Increasing Quality of Life in Ovarian Cancer Patients 

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Physical activity leads to significant improvements in the quality of life of ovarian cancer survivors. In addition, studies are looking at the best ways to get cancer survivors to follow a healthy lifestyle.







Physical activity is recommended all cancer survivors by the American Cancer Society.  A study published in 2007 found that ovarian cancer survivors showed significant increases in quality of life through physical activity, (Associations between physical activity and quality of life in ovarian cancer survivors, 2007, Clare Stevinson, et al.) Ovarian cancer ranks fourth in cancer-related deaths among women. Unfortunately, the current five-year survival rate among ovarian cancer patients is less than 50%. A major focus of the treatment of ovarian cancer patients is on improving quality of life.

The study was published in Gynecologic Oncology and used ovarian cancer survivors from Alberta, Canada. The study categorized participants based on recommendations set forth by the American Cancer Society (150 to 300 weekly minutes of moderate exercise or 60 to 120 weekly minutes of strenuous exercise). Four groups were established: sedentary, below guidelines, meeting guidelines and above guidelines. Quality of life was measured with the Functional Assessment of Cancer Treatment-Ovarion (FACT-O) scale. Physical activity was self-reported using a mail-in questionnaire.  Of the respondents only 31.1% were meeting or exceeding American Cancer Society recommendations. The author's suggested that this number is probably even lower because physical activity tends to be slightly inflated when self-reported and survivors in poor health were excluded from the study. As the figure below shows, quality of life among those below the guidelines was significantly lower than those meeting or exceeding physical activity guidelines. However, no significance was established between the sedentary group and below guideline group or between the within the guidelines group and exceeding guideline group.

Quality of life of ovarian cancer survivors across the four physical activity categories.

In addition, FACT-O scores were compared between ovarian cancer survivors currently fighting the disease and those with the disease in intermission. The figure below shows that the rise in FACT-O score from being in the physical activity group was three times higher among those currently fighting the cancer. Surprisingly, quality of life as measured by FACT-O score was found to be higher among those currently with the ovarian cancer, but meeting the guidelines of physical activity, than those in remission regardless of whether or not they met the guidelines.

Interaction between disease status and physical activity guidelines on quality of live in ovarian cancer survivors.

Exercise may increase quality of life through two paths. A study found that physical and functional well-being, but not emotional or social well-being, was improved by exercise in cancer survivors participating in group psychotherapy classes (The group psychotherapy and home-based physical exercise trial in cancer survivors: physical fitness and quality of life outcomes, 2003, K.S. Courneya, et al.). Exercise controls obesity. Obesity has been shown to dramatically decrease ovarian cancer survival rate (Effect of obesity on survival in epithelial ovarian cancer, 2006, J.C. Pavelka, R.S. Brown, B.Y. Karlan, I. Cass, R.S. Leuchter, L.D. Lagasse et al.).

If physical activity increases quality of life in ovarian cancer survivors, how can patient adherence to physician prescribed exercise treatment be increased? 

A recent study looked at moderate to vigorous physical activity in breast and prostrate cancer survivors receiving two types of mailed print intervention for ten months (Long-term physical activity outcomes of home-based lifestyle interventions among breast and prostate cancer survivors, 2012, Allison J. Ottenbacher, et al.). One group received publicly-available lifestyle brochures (attention control) and another received tailored brochures (tail intervention). As the figure below demonstrates, both groups (who were initially sedentary) showed significant increases in physical activity. Although the tailor intervention group had higher physical activity rates after a year, the gains in the tailor intervention group became somewhat diminished in a two-year follow-up.  


Trajectory of median minutes of moderate to vigorous physical activity over time, by intervention assignment.

 



Another recent study found that quality of life in ovarian cancer survivors was significantly improved through lifestyle counseling (Feasibility of a lifestyle intervention for ovarian cancer patients receiving adjust chemotherapy, 2011, V. Gruenigen, et al.). The study found that patients enrolled in physical activity and nutritional counseling with every chemotherapy visit increased nutritional dietary intake and physical activity. In addition, quality of life as measured with the Functional Assessment of Cancer Therapy and symptom severity measured by the Memorial Symptom Assessment Scale also showed improvement in ovarian cancer patients receiving the lifestyle counseling.

In summary, participating in 150 minutes of moderate exercise a week has been shown to improve quality of life in ovarian cancer survivors. However, getting patients to follow physical activity guidelines poses a significant hurdle. Studies have found that tailored intervention mailings and lifestyle counseling increase adherence to prescribed physical activity, but more measures may be needed to reach higher levels of participation. Please share your thoughts!

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