Ranked importance of outcomes of first-line versus repeated chemotherapy among ovarian cancer patients.
OBJECTIVE
To examine the importance of possible outcomes of first-line versus repeated chemotherapy to ovarian cancer patients and to compare doctors' treatment intentions with patients' beliefs about cure.


METHODS
Women with newly diagnosed (74) or relapsed (48) ovarian cancer were prospectively followed over 2 years. The level of importance they ascribed to four chemotherapy outcomes and their beliefs about cure were assessed. Their doctors independently specified intent of successive treatments.


RESULTS
Approximately half (54%) of newly diagnosed ovarian cancer patients (65% with residual disease >2 cm and 49% with no or < or =2 cm residual disease) ranked 'tumour shrinkage (or decrease in blood levels of CA125)' as 'most important' during first-line chemotherapy. Approximately two thirds (65-70%) of all women whose disease had relapsed also ranked 'tumour shrinkage' as 'most important' during repeated chemotherapy. Few women (<8%) rated symptom relief or absence of side-effects as most important. While both patients' and doctors' belief about cure decreased over successive treatments, patients grew more optimistic relative to doctors over time. Women's reports of advice by doctors about cure were consistent with doctors' stated intent for repeat chemotherapy. However, discordance between doctors' actual treatment intent and patients' beliefs about cure increased from 24% at first-line to 83% by fourth-line chemotherapy.


CONCLUSIONS
Women prioritise tumour response as the most important outcome of chemotherapy for ovarian cancer. This priority predominates in women with residual and relapsed disease despite declining likelihood of cure. Women may still hope for a cure while acknowledging their doctor's advice that their disease is incurable.
Beesley
Vanessa L
VL
Queensland Institute of Medical Research, Genetics and Population Health Division, PO Royal Brisbane Hospital, Herston, Australia. Vanessa.Beesley@qimr.edu.au
Clavarino
Alexandra M
AM
Webb
Penelope M
PM
Wyld
David K
DK
Francesconi
Alessandra B
AB
Horwood
Keith R
KR
Doecke
James D
JD
Loos
Colleen A
CA
Green
Adele C
AC
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D018394:CA-125 Antigen / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology; D011446:Prospective Studies; D019452:Terminally Ill / Q000523:psychology; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D018394:CA-125 Antigen