Esther Lems, Eveline M van Luik, Jaklien C Leemans, Marlies Y Bongers, Sander M J van Kuijk, Viola M J Verhoef, Gatske M Nieuwenhuyzen-de Boer, Janneke S Hoogstad-van Evert, Jordy E Mongula, Fleur M F Rosier-van Dunné, Jeroen Kaijser, Harold R Verhoeve, Bram L Ramaekers, Christianne A R Lok, Peggy M A J Geomini, ACCEPT study group
Women undergoing surgery for an ovarian tumor experience diminished quality of life relative to the general population, with the lowest quality of life observed among women with malignant tumors who were not referred pre-operatively. These findings underscore the potential value of highly sensitive pre-operative risk-assessment strategies to reduce false-negative non-referrals.
OBJECTIVE: The pre-operative classification of ovarian tumors remains challenging due to the inherent limitations in the diagnostic accuracy of current risk-assessment strategies, leading to both false-negative non-referrals and false-positive referrals. This study aimed to assess how (in)correct referrals affect quality of life in women undergoing surgery for an ovarian tumor.
METHODS: A prospective multi-center cohort study was conducted and 571 consecutive women with an ovarian tumor with an indication for surgery were prospectively enrolled in 28 Dutch non-oncology centers. Quality of life was measured using the EuroQol 5-Dimension 5-Level questionnaire at surgical decision-making, pre-operatively, and at 6 weeks and 3 months post-operatively. Patients were categorized as true negative, false positive, false negative, or true positive based on referral status and histopathology.
RESULTS: Among 571 women, 75.0% had surgery in a non-oncological center. Final histopathology showed 66.2% benign, 17.5% borderline, and 16.3% malignant tumors. Quality of life prior to surgery did not differ significantly between patients with benign tumors (true-negative and false-positive groups: 0.785 ± 0.183 versus 0.778 ± 0.196), or those with malignant tumors (false-negative and true-positive groups: 0.715 ± 0.244 versus 0.734 ± 0.178), p >.05 for both comparisons. Overall, patients reported lower pre-operative quality of life compared with age-matched population means. Three months post-operatively, women with benign tumors who were referred to an oncology center reported higher quality of life than those who were not referred (0.937 ± 0.081 versus 0.889 ± 0.151, p <.05). Women with malignant tumors who were not referred to an oncology center reported the lowest quality of life, although the difference with the referred group was not statistically significant.
CONCLUSIONS: Women undergoing surgery for an ovarian tumor experience diminished quality of life relative to the general population, with the lowest quality of life observed among women with malignant tumors who were not referred pre-operatively. These findings underscore the potential value of highly sensitive pre-operative risk-assessment strategies to reduce false-negative non-referrals.