Dissertation
Risk and resilience in ovarian cancer survivorship: longitudinal impacts on psychosocial functioning
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Summer 2023
DOI: 10.25820/etd.007213
Abstract
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),
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
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.
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.
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.
Details
- Title: Subtitle
- Risk and resilience in ovarian cancer survivorship: longitudinal impacts on psychosocial functioning
- Creators
- Jessica S. Armer
- Contributors
- Susan Lutgendorf (Advisor)Molly A Nikolas (Committee Member)Alan Kim Johnson (Committee Member)Isaac T Petersen (Committee Member)Mark W Vander Weg (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Psychology
- Date degree season
- Summer 2023
- Publisher
- University of Iowa
- DOI
- 10.25820/etd.007213
- Number of pages
- xii, 128 pages
- Copyright
- Copyright 2022 Jessica S. Armer
- Language
- English
- Date submitted
- 04/21/2022
- Description bibliographic
- Includes bibliographical references (pages 78-106).
- Public Abstract (ETD)
Compared to other cancers, ovarian cancer has a relatively high mortality rate, with a 5- year survival rate of 47.4% for advanced stage disease. Much of the existing research on ovarian cancer survivorship has focused on the time surrounding and just after diagnosis and primary cancer treatment (e.g. chemotherapy). Previous research has indicated a connection between mental health risk factors, such as depression or anxiety, and poorer psychosocial outcomes in ovarian cancer patients. Additionally, there is previous evidence to support the importance of potential resilience factors, such as spirituality and social connection, during initial cancer diagnosis and treatment. However, less is known about the long-term impact of mental health risk factors and potential resilience factors in women surviving years after their initial diagnosis (long-term survivors). This project aims to examine the stability of risk factors (such as anxiety or depression) and resilience factors (such as social support, spirituality, or psychological wellbeing) over the first year of ovarian cancer survivorship that may predict long-term mental health and quality of life outcomes 4 or more years after cancer diagnosis.
Additionally, cancer survivors have currently been facing an unprecedented challenge in the global COVID-19 pandemic. This study also aims to understand how increased COVID-19-related disruption and life stress after primary cancer treatment may impact relationships between initial risk and long-term outcomes among ovarian cancer survivors. Results suggest that while most long-term ovarian cancer survivors are at overall low risk for persistent mental health disruption over their first year of treatment, those at higher risk over the first year are more likely to experience long-term poorer outcomes in the areas of sleep, depression, anxiety, positive coping strategies, and psychological well-being. In addition, survivors showed high levels of resilience at 1 year post-treatment. Both life stress and COVID-related-disruption were shown to impact relationships between elevated mental health risk and later negative outcomes (COVID- 19-disruption and poorer sleep, severity of previous life stress and self-acceptance, a component of psychological well-being.) Taken together, these results suggest that persistent negative mental health states over the first year of cancer treatment have long-lasting outcomes even after the conclusion of treatment. This emphasizes both the urgency and continued need for increases in accessibility of appropriate mental health screening and treatment options for ovarian cancer patients near the time of diagnosis.
- Academic Unit
- Psychological and Brain Sciences
- Record Identifier
- 9984454320402771
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