title: Risk and resilience in ovarian cancer survivorship
title: longitudinal impacts on psychosocial functioning
titleType: Subtitle
Creators: name: Armer, Jessica S.
Publisher: name: University of Iowa
Year: 2023
Subjects: cancer
cancer survivorship
COVID-19
resilience
public abstract
Mental Health

description: Objective. To examine trajectories of risk and resilience factors over the first year of cancer diagnosis and treatment as predictors of long-term psychosocial functioning in ovarian cancer survivorship. Associations between both longitudinal risk trajectory category and resilience trajectory category and long-term psychosocial outcomes (depression, anxiety, perceived stress, sleep disruption, intrusive/avoidant thoughts, coping strategies, optimism, and psychological well-being) were examined. Furthermore, both total amount and severity of life stress and severity of COVID-19-related disruption were evaluated as moderators of the relationship between risk trajectory and long-term psychosocial outcomes. Qualitative responses to questions about challenges and resilience opportunities during the COVID-19 pandemic were also collected and coded for themes to provide further context surrounding associations between risk, resilience, and psychosocial outcomes in this population during the novel challenge of a global pandemic.Methods. 92 gynecologic cancer survivors (100% female; 86.9% Caucasian, age: M= 65.68 [SD=11.67; range: 38-93] years) were recruited for long-term follow-up from a larger longitudinal study assessing biobehavioral influences on tumor progression in epithelial ovarian cancer. Women scheduled to have surgery for a pelvic mass suspected for ovarian cancer were initially recruited during a clinic visit at the University of Iowa Hospitals and Clinics and Washington University in St. Louis. Women from this initial sample surviving at least 4 years following their initial visit were re-contacted by mail. Psychosocial packets were completed at 1-2 weeks prior to primary surgery or beginning of neoadjuvant chemotherapy (T1), and at 6-month (T2) and 1-year follow-up visits (T3). After re-contact at 4+ years post-initial visit (T4),
description: consenting participants were mailed T4 psychosocial and qualitative packets and asked to complete a structured lifetime stress interview via phone. Latent class analysis was used to
description: classify patients into risk and resilience trajectory profile categories based on similar changes in risk or resilience factors over the first year after diagnosis (T1, T2, T3). Associations between both risk trajectory category and resilience trajectory category and long-term psychosocial outcomes at T4 were examined via linear regression, with both number and severity of previous life stressors and severity of COVID-19-related disruption examined as potential moderators of the relationship between risk trajectory and long-term outcomes.
description: Results. Three classes of risk trajectory (low, moderate, and high) emerged as the best-fitting latent risk model. Higher risk class over the first year predicted more negative psychosocial outcomes (poorer sleep quality and increases in depressive symptoms, anxious symptoms, and behavioral disengagement), and fewer positive psychosocial outcomes [environmental mastery, self-acceptance, and optimism] at 4+ years postdiagnosis. Two classes of resilience trajectory (low baseline and high baseline) emerged as the best-fitting resilience model; notably, both classes showed similarly high levels of resilience at 1-year postdiagnosis. Resilience class did not predict any psychosocial outcomes at long-term follow-up. Severity of previous life stressors moderated the relationship between risk trajectory and self-acceptance, while COVID-related disruption moderated the relationship between risk trajectory and sleep quality. Number of previous life stressors was not a significant moderator of risk and long-term outcomes. The most commonly coded qualitative themes included isolation, change in routine, loss, gratitude, and reflection/recognition of values.
description: Conclusions. These findings support the long-term impact of psychological risk factors, including depression, anxiety, perceived stress, and symptoms related to post-traumatic stress, on psychosocial functioning in ovarian cancer survivorship. Furthermore, the pattern of findings in this study suggest high levels of resilience among the majority of ovarian cancer patients post-treatment. Notably, severity of previous life stressors, rather than number of life stressors, mediated the relationship between risk trajectory and self-acceptance, which is often viewed as a component of general mental health. While this population overall exhibited resilience during the global COVID-19 pandemic, COVID-related disruption was significantly related to sleep disruption among long-term survivors. Theoretical and clinical implications of these findings are discussed.