Persistent Long-term Fatigue Among Epithelial Ovarian Cancer Survivors

Findings from GINECO case-control study

A study amongepithelial ovarian cancer survivors from 25 cooperative GINECO centres in France showed similar quality-of-life (QoL) compared to healthy controls that were randomly selected from the electoral rolls, but persistent long-term fatigue. The researchers found depression, neuropathy and sleep disturbance as the main conditions associated with severe long-term fatigue. 

Little data is available on patient-reported outcomes in this population including QoL and symptoms during post-treatment periods, and the results are conflicting. The physical and psychological consequences of epithelial ovarian cancer and its treatments were shown to be negatively associated with QoL, including fatigue, sleep problems, pain, anxiety, depression, negative self-concept, and reduced feelings of sexuality. But some other studies have reported that most of epithelial ovarian cancer survivors were satisfied with their global QoL, despite persistent psychological and physical symptoms. 

Long-term fatigue has been described as one of the most common and distressing adverse effects of cancer and its treatment. Little is known about the prevalence of long-term fatigue in epithelial ovarian cancer survivors several years after treatment in comparison with age-matched healthy women. 

The factors associated with severe long-term fatigue have not yet been assessed in a large group of long-term relapse-free epithelial ovarian cancer survivors which prompted French investigators to perform a case-control study on long-term fatigue, symptoms and several QoL domains in population of epithelial ovarian cancer survivors who are relapse-free more than 3 years after first-line treatment and make comparison with age-matched healthy women. 

All participants in this study completed validated self-reported questionnaires: FACIT-F in terms of fatigue, FACT-G/O for QoL, FACT-Ntx for neurotoxicity, HADS for anxiety/depression, ISI for sleep disturbance, and IPAQ for physical activity. 

Severe long-term fatigue was defined as a FACIT-F score less than 37/52. Univariate and multivariate logistic regression were conducted to analyze severe long-term fatigue and its influencing factors in epithelial ovarian cancer survivors. 

In this study 318 epithelial ovarian cancer survivors and 318 controls were included. Epithelial ovarian cancer survivors were 63-year old on average, 50% with FIGO stage I/II, 48% with FIGO stage III/IV (48%). Nearly all (99%) had received platinum and taxane chemotherapy, with an average 6-year follow-up. 

There were no differences between the two groups in socio-demographic characteristics and global QoL. 

Epithelial ovarian cancer survivors had poorer FACIT-F scores (p < 0.0001), lower functional well-being scores (p = 0.0002), poorer FACT-O scores (p < 0.0001), and poorer FACT-Ntx scores (p < 0.0001). 

They also reported more severe long-term fatigue (26% vs 13%, p = 0.0004), poorer sleep quality (63% vs 47%, p = 0.0003), and more depression (22% vs 13%, p = 0.01). 

Fewer than 20% of epithelial ovarian cancer survivors and controls exercised regularly. 

In multivariate analyses, epithelial ovarian cancer survivors with high levels of depression, neurotoxicity, and sleep disturbance had an increased risk of developing severe long-term fatigue (p < 0.01).

The authors concluded that even if epithelial ovarian cancer survivors present a good global QoL, they report persistent long-term side effects including chronic fatigue, ovarian cancer related symptoms, neurotoxicity, depression and sleep disturbances. Depression, neuropathy and sleep disturbance were the main conditions associated with severe long-term fatigue. 

 

Reference

Joly F, Ahmed-Lecheheb D, Kalbacher E, et al. Long-term fatigue and quality of life among epithelial ovarian cancer survivors: A GINECO case/control VIVROVAIRE I Study.Annals of Oncology; Published online 9 March 2019. pii: mdz074. doi: 10.1093/annonc/mdz074.