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Quality of life trajectories after diagnosis of gynecologic cancer: a theoretically based approach

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Abstract

Purpose

The course of quality of life after diagnosis of gynecologic cancer is not well understood. We aimed to identify subgroups of gynecologic cancer patients with distinct trajectories of quality of life outcomes in the 18-month period after diagnosis. We also aimed to determine whether these subgroups could be distinguished by predictors derived from Social-Cognitive Processing Theory.

Methods

Gynecologic cancer patients randomized to usual care as part of a psychological intervention trial (NCT01951807) reported on depressed mood, quality of life, and physical impairment soon after diagnosis and at five additional assessments ending 18 months after baseline. Clinical, demographic, and psychosocial predictors were assessed at baseline, and additional clinical factors were assessed between 6 and 18 months after baseline.

Results

A two-group growth mixture model provided the best and most interpretable fit to the data for all three outcomes. One class revealed subclinical and improving scores for mood, quality of life, and physical function across 18 months. A second class represented approximately 12 % of patients with persisting depression, diminished quality of life, and greater physical disability. Membership of this high-risk subgroup was associated with holding back concerns, more intrusive thoughts, and use of pain medications at the baseline assessment (ps < .05).

Conclusions

Trajectories of quality of life outcomes were identified in the 18-month period after diagnosis of gynecologic cancer. Potentially modifiable psychosocial risk factors were identified that can have implications for preventing quality of life disruptions and treating impaired quality of life in future research.

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Acknowledgments

We wish to acknowledge Sara Frederick, Tina Gadja, Shira Hichenberg, and Kristen Sorice for study management, Joanna Crincoli, Katie Darabos, Lauren Faust, Rebecca Henderson, Sloan Harrison, Travis Logan, Kellie McWilliams, Marie Plaisme, Danielle Ryan, Arielle Schwerd, Kaitlyn Smith, Nicole Teitelbaum, and Amanda Viner for collection of study data. We thank the oncologists and nurses at all five cancer centers for allowing access to patients. Finally, we thank the study participants and therapists for their time.

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Authors and Affiliations

  1. Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA

    Brian D. Gonzalez, Sharon L. Manne & Jerod Stapleton

  2. Temple University School of Dentistry, Philadelphia, PA, USA

    Shannon Myers-Virtue

  3. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Melissa Ozga & David Kissane

  4. Monash University, Clayton, Australia

    David Kissane

  5. Fox Chase Cancer Center, Philadelphia, PA, USA

    Carolyn Heckman

  6. University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Mark Morgan

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  1. Brian D. Gonzalez
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  2. Sharon L. Manne
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  5. Melissa Ozga
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  8. Mark Morgan
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Corresponding author

Correspondence to Brian D. Gonzalez.

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Funding

This work was supported by grants R01CA85566 (PI: Manne) and R01CA185623-S1 (PI: Bandera) from the National Cancer Institute.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Gonzalez, B.D., Manne, S.L., Stapleton, J. et al. Quality of life trajectories after diagnosis of gynecologic cancer: a theoretically based approach. Support Care Cancer 25, 589–598 (2017). https://doi.org/10.1007/s00520-016-3443-4

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  • DOI: https://doi.org/10.1007/s00520-016-3443-4

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