The Effects of Ovarian Cancer Treatment
Cancer is a physical illness; however, the effects can be traumatic and have enduring psychological consequences for survivors.[50]In addition to the physical impact of ovarian cancer treatment, numerous psychological issues affect survivors. When an individual receives a cancer diagnosis, contemplation of mortality and feelings of distress, anxiety, and depression are common.[16,59] These emotional responses can continue throughout survivorship and may be evoked by treatment, side effects, functional limitations, financial burden, uncertainty, and fear of recurrence.
Physical Challenges
Cancer-related Fatigue
Cancer-related fatigue (CRF) affects almost 80% of patients who undergo chemotherapy and radiation and is among the top concerns reported by ovarian cancer survivors. [16, 59, 63] CRF encompasses overwhelming physical and mental exhaustion as a result of the treatments. The pervasive weariness is usually disproportional to the associated task and can impede engagement in meaningful activities such as work and leisure pursuits. CRF can also impact compliance with routines that contribute to survival and quality of life. [16, 59, 75]
Cancer-related Pain
Including Neuropathy & Plexopathy
Cancer-related pain (CRP) is another significant concern of ovarian cancer survivors because it can affect occupational performance.[19, 58, 62] Common types of pain among ovarian cancer survivors are back, abdominal, pelvic, and pain during intercourse.[13, 26, 63]
Additionally, ovarian cancer survivors may experience peripheral neuropathy, which includes tingling, numbness, weakness, and hypersensitivity in the extremities due to nerve damage from treatment.[16, 26, 36, 63]
Peripheral neuropathy can impact stability, balance, and posture. Plexopathy is another type of cancer-related pain and is caused by radiation therapy. Plexopathy affects blood vessels, nerves, and the lymphatic system and may cause persistent pain, muscle atrophy, and sensory changes.[16]
Gastro-
intestinal
Issues
A significant number of ovarian cancer survivors experience gastrointestinal (GI) issues after the acute stage of survivorship and even without recurrence of the disease. [63, 66]
GI symptoms include abdominal pain, nausea, diarrhea, constipation, lack of appetite, indigestion, bloating, fullness while eating, strictures, and bowel obstruction. These symptoms can be debilitating and limit functional activities.[63, 64] Moreover, GI symptoms can also be upsetting because they mirror the symptoms of ovarian cancer and the side effects of treatment.
Sexual Dysfunction
Sexual dysfunction is one of the most prevalent and distressing side effects of treatment in ovarian cancer survivors, and it profoundly affects an individual's quality of life.[13, 58] Ovarian cancer treatment generally includes radical abdominopelvic debulking surgery with removal of the tumor, ovaries, fallopian tubes, cervix, and uterus, followed by multiple rounds of intense platinum-based chemotherapy.[30, 34] These modalities can cause irreversible changes such as vaginal shortening and pelvic nerve damage.
Additionally, ovarian cancer treatment triggers immediate menopause in pre-menopausal survivors causing vasomotor symptoms such as hot flashes and night sweats.[30, 34, 64] Treatments can also cause severe genitourinary symptoms, including urinary urgency, vaginal dryness, vaginal atrophy, vaginal narrowing, pelvic floor dysfunction, and painful intercourse. Furthermore, the side-effects amplify genitourinary symptoms in post-menopausal survivors.[64]
Decreased arousal, diminished libido, decreased sexual satisfaction, negative body image, mood, and sleep disorders are also associated with sexual dysfunction.[13, 26, 30, 34] Sexual dysfunction is distressing because symptoms worsen over time. Despite its prevalence and the physical, psychological, and social impact that sexual dysfunction can have on ovarian cancer survivors, it remains underestimated and undertreated by healthcare professionals.
Psychological
Impact
Distress
Distress is an overwhelming emotional reaction to a life-threatening event that can impede an individual’s ability to function.[16] Ovarian cancer survivors experience considerable emotional distress at the time of diagnosis, as some perceive it as a death sentence. The expedited surgery process and the treatment aftermath can also cause distress. Some survivors may ruminate on self-care needs and functional limitations.[59]
Additionally, sex-related distress is higher in ovarian cancer survivors than in other women.[26] About 90% of ovarian cancer survivors indicate that sexual dysfunction affected them psychologically and influenced relationships.[34] The pain, scarring, burns, and nerve damage causes devastating effects on sexuality and leads to problems with intimacy, body image, and self-confidence.[27, 34, 59]
Moreover, women associate reproductive organs with womanhood, and some ovarian cancer survivors perceive the removal of ovaries and subsequent infertility as a loss of femininity.[33, 37, 64] The distress may be enduring and lead to anxiety and depression because survivors do not know how to address these issues. [37]
Anxiety & Depression
Anxiety involves uneasiness and irritability that can have physiological effects such as increased heart rate, blood pressure, breathing, and sleep disturbance. Persistent anxiety can precipitate posttraumatic stress characterized by intrusive thoughts, hypo-arousal, and hyperarousal. In contrast, depression is a mood disorder with feelings of constant despair and loss of interest in routines which may lead to avoidance behaviors.[16]
Ovarian cancer survivors experience higher rates of depression compared to survivors of other types of cancer and the general population. [19, 26] The source of anxiety and depression among ovarian cancer survivors may be attributed to treatment, prognosis, loss of sexual identity, and fear of recurrence, metastasis, and death.[26, 50, 63]
Sleep Disturbances
Approximately one-third of gynecological cancer survivors report sleep disturbances following treatment.[29] Cancer-related sleep disturbance (CRSD) encompasses insomnia, premature awakening, sleep inefficiencies, and unrefreshing sleep and can have physical and psychological effects on ovarian cancer survivors. Additionally, CRSD is linked to decreased quality of life and exacerbated side effects such as depression, fatigue, decreased occupational performance, and impaired cognition.[16, 19]
Cognitive Impairments aka
"Chemo-Brain"
Cognition is integral to an individual’s identity, assumption of roles, and performance in all valued occupations. However, the harsh effects of cancer and treatment can severely limit function, participation and diminish quality of life.[16]
Cancer-related cognitive impairment (CRCI) affects individuals at all stages of survivorship and is the most dreaded and upsetting side effect of treatment. Changes in attention, concentration, memory, processing, word-finding abilities, and acquisition of new knowledge are manifestations of CRCI. [16, 24]