title: Rising cancer antigen 125 level and the type and timing of treatment for recurrent ovarian cancer: a clinical dilemma, but what would women do?
abstract: OBJECTIVE
  Clinical uncertainty currently exists for the timing of treatment for women with epithelial ovarian cancer who are under surveillance for their first recurrence and have rising cancer antigen 125 levels. This study ascertained women's preferences for this clinical scenario and the impact of regular surveillance on psychosocial well-being.
  
  
  METHODS
  Women with a diagnosis of epithelial ovarian cancer who had completed primary treatment and were in surveillance for their first recurrence were eligible to participate. Treatment preferences were ascertained using the Prospective Measure of Preference, and psychological well-being was ascertained using a series of psychological scales.
  
  
  RESULTS
  Women (n = 21) had highly variable preferences for the type and timing of second-line treatment when basing their decision on rising cancer antigen 125 levels. Around half indicated a preference against treatment and were willing to trade life expectancy (WTT) to avoid chemotherapy (WTT = 0.45) or tamoxifen (WTT = 0.50). For these women, strong preferences against treatment were reflected in high Prospective Measure of Preference utility scores (0.15 for chemotherapy and 0.19 for tamoxifen). The negative experience of chemotherapy, the uncertainty about tamoxifen's effectiveness, and remaining symptom-free influenced these decisions. The remaining women indicated they would begin chemotherapy or tamoxifen immediately. These women believed taking early steps to treatment was positive and a coping mechanism; however, some revealed unrealistic expectations of treatment. Most women reported good levels of psychological well-being and were coping with ongoing surveillance.
  
  
  CONCLUSIONS
  Women in surveillance for recurrent ovarian cancer have highly variable preferences, and their reasons for their treatment choices are diverse. Therefore, although uncertainty exists for this clinical scenario, treatment preference should be ascertained on an individual basis.
authors.affiliation: Surgical Outcomes Research Centre, Sydney South West Area Health Service and School of Public Health, University of Sydney, New South Wales, Australia. james.harrison@email.cs.nsw.gov.au
authors.forename: James D
authors.initials: JD
authors.lastname: Harrison
authors.forename: Ilona
authors.initials: I
authors.lastname: Juraskova
authors.forename: Caroline
authors.initials: C
authors.lastname: Anderson
authors.forename: Kathryn
authors.initials: K
authors.lastname: Nattress
authors.forename: Philip
authors.initials: P
authors.lastname: Beale
authors.forename: Anna-Lena
authors.initials: AL
authors.lastname: Lopez
authors.forename: Jonathan
authors.initials: J
authors.lastname: Carter
mesh_terms: D024221:Antineoplastic Protocols; D014408:Biomarkers, Tumor / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood*; D003657:Decision Making; D005260:Female; D006801:Humans; D009375:Neoplasms, Glandular and Epithelial / Q000097:blood / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D010353:Patient Education as Topic; D057240:Patient Preference / Q000523:psychology; D012008:Recurrence; D018571:Sentinel Surveillance; D012923:Social Class; D011795:Surveys and Questionnaires; D013997:Time Factors; D015854:Up-Regulation
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen