionnaire to assess psychosocial outcomes and supportive care needs.
  
  
  RESULTS
  In total, 199 survivors participated in the study. Survivors reported normal quality of life and relationship adjustment although functioning was at the lower end of the range; over two-thirds (68%) reported positive outcomes. However, nearly one-third (29%) reported clinical levels of anxiety and the most frequently endorsed need concerned fear of disease recurrence (24%). About one-fifth (19%) reported symptoms that indicated posttraumatic stress disorder (PTSD) and this rose to close to one-third (29%) for survivors of advanced stage disease. Nearly 90% of survivors reported supportive care needs and the diagnosis of anxiety or PTSD resulted in a four-fold increase in unmet needs. Needs most frequently concerned "existential survivorship" (e.g., spiritual beliefs, decision making, the meaning of life) and "comprehensive cancer care" (e.g., team care, communication, local health care services). Years since diagnosis was not related to distress or need levels.
  
  
  CONCLUSIONS
  All members of the care team need to be aware that significant psychosocial morbidity may occur many years after the successful treatment of a gynecologic malignancy and may be associated with elevated supportive care needs. Comprehensive and extended supportive care services are required to address anxiety and trauma responses and investigate strategies to meet ongoing needs in order to improve long-term psychosocial outcomes.
authors.affiliation: Department of Gynecologic Cancer, Westmead Hospital, Westmead, and Department of Psychological Medicine, University of Sydney, NSW 2006, Australia. khodgkinson@student.usyd.edu.au
authors.forename: Katharine
authors.initials: K
authors.lastname: Hodgkinson
authors.forename: Phyllis
authors.initials: P
authors.lastname: Butow
authors.forename: Anne
authors.initials: A
authors.lastname: Fuchs
authors.forename: Glenn E
authors.initials: GE
authors.lastname: Hunt
authors.forename: Annie
authors.initials: A
authors.lastname: Stenlake
authors.forename: Kim M
authors.initials: KM
authors.lastname: Hobbs
authors.forename: Alison
authors.initials: A
authors.lastname: Brand
authors.forename: Gerard
authors.initials: G
authors.lastname: Wain
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D005833:Genital Neoplasms, Female / Q000523:psychology*; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care; D011584:Psychology; D012944:Social Support