Quality of life from cytoreductive surgery in advanced ovarian cancer: Investigating the association between disease burden and surgical complexity in the international, prospective, SOCQER‐2 cohort study

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 129; no. 7; pp. 1122 - 1132
• Main Authors: Sundar, Sudha, Cummins, Carole, Kumar, Satyam, Long, Joanna, Arora, Vivek, Balega, Janos, Broadhead, Tim, Duncan, Tim, Edmondson, Richard, Fotopoulou, Christina, Glasspool, Ros, Kolomainen, Desiree, Leeson, Simon, Manchanda, Ranjit, McNally, Orla, Morrison, Jo, Mukhopadhyay, Asima, Paul, Jim, Tidy, John, Wood, Nick
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-06-2022; John Wiley and Sons Inc
• Subjects: Cancer surgery; Cohort analysis; extensive surgery; Gynecological surgery; Ovarian cancer; Patients; Quality of life; Statistical analysis; Surgery; Surgical techniques; ultraradical surgery; ultraradical surgery; quality of life; ovarian cancer; extensive surgery
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.17041

Objective
To investigate quality of life (QoL) and association with surgical complexity and disease burden after surgical resection for advanced ovarian cancer in centres with variation in surgical approach.
Design
Prospective multicentre observational study.
Setting
Gynaecological cancer surgery centres in the UK, Kolkata, India, and Melbourne, Australia.
Sample
Patients undergoing surgical resection (with low, intermediate or high surgical complexity score, SCS) for late‐stage ovarian cancer.
Main Outcome Measures
Primary: change in global score on the European Organisation for Research and Treatment of Cancer (EORTC) core quality‐of‐life questionnaire (QLQ‐C30). Secondary: EORTC ovarian cancer module (OV28), progression‐free survival.
Results
Patients’ preoperative disease burden and SCS varied between centres, confirming differences in surgical ethos. QoL response rates were 90% up to 18 months. Mean change from the pre‐surgical baseline in the EORTC QLQ‐C30 was 3.4 (SD 1.8, n = 88) in the low, 4.0 (SD 2.1, n = 55) in the intermediate and 4.3 (SD 2.1, n = 52) in the high‐SCS group after 6 weeks (p = 0.048), and 4.3 (SD 2.1, n = 51), 5.1 (SD 2.2, n = 41) and 5.1 (SD 2.2, n = 35), respectively, after 12 months (p = 0.133). In a repeated‐measures model, there were no clinically or statistically meaningful differences in EORTC QLQ‐C30 global scores between the three SCS groups (p = 0.840), but there was a small statistically significant improvement in all groups over time (p < 0.001). The high‐SCS group experienced small to moderate decreases in physical (p = 0.004), role (p = 0.016) and emotional (p = 0.001) function at 6 weeks post‐surgery, which resolved by 6–12 months.
Conclusions
The global QoL of patients undergoing low‐, intermediate‐ and high‐SCS surgery improved at 12 months after surgery and was no worse in patients undergoing extensive surgery.
Tweetable
Compared with surgery of lower complexity, extensive surgery does not result in poorer quality of life in patients with advanced ovarian cancer.
Tweetable
Compared with surgery of lower complexity, extensive surgery does not result in poorer quality of life in patients with advanced ovarian cancer.