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Associations with worry about dying and hopelessness in ambulatory ovarian cancer patients
- Eileen Huh Shinn, Cindy L. Carmack Taylor, Kelly Kilgore, Alan Valentine, Diane C. Bodurka, John Kavanagh, Anil Sood, Yisheng Li, Karen Basen-Engquist
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- Journal:
- Palliative & Supportive Care / Volume 7 / Issue 3 / September 2009
- Published online by Cambridge University Press:
- 30 September 2009, pp. 299-306
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- Article
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Objective: Women with ovarian cancer face a poor prognosis, with prolonged periods of treatment but relatively high levels of physical functioning. Their thoughts and feelings regarding the prospect of dying are complex and have not been adequately studied. Various demographic, medical and psychosocial factors were examined to determine their independent associations with fear of dying and hopelessness in a cross-sectional design.
Method: Two hundred fifty-four ovarian cancer patients were assessed at the beginning of a new chemotherapy regimen. Separate logistic regressions were performed for worry about dying and loss of hope. For each analysis, psychosocial variables were entered after the demographic and medical variables to determine whether the psychosocial variables had an independent association with the respective outcome.
Results: Fifty-five percent of the sample acknowledged fear of dying, and 31.6% acknowledged loss of hope in the fight against their illness. Being younger (p = .001), being of non-Hispanic White ethnicity (p = .026), and having poorer physical well-being (p = .000) were significantly associated with worry about dying after controlling for all other variables in the model. Regarding loss of hope, depressive symptoms (p = .002), lack of social support/well-being (p = .001), and number of treatments (p = .04) were significant.
Significance of results: This is one of the largest studies to examine end-of-life concerns in a sample of advanced cancer patients. Our results underscore the importance of demographic and psychosocial variables in the examination of ovarian cancer patients' end-of-life concerns. Their fears and concerns should be openly acknowledged, even when the clinical focus is still on curative treatment.
27 - Ovarian cancer
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- By Diane C. Bodurka, Department of Gynecologic Oncology, U.T. M.D. Anderson Cancer Center, USA
- Edited by Michael J. Fisch, University of Texas, M. D. Anderson Cancer Center, Eduardo Bruera, University of Texas, M. D. Anderson Cancer Center
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- Book:
- Handbook of Advanced Cancer Care
- Published online:
- 04 August 2010
- Print publication:
- 27 March 2003, pp 229-234
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- Chapter
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Summary
Natural history
Ovarian cancer is the leading cause of death in women with gynecologic cancers. Often called the “Silent Killer” because there are no obvious symptoms until the disease is in its later stages, more than 23 400 new cases and 13 900 deaths were predicted from this disease in the US in 2001. One in 70 women in the US develop this disease, and 1 in 100 women die from ovarian cancer. Most women have a 1.8% lifetime risk of developing this cancer.
Ovarian cancer occurs most frequently in women aged 40–70, and the greatest number of cases is found in women between 50 and 59 years of age. Eight percent of the cases occur in women less than 35 years of age. A higher incidence is seen in Caucasian women, and this disease is more common in industrialized countries.
Approximately 20% of ovarian cancers are germ cell tumors and sex-cord stromal tumors; these cancers develop in the cells that form the eggs (germ cells) or in the cells that produce the female hormones and form the structure of the ovaries (sex-cord stromal cells). The remaining 80% are epithelial ovarian carcinomas, which begin in the cells that cover the surfaces of the ovaries. These cancers will be the subject of this chapter.
The exact etiology of ovarian cancer is unknown, although events related to incessant ovulatory function have been consistently reported in the literature.