Quality of life in patients with advanced ovarian cancer under personalised treatment: the impact of HIPEC

Abstract

Ovarian cancer ranks first among gynaecological cancers in terms of mortality, mainly due to late detection and high recurrence rates. The standard treatment for late stages remains cytoreductive surgery combined with systemic chemotherapy. However, survival and quality of life for patients receiving traditional treatment remain unsatisfactory. The aim of the study was to analyse the quality of life of patients with primary advanced ovarian cancer depending on the type of personalised management before the start of specialised treatment, after cytoreductive surgery in the early and late postoperative periods, during chemotherapy and after the end of specialised treatment.

Materials and methods. A comparative analysis of the results of clinical examination and treatment of 74 patients with primary serous adenocarcinoma of the ovary, stages III–IV (FIGO 2015), was performed: Group IA – patients with primary ovarian cancer who underwent primary cytoreductive surgery (PDS) + adjuvant chemotherapy (ACT) – 43 patients; Group IB – patients with primary ovarian cancer who underwent neoadjuvant chemotherapy (NACT) + interval cytoreductive surgery (IDS) + adjuvant chemotherapy – 16 patients; IC group – patients with primary ovarian cancer who underwent primary cytoreductive surgery (PDS) +  hyperthermic intraperitoneal chemotherapy (HIPEC) +  adjuvant chemotherapy (ACT) – 15 patients. The quality of life of patients with advanced ovarian cancer was also assessed using special questionnaires EORTC QLQ-C30 and QLQ-OV28. Results and discussion. In the early postoperative period, when comparing patients in groups IA (PDS + ACT) and IC (PDS + HIPEC + ACT) using the Mann-Whitney test, a significant difference was obtained on the pain scales (Ukr. = 229, Uemp. = 208 Ukr.> Uemp. at a significance level of p = 0.05), nausea and vomiting (Ukr. = 229, Uemp. = 137 Ukr. > Uemp. at a significance level of p = 0.05), stool retention (Ukr. = 229, Uemp. = 189 Ukr. > Uemp. at a significance level of p = 0.05) and gastrointestinal symptoms (Ukr. = 229, Uemp. = 191 Ukr. > Uemp. at a significance level of p = 0.05). A significant deterioration in the quality of life of patients who underwent hyperthermic intraperitoneal chemoperfusion due to an increase in pain, nausea and vomiting scores, stool retention and gastrointestinal symptoms among patients with primary ovarian cancer was observed only in the early postoperative period. In the subsequent stages of special treatment and after its completion, no significant deterioration in the quality of life among patients who underwent hyperthermic intraperitoneal chemoperfusion was observed compared with other groups.

Conclusions. According to the authors, patients with primary ovarian cancer in the early postoperative period showed a marked decrease in physical functioning, pain intensity, general well-being and role functioning scales due to their physical condition. Subsequently, there was a tendency towards a gradual increase in physical health indicators in all groups of patients with primary ovarian cancer in the late postoperative period and after adjuvant chemotherapy. At the same time, there was a moderate decrease in the scores of the scales of life activity, role functioning due to emotional state, social functioning and mental health during special treatment and partial recovery of these scores after the end of special treatment. Hyperthermic intraperitoneal chemoperfusion was accompanied by a decrease in physical health scales in patients, most significantly in the early postoperative period. When assessing the quality of life of patients with primary ovarian cancer using the EORTC QLQ-C30 and QLQ-OV28 questionnaires, the results indicate no statistically significant negative effect of hyperthermic intraperitoneal chemoperfusion at all stages of treatment.