Psychological impact of referral to an oncology hospital on patients with an ovarian mass

Pien Lof; Ellen G Engelhardt; Mignon D J M van Gent; Constantijne H Mom; Fleur M F Rosier-van Dunné; W Marchien van Baal; Harold R Verhoeve; Brenda B J Hermsen; Marjolijn B Verbruggen; Majoie Hemelaar; Jojanneke M G van de Swaluw; Haye C Knipscheer; Judith A F Huirne; Steven M Westenberg; Willemien J van Driel; Eveline M A Bleiker; Frédéric Amant; Christianne A R Lok

doi:10.1136/ijgc-2022-003753

Psychological impact of referral to an oncology hospital on patients with an ovarian mass

Int J Gynecol Cancer. 2022 Dec 13:ijgc-2022-003753. doi: 10.1136/ijgc-2022-003753. Online ahead of print.

Authors

Pien Lof¹, Ellen G Engelhardt², Mignon D J M van Gent³, Constantijne H Mom³, Fleur M F Rosier-van Dunné⁴, W Marchien van Baal⁵, Harold R Verhoeve⁶, Brenda B J Hermsen⁶, Marjolijn B Verbruggen⁷, Majoie Hemelaar⁸, Jojanneke M G van de Swaluw⁸, Haye C Knipscheer⁹, Judith A F Huirne¹⁰, Steven M Westenberg¹¹, Willemien J van Driel¹², Eveline M A Bleiker², Frédéric Amant^{12

13}, Christianne A R Lok¹²

Affiliations

¹ Department of Gynecologic Oncology, Netherlands Cancer Institute, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands p.lof@nki.nl.
² Division of Psychological Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
³ Department of Gynecologic Oncology, Amsterdam University Medical Center, location Academic Medical Center, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands.
⁴ Department of Gynecology, Tergooi Hospital, Blaricum and Hilversum, The Netherlands.
⁵ Department of Gynecology, Flevo Hospital, Almere, The Netherlands.
⁶ Department of Gynecology, OLVG, Amsterdam, The Netherlands.
⁷ Department of Gynecology, Zaans Medical Hospital, Amsterdam, The Netherlands.
⁸ Department of Gynecology, Dijklander Hospital, Hoorn and Purmerend, The Netherlands.
⁹ Department of Gynecology, Spaarne Hospital, Haarlem and Hoofddorp, The Netherlands.
¹⁰ Department of Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
¹¹ Department of Gynecology, Noordwest Clinics, Alkmaar, The Netherlands.
¹² Department of Gynecologic Oncology, Netherlands Cancer Institute, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands.
¹³ Department of Gynecologic Oncology, UZ Leuven, Leuven, Belgium.

PMID: 36600495
DOI: 10.1136/ijgc-2022-003753

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.

Keywords: ovarian cancer; ovarian neoplasms; surgery.