title: Helplessness/hopelessness, minimization and optimism predict survival in women with invasive ovarian cancer: a role for targeted support during initial treatment decision-making?
abstract: Women with advanced ovarian cancer generally have a poor prognosis but there is significant variability in survival despite similar disease characteristics and treatment regimens. The aim of this study was to determine whether psychosocial factors predict survival in women with ovarian cancer, controlling for potential confounders.
  
  
  
  The sample comprised 798 women with invasive ovarian cancer recruited into the Australian Ovarian Cancer Study and a subsequent quality of life study. Validated measures of depression, optimism, minimization, helplessness/hopelessness, and social support were completed 3-6 monthly for up to 2 years. Four hundred nineteen women (52.5 %) died over the follow-up period. Associations between time-varying psychosocial variables and survival were tested using adjusted Cox proportional hazard models.
  
  
  
  There was a significant interaction of psychosocial variables measured prior to first progression and overall survival, with higher optimism (adjusted hazard ratio per 1 standard deviation (HR) = 0.80, 95 % confidence interval (CI) 0.65-0.97), higher minimization (HR = 0.79, CI 0.66-0.94), and lower helplessness/hopelessness (HR = 1.40, CI 1.15-1.71) associated with longer survival. After disease progression, these variables were not associated with survival (optimism HR = 1.10, CI 0.95-1.27; minimization HR = 1.12, CI 0.95-1.31; and helplessness/hopelessness HR = 0.86, CI 0.74-1.00). Depression and social support were not associated with survival.
  
  
  
  In women with invasive ovarian cancer, psychosocial variables prior to disease progression appear to impact on overall survival, suggesting a preventive rather than modifying role. Addressing psychosocial responses to cancer and their potential impact on treatment decision-making early in the disease trajectory may benefit survival and quality of life.
authors.affiliation: Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia. melanie.price@sydney.edu.au.|Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, Australia. melanie.price@sydney.edu.au.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Price
authors.affiliation: Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.|Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, Australia.
authors.forename: Phyllis N
authors.initials: PN
authors.lastname: Butow
authors.affiliation: Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, Australia.|Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
authors.forename: Melanie L
authors.initials: ML
authors.lastname: Bell
authors.affiliation: Department of Gynaecological Oncology, Westmead Hospital and Westmead Institute for Cancer Research, The University of Sydney at Westmead Millennium Institute, Westmead, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: deFazio
authors.affiliation: Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia.|Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Friedlander
authors.affiliation: Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, Australia.
authors.forename: Joanna E
authors.initials: JE
authors.lastname: Fardell
authors.affiliation: Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Protani
authors.affiliation: Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
authors.forename: Penelope M
authors.initials: PM
authors.lastname: Webb
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D003657:Decision Making; D003863:Depression / Q000523:psychology; D005260:Female; D006380:Helplessness, Learned; D065026:Hope; D006801:Humans; D008875:Middle Aged; D000067656:Optimism / Q000523:psychology*; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000523:psychology*; D016016:Proportional Hazards Models; D011788:Quality of Life; D012944:Social Support
keywords: Oncology; Ovarian cancer; Predictors; Psychological factors; Survival