My presentation is a little bitdifferent to the ones we've been talking about so far.
I'm going to present someresults from large international survey looking at the symptoms andquality-of-life concerns of women who have had treatment for ovarian cancer.
SoI guess by way of background, ovarian cancer survivors are relativelyunderstudied compared to other populations of survivors but they're due toimprovements in our diagnosis and treatment over the last few decadesthat there is a growing population of long-term survivors of ovarian cancer.
Even among the women though whose disease will inevitably relapse, the usualtrajectory for these women is that they go through periods of relapse andremission, and during these periods of time, survivorship concerns are equallyrelevant for these, these patients and so it's really important that we understandwhat it is that's troubling these women and what we might be able to do to helpthem.
Prior to this survey this was the largest study that had really looked atsurvivorship concerns in ovarian cancer.
It was done in the UK and included onlya hundred patients.
I don't really expect you to see what all of that says butbasically the blue bars are the symptoms and concerns patients reported, and thered bars are what the doctor said they they felt they had in their clinicalletters so there was a big disconnect between what patients were complainingof and what the doctors were reporting that they had.
So we undertook aninternet-based questionnaire and this is what it looked like: basically what we did was we developedin conjunction with and ANZOV, it was piloted and tested with consumers fromovarian cancer Australia, and then it was distributed by ovarian cancer consumergroups in Australia, the UK, the US, and Canada.
It was basically rebadged forthose different groups, eligibility was deliberately broad to try and capture asmany women as possible who had completed treatment for ovarian cancer and thesurvey was relatively long and we were a little bit nervous about that, but thewomen were actually were really committed once they started that.
Theylargely finished it, they self-reported their cancerdiagnosis and treatment history, and we used in standardizedinstruments to look at the symptoms and quality-of-life concerns and thenthere's some free text comments at the end.
They were incredibly generous aboutcompleting and we did some standard statistical analyses and in particularwill look, look as well as its symptoms and quality of life, and theirrelationship between physical activity and obesity.
So over a thousand womencompleted the survey, we think they were broadly representative of the populationof ovarian cancer survivors who are out there.
The majority had presented with advancedstage disease as is the usual for this this cancer and about a third ofrespondents had had recurrent ovarian cancer.
Most of them have received standardplatinum and taxane base chemotherapy and um, I guess there, and their median offour years since diagnosis.
So this is the symptoms and basically what we can seeis the green bars the whole population the dark blue bar those who don't haverecurrent disease, in the light blue bar those who have recurrent ovarian cancerand this is the proportion who had above threshold symptom levels.
What you can see that peripheralneuropathy was incredibly common in this population.
This was because of thetaxanes involved in their chemotherapy largely, um, so over three-quarters of womenwere complaining of persistent peripheral neuropathy, some degree over halfwomen were complaining of significant fatigue, and just under half significantmood disturbance and about a quarter, insomnia.
Interestingly, we always thought womenwith recurrent ovarian cancer might have worse symptoms, it wasn't the case, infact it was women who do not have recurrent disease that had statisticallysignificantly higher rates of mood disturbance and insomnia.
There was someinternational variation in mood disturbance but not in other symptoms.
This is looking at their factoredquality-of-life scores compared to population norms.
Interesting, theAustralian population norms are better than the US population norm, so morevariations was saying when we can place the Australian population, that theirdeficits across all areas with the exception of social well-being.
When we look at physical inactivity, we knowbasically a significant proportion of our women, more than half, of them werecategorized as overweight or obese, and a similarly large proportion wherephysically inactive.
Somewhat perhaps unexpectedly, the US had the mostoverweight or obese but um, everywhere else was not far behind and oh, andsomething funny happened to that slide but the picture is clear, basically onmultivariable analysis, overweight obesity and/or physical inactivity wereindependently associated with all the symptoms of interest and they were poorfact G and fact O, our quality of life scores in the overweight and obese, but inthose patients and the difference is restricted to physicalwell-being.
Other aspects of quality of life seemed relatively put, preserved um, butphysical activity, inactivity, was associated with poor quality of lifeacross the range of domains.
They're also association seen between obesity andphysical inactivity, and unmet supportive care needs, which were across againrelatively restricted to physical care needs for the O base, but across a range ofdomains for the physically and inactive.
So in conclusion, women with ovariancancer reported a high symptom burden which was strongly associated withphysical inactivity and obesity.
Now we know that as an internet-basedcross-sectional survey there will be selection and response bias is involvedwe probably under sampled called communities, and the list are sociallyadvantaged populations but nevertheless this was a very large study and of courseit's cross-sectional, so we can talk about associations rather than causality.
Nevertheless, the association seenbetween obesity and physical inactivity and quality-of-life provide support forprospective evaluation of interventions in this population.
Relations and importantly consumer groupswere very, very engaged in this study and they're incredibly well placed to lookat delivering, disseminating information and delivering relevant interventions inthis population group and these are all the people that helped contribute.