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Symptom Experience and Self-rated Physical Functioning in Patients With Ovarian Cancer Receiving Chemotherapy: A Longitudinal Study
  1. Ingvild Vistad, MD, PhD*,
  2. Milada Cvancarova, PhD,,
  3. Guro Lindviksmoen Astrup, RN, PhD§,
  4. Tone Rustøen, RN, PhD, and
  5. Astrid H. Liavaag, MD, PhD#
  1. *Department of Obstetrics and Gynecology, Sørlandet Hospital HF, Kristiansand;
  2. Department of Public Health, Oslo and Akershus University College;
  3. Department of Research and Development, Division of Emergencies and Critical Care,
  4. §Department of Oncology, Division of Cancer Medicine, and
  5. Research Support Services, Oslo University Hospital;
  6. Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo; and
  7. #Department of Obstetrics and Gynecology, Sørlandet Hospital HF, Arendal, Norway.
  1. Address correspondence and reprint requests to Ingvild Vistad, MD, PhD, Department of Obstetrics and Gynecology, Sorlandet Hospital HF, Service Box 416, 4604 Kristiansand, Norway. E-mail:


Objectives In this longitudinal study, we investigated occurrence of multiple symptoms during chemotherapy in patients with ovarian cancer. We also evaluated whether self-rated physical functioning, selected demographic, and clinical variables were associated with symptom burden over time.

Methods and Materials In total, 82 patients provided longitudinal data (4 time points) by completing questionnaires including the Memorial Symptom Assessment Scale, the Karnofsky Performance Status Scale, and the Self-Administered Comorbidity Questionnaire. Demographic and clinical data were collected from medical records. Karnofsky Performance Status Scale score of less than 80 was defined as low and Karnofsky Performance Status Scale score 80 or higher as high physical functioning. Possible associations between the most frequent symptoms and selected variables were modeled using binary logistic regression for repeated measures.

Results Palliative treatment was the main reason for treatment for 85% of the patients. Sixty percent of the patients reported high prevalence of symptoms, particularly lack of energy, difficulty sleeping, and worrying. The total number of symptoms increased during the treatment and returned to enrollment values at 6 months. This trend was dominated with physical symptoms. When we compared women with low (n = 33) versus high physical functioning (n = 49) at enrollment, low physical functioning was significantly associated with more symptoms and distress for the study period. Patients with low physical functioning were more likely to experience lack of energy (odds ratio [OR] = 8.33), feeling drowsy (OR = 4.17), feeling bloated (OR = 2.44), feeling sad (OR = 3.33), having pain (OR = 4.72), and worrying (OR = 2.50), and this remained stable throughout the observation period of 6 months.

Conclusions A high symptom burden was reported in this cohort of patients with ovarian cancer mainly treated with palliative intent. Low self-rated physical functioning was strongly associated with high symptom burden for the 6-month period. When chemotherapy is discussed with patients with ovarian cancer with low physical functioning, possible palliation benefits must be weighed against the added risk of long-term distressful symptoms that chemotherapy implies.

  • Ovarian cancer
  • Symptoms
  • Physical functioning
  • Longitudinal
  • Chemotherapy

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  • The study was funded by the Norwegian Cancer Society.

  • The authors declare no conflicts of interest.