Background: After primary treatment for ovarian cancer, women often ask when they will feel “normal” again. We aimed to document the proportions of women who report high levels of physical and emotional symptoms at the end of treatment, determine if/when they return to normal and identify groups at risk of persistent symptoms/delayed recovery.
Methods: Women in the OPAL (Ovarian cancer Prognosis And Lifestyle) study who received ≥3 cycles of first-line chemotherapy and completed questionnaires on or <6 weeks after completing chemotherapy (baseline) were included in this analysis (n=605). Questionnaires measured symptoms (anxiety, depression, insomnia fatigue) and wellbeing (quality-of-life) at baseline, 3, 6, 9 and 18 months post-baseline. Group-based trajectory models identified clusters of individuals who followed similar trajectories. Logistic and Cox regression identified factors associated with persistent symptoms and delayed recovery, respectively.
Results: At baseline, 57% of women reported clinically significant fatigue, 21% sub/clinical anxiety or depression and 13% clinical insomnia; 46% had quality-of-life scores significantly lower than the general population. For 50-70% of women, individual symptoms and wellbeing normalised within six months, with the exception of emotional wellbeing where recovery rates for were lower (39% at 6 months). Overall, 35% of women still had at least one persistently poor symptom or wellbeing domain at 18 months. Women with more severe symptoms at baseline, who were younger, had multiple comorbidities or a history of anxiety/depression were more likely to have persistently poor or delayed symptoms/wellbeing recovery.
Conclusions: Although most women report resolution of symptoms and normalisation of wellbeing within six months of completing primary treatment for ovarian cancer, one-in-three never fully return to normal. Those at risk of delayed or no recovery should be triaged for early intervention with supportive measures.