Quality of Life and Adverse Events: Prognostic Relationships in Long-Term Ovarian Cancer Survival

Lari Wenzel*, Kathryn Osann, Chelsea McKinney, David Cella, Giulia Fulci, Mary J. Scroggins, Heather A. Lankes, Victoria Wang, Kenneth P. Nephew, George L. Maxwell, Samuel C. Mok, Thomas P. Conrads, Austin Miller, Robert S. Mannel, Heidi J. Gray, Parviz Hanjani, Warner K. Huh, Nick Spirtos, Mario M. Leitao, Gretchen GlaserSudarshan K. Sharma, Alessandro D. Santin, Paul Sperduto, Shashikant B. Lele, Robert A. Burger, Bradley J. Monk, Michael Birrer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: There is a critical need to identify patient characteristics associated with long-term ovarian cancer survival. Methods: Quality of life (QOL), measured by the Functional Assessment of Cancer Therapy-Ovarian-Trial Outcome Index (FACT-O-TOI), including physical, functional, and ovarian-specific subscales, was compared between long-term survivors (LTS) (8+ years) and short-term survivors (STS) (<5 years) of GOG 218 at baseline; before cycles 4, 7, 13, 21; and 6 months post-treatment using linear and longitudinal mixed models adjusted for covariates. Adverse events (AEs) were compared between survivor groups at each assessment using generalized linear models. All P values are 2-sided. Results: QOL differed statistically significantly between STS (N = 1115) and LTS (N = 260) (P <. 001). Baseline FACT-O-TOI and FACT-O-TOI change were independently associated with long-term survival (odds ratio = 1.05, 95% confidence interval = 1.03 to 1.06 and odds ratio = 1.06, 95% confidence interval = 1.05 to 1.07, respectively). A 7-point increase in baseline QOL was associated with a 38.0% increase in probability of LTS, and a 9-point increase in QOL change was associated with a 67.0% increase in odds for LTS. QOL decreased statistically significantly with increasing AE quartiles (cycle 4 quartiles: 0-5 vs 6-8 vs 9-11 vs ≥12 AEs, P =. 01; cycle 21 quartiles: 0-2 vs 3 vs 4-5 vs ≥6 AEs, P =. 001). Further, LTS reported statistically significantly better QOL compared with STS (P =. 03 and P =. 01, cycles 4 and 21, respectively), with similar findings across higher AE grades. Conclusions: Baseline and longitudinal QOL change scores distinguished LTS vs STS and are robust prognosticators for long-term survival. Results have trial design and supportive care implications, providing meaningful prognostic value in this understudied population.

Original languageEnglish (US)
Pages (from-to)1369-1378
Number of pages10
JournalJournal of the National Cancer Institute
Issue number10
StatePublished - Oct 1 2021

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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