SAN FRANCISCODepression serious enough to affect daily
functioning occurs in one of every five patients who have epithelial
ovarian cancer, according to data presented at the 30th Annual
Meeting of the Society of Gynecologic Oncologists. Diane
Bodurka-Bevers, MD, and her colleagues at the University of Texas
M.D. Anderson Cancer Center studied this problem in 275 patients with
Dr. Bodurka-Bevers said in an interview that the prevalence of
depressive symptoms in her subjects was much higher than is generally
assumed for ovarian cancer patients. The estimates of
prevalence of depressive symptoms range from 5% to more than 25% in
cancer patients, but no one has previously looked at this in ovarian
cancer patients, she said. This is the first study to
show that depression and anxiety affect the daily functioning of
patients who have ovarian cancer.
Dr. Bodurka-Bevers reported that as part of a validation of the
Functional Assessment of Cancer Therapy-Ovary (FACT-O, the FACT-G
ovarian subscale), a prospective study was conducted to assess
quality of life (QOL), evaluate performance status, and screen for
depression in patients with epithelial ovarian cancer. Of 360
consecutive patients identified with ovarian cancer, 275 agreed to
participate in the study.
One Fifth Were Depressed
Five dimensions of cancer patient QOL were assessed, including
physical, functional, social/family, and emotional well-being, as
well as relationship with health care providers. Depression was
measured with the Center for Epidemiological Studies-Depression scale
(CES-D). Performance status was evaluated by the Zubrod score.
Of the 243 patients who completed the questionnaire, 57 (24%) had
early-stage disease, 149 (61%) had advanced disease, and 37 (15%)
were unstaged. Patients were being treated for recurrence (25%) or
newly diagnosed disease (24%), or were being seen for post-therapy
Fifty patients (20%) met CES-D criteria for depression. Thirty-two of
these (64%) were receiving treatment for ovarian cancer recurrence,
12 (24%) were being seen in follow-up, and 6 (12%) were newly
diagnosed with ovarian cancer. The number of patients who were
receiving treatment for depression is unknown.
Depression was correlated with decreased QOL as measured by the
FACT-O and with poor performance status.
The therapeutic implications of our study include the need for
further evaluation and possible pharmacologic treatment of depression
in these patients, Dr. Bodurka-Bevers said. Patients
under active treatment for newly diagnosed or recurrent ovarian
cancer exhibit a substantially higher number of depressive symptoms
than women undergoing post-therapy surveillance or women in the
She added that women under active treatment for ovarian cancer have
substantially more anxiety than women in the general population.
Depression and anxiety significantly impact the emotional and
functional well-being of patients with epithelial cancer, Dr.
Bodurka-Bevers concluded, and patients who report a higher
number of depressive symptoms warrant clinical assessment and
She recommended that a workup for suspected depression in ovarian
cancer patients should include completion of a screening
questionnaire, and, for those whose screening indicates depressive
symptomatology, referral to a specialist for further evaluation.