Elsevier

Gynecologic Oncology

Volume 144, Issue 2, February 2017, Pages 348-353
Gynecologic Oncology

Pre-diagnosis health-related quality of life, surgery, and survival in women with advanced epithelial ovarian cancer: A SEER-MHOS study

https://doi.org/10.1016/j.ygyno.2016.12.005Get rights and content

Highlights

  • SEER-MHOS is a linked national data set of cancer and HRQOL data.

  • Women with ovarian cancer who had HRQOL surveys prior to diagnosis were analyzed.

  • Pre-diagnosis HRQOL was predictive of receiving surgery.

  • Pre-diagnosis HRQOL was not associated with overall survival.

Abstract

Objective

Health-related quality of life (HRQOL) has been found to be associated with overall survival in women with ovarian cancer. However, previous studies assessed HRQOL after surgery within clinical trial populations only. The study goal was to determine the association of pre-cancer diagnosis HRQOL with the likelihood of receiving surgery and with overall survival in a national, population-based cohort of older women with advanced ovarian cancer.

Methods

The Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database was queried to identify 374 women aged 65 years and older with advanced stage epithelial ovarian cancer from 1998 to 2011. Responses to the Short Form 36 (SF-36) and Veterans-RAND-12 (VR-12), two single-item global health questions, and Activities of Daily Living (ADLs) were abstracted. Multivariable models were used to quantify associations of HRQOL and ADL assessments with surgery and overall survival, adjusted for demographic and clinical characteristics.

Results

Of 374 women with a HRQOL assessment prior to diagnosis, 199 (53%) underwent surgery. Increases in physical and mental HRQOL domains were significantly associated with receipt of surgery. The relationship between HRQOL domains and overall survival were not statistically significant. For ADLs, only difficulty in toilet use was significantly associated with survival.

Conclusion

In this population-based sample of older women with advanced epithelial ovarian cancer, pre-diagnosis HRQOL was predictive of receiving surgery, but not of overall survival.

Introduction

Health-related quality of life (HRQOL) is a patient-reported construct that can be influenced by a patient's clinical status and demographic background [1], [2]. In ovarian cancer, measures of HRQOL [3], [4] have been shown to be associated with overall survival in clinical trial populations. With respect to HRQOL in ovarian cancer, previous studies have used HRQOL data collected from newly enrolled, post-operative clinical trial patients. As this time point is both after diagnosis and initial surgery, it may not reflect true baseline HRQOL. Cancer clinical trial populations are also limited by underrepresentation of racial/ethnic minorities [5], low-income populations [6], [7], and older adults [5] – three demographic factors that are significantly associated with HRQOL. As the incorporation of patient-reported outcomes becomes more important in cancer care [8], population-based data may improve generalizability of the relationships between HRQOL and outcomes.

To date, whether pre-diagnostic and pre-treatment patient-reported HRQOL is associated with overall survival among ovarian cancer patients is unknown. The relationship between pre-diagnosis HRQOL and whether or not surgery is performed is also unknown. Given that surgery is the strongest mediator of overall survival in ovarian cancer, the relationship between HRQOL and surgery may help explain how HRQOL relates to survival. The objective of our study was to use a nationally representative, population-based sample to evaluate associations between pre-cancer diagnosis HRQOL and patient-reported functional status with receipt of surgery and with overall survival in older women with advanced epithelial ovarian cancer in the United States (U.S.).

Section snippets

Data

The study used the SEER-MHOS dataset (Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS)), a publically available linked resource of patient-reported HRQOL indicators and cancer outcomes, starting with cohorts from 1998 through 2013. The SEER program includes 18 cancer registries collecting information on newly diagnosed cases within SEER geographic regions including 26% of the U.S. population [9]. The Medicare Health Outcomes Survey (MHOS) is a

Participant characteristics

Demographics characteristics and comorbidities, overall and by receipt of surgery are presented in Table 1. All women had advanced stage (SEER ‘distant’: stage 3–4) disease. The surgery group had a greater proportion of women who were younger, married, and had college level or higher education. Hypertension and heart disease were also less common in the surgery group.

We compared women who were alive at the end of follow-up to those who had died. Race, geographic region, education, comorbidity

Discussion

We sought to determine the relationship of self-reported HRQOL measures assessed prior to cancer diagnosis with likelihood of receiving surgery and with overall survival among a cohort of Medicare beneficiaries with advanced stage epithelial ovarian cancer. Higher HRQOL scores on SF-36/VR-12 measures were associated with higher likelihood of undergoing surgery. The relationship between higher HRQOL measures and survival was not statistically significant, although likely underpowered. Estimates

Disclosure

The authors have no financial disclosures or potential conflicts of interest to report.

Funding

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R25CA116339. This project was reviewed and deemed exempt by the Human Research Protections Program (IRB Number: 14-3052) at the University of North Carolina at Chapel Hill

Acknowledgements

The research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R25CA116339. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the

References (19)

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