The psychological impact and clinical outcomes associated with testing for ovarian cancer in symptomatic women

Ng Kee Kwong, Fong Lien (2024). The psychological impact and clinical outcomes associated with testing for ovarian cancer in symptomatic women. University of Birmingham. M.D.

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Abstract

Aims: To investigate the psychological and clinical impact of symptom-triggered testing for ovarian cancer (OC).

Method: To investigate the psychological impact of symptom triggered testing for OC, a systematic review (SR) was undertaken to identify variables that were associated with psychological morbidity in patients undergoing testing for any cancer. The association between variables identified in the SR and anxiety and distress levels in women undergoing diagnostic testing for OC was subsequently explored in the dataset from a single-arm prospective diagnostic test accuracy study (Refining Ovarian Cancer Test accuracy Scores (ROCkeTS). To estimate the prevalence of psychological morbidity following testing for OC. To investigate the clinical benefit of symptom triggered testing for OC, the true positive rate of OC diagnosis by age, menopausal status and referral pathway was estimated in the ROCkeTS dataset. Finally, the oncological outcomes (performance status, stage at diagnosis, cytoreduction rate, extent of disease) in women diagnosed with high grade serous OC, the most lethal form of OC was evaluated.

Results: Findings from our SR demonstrated that the contribution of some factors to anxiety in cancer testing and their specificity of effect remain inconclusive. Targeting young women or those who are unemployed or who have low levels of educational attainment may offer a means to mitigate anxiety. Some studies suggested that one-stop clinics and patient navigators may be beneficial to mitigate anxiety. Most women
experienced moderate-to-severe distress and anxiety following a referral for OC testing. The severity of anxiety and distress levels remained unchanged or worsened in the majority of women at 12 months post OC testing despite a non-cancer diagnosis. Younger women and those who presented via the emergency pathway reported higher distress levels but were less likely to receive a diagnosis of OC. Symptom triggered testing facilitates the diagnosis of high grade serous OC at an early stage when women are in generally good health. Even in women with advanced
stage OC, the tumour load is relatively not extensive and complete surgical clearance can be achieved in a high proportion.

Conclusion: Younger women have a lower risk of developing OC but are at especially high risk of psychological harm from testing and should be targeted for support. Improving awareness of the symptoms of OC will facilitate the institution of early investigations and evidence demonstrates that surgical intervention at an early stage improves outcomes.

Type of Work:

Thesis (Doctorates > M.D.)

Award Type:

Doctorates > M.D.

Supervisor(s):