title: A prospective study of phobic anxiety, risk of ovarian cancer, and survival among patients.
abstract: OBJECTIVE
  In ovarian cancer patients and mouse models, psychosocial stress is associated with higher circulating markers of angiogenesis and cell migration, impaired immune response, and increasing tumor burden and aggressiveness. In the Nurses' Health Studies (NHS/NHSII), we assessed whether phobic anxiety, a marker of chronic distress, was associated with risk of incident ovarian cancer as well as survival among ovarian cancer patients.
  
  
  METHODS
  We used Cox proportional hazards regression to model the relative risks (RRs) and 95 % confidence intervals (CI) of ovarian cancer incidence and survival by categories of the Crown-Crisp phobic anxiety index (CCI).
  
  
  RESULTS
  We identified 779 cases of ovarian cancer during 2,497,892 person-years of follow-up. For baseline CCI (NHS: 1988; NHSII: 1993), we observed a statistically nonsignificant increased risk of epithelial ovarian cancer (RR for CCI ≥ 4 vs. 0 or 1: 1.14; 95 % CI 0.96-1.36). However, when we updated CCI (NHS: 2004; NHSII: 2005), the associations were attenuated. Pre-diagnosis CCI was not associated with ovarian cancer survival (RR for ≥4 vs. 0 or 1: 1.00; 95 % CI 0.77-1.31); results were similar for post-diagnosis CCI.
  
  
  CONCLUSIONS
  Distress, as measured by phobic anxiety symptoms, was not associated with ovarian cancer risk, although we cannot rule out a modest association. Future research should explore the role of phobic anxiety and other forms of psychological distress and ovarian cancer risk and survival.
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, 3rd Floor, Boston, MA, 02115, USA. nhlip@channing.harvard.edu.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Poole
authors.affiliation: Harvard TH Chan School of Public Health, Boston, MA, USA.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Kubzansky
authors.affiliation: MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Sood
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, 3rd Floor, Boston, MA, 02115, USA.|Harvard TH Chan School of Public Health, Boston, MA, USA.
authors.forename: Olivia I
authors.initials: OI
authors.lastname: Okereke
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, 3rd Floor, Boston, MA, 02115, USA.|Harvard TH Chan School of Public Health, Boston, MA, USA.
authors.forename: Shelley S
authors.initials: SS
authors.lastname: Tworoger
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001007:Anxiety; D015415:Biomarkers; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D006801:Humans; D015994:Incidence; D051379:Mice; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000209:etiology / Q000401:mortality*; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D010698:Phobic Disorders / Q000150:complications*; D011446:Prospective Studies; D012306:Risk; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers
keywords: Anxiety; Cancer; Distress; Oncology; Ovarian cancer