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Original research
Psychological impact of referral to an oncology hospital on patients with an ovarian mass
  1. Pien Lof1,
  2. Ellen G Engelhardt2,
  3. Mignon D J M van Gent3,
  4. Constantijne H Mom3,
  5. Fleur M F Rosier-van Dunné4,
  6. W Marchien van Baal5,
  7. Harold R Verhoeve6,
  8. Brenda B J Hermsen6,
  9. Marjolijn B Verbruggen7,
  10. Majoie Hemelaar8,
  11. Jojanneke M G van de Swaluw8,
  12. Haye C Knipscheer9,
  13. Judith A F Huirne10,
  14. Steven M Westenberg11,
  15. Willemien J van Driel1,
  16. Eveline M A Bleiker2,
  17. Frédéric Amant1,12 and
  18. Christianne A R Lok1
  1. 1 Department of Gynecologic Oncology, Netherlands Cancer Institute, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
  2. 2 Division of Psychological Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
  3. 3 Department of Gynecologic Oncology, Amsterdam University Medical Center, location Academic Medical Center, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
  4. 4 Department of Gynecology, Tergooi Hospital, Blaricum and Hilversum, The Netherlands
  5. 5 Department of Gynecology, Flevo Hospital, Almere, The Netherlands
  6. 6 Department of Gynecology, OLVG, Amsterdam, The Netherlands
  7. 7 Department of Gynecology, Zaans Medical Hospital, Amsterdam, The Netherlands
  8. 8 Department of Gynecology, Dijklander Hospital, Hoorn and Purmerend, The Netherlands
  9. 9 Department of Gynecology, Spaarne Hospital, Haarlem and Hoofddorp, The Netherlands
  10. 10 Department of Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
  11. 11 Department of Gynecology, Noordwest Clinics, Alkmaar, The Netherlands
  12. 12 Department of Gynecologic Oncology, UZ Leuven, Leuven, Belgium
  1. Correspondence to Ms Pien Lof, Department of Gynecologic Oncology, Netherlands Cancer Institute, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands; p.lof{at}nki.nl

Abstract

Objectives In patients with an ovarian mass, a risk of malignancy assessment is used to decide whether referral to an oncology hospital is indicated. Risk assessment strategies do not perform optimally, resulting in either referral of patients with a benign mass or patients with a malignant mass not being referred. This process may affect the psychological well-being of patients. We evaluated cancer-specific distress during work-up for an ovarian mass, and patients’ perceptions during work-up, referral, and treatment.

Methods Patients with an ovarian mass scheduled for surgery were enrolled. Using questionnaires we measured (1) cancer-specific distress using the cancer worry scale, (2) patients’ preferences regarding referral (evaluated pre-operatively), and (3) patients’ experiences with work-up and treatment (evaluated post-operatively). A cancer worry scale score of ≥14 was considered as clinically significant cancer-specific distress.

Results A total of 417 patients were included, of whom 220 (53%) were treated at a general hospital and 197 (47%) at an oncology hospital. Overall, 57% had a cancer worry scale score of ≥14 and this was higher in referred patients (69%) than in patients treated at a general hospital (43%). 53% of the patients stated that the cancer risk should not be higher than 25% to undergo surgery at a general hospital. 96% of all patients were satisfied with the overall work-up and treatment. No difference in satisfaction was observed between patients correctly (not) referred and patients incorrectly (not) referred.

Conclusions Relatively many patients with an ovarian mass experienced high cancer-specific distress during work-up. Nevertheless, patients were satisfied with the treatment, regardless of the final diagnosis and the location of treatment. Moreover, patients preferred to be referred even if there was only a relatively low probability of having ovarian cancer. Patients’ preferences should be taken into account when deciding on optimal cut-offs for risk assessment strategies.

  • ovarian neoplasms
  • surgery
  • ovarian cancer

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/ijgc-2022-003753

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors CL and EB designed the project. PL and CL directed the project. CL, PL, MvG, CM, FR-vD, WvB, HV, BH, MV, MH, JvdS, HK, JH, SW and WvD recruited the participants and collected the questionnaires and corresponding data. PL performed the statistical analyses in consultation with EE. PL wrote the manuscript in consultation with EE and CL. All authors provided critical feedback, and helped shape the analysis and the manuscript. CL acted as guarantor.

    • Funding Funding of this project was provided by the Hanarth Fonds.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.