Article

Sword of Damocles Cutting Through the Life Stages of Women With Ovarian Cancer

Sandra K. Cesario

Leslie S. Nelson

Anita Broxson

Anastasia L. Cesario

ovarian neoplasms
ONF 2010, 37(5), 609-617. DOI: 10.1188/10.ONF.609-617

Purpose/Objectives: To identify the most prevalent worries and fears of women diagnosed with ovarian cancer.

Research Approach: Online survey design was used to elicit qualitative data. Examination of worry was a single question extracted from a broader investigation.

Setting: A "virtual interview" enabled women from 12 countries and 44 states to participate in this study.

Participants: 360 English-speaking women aged 19-82 years with a diagnosis of ovarian cancer. Ninety-one percent of the women were partnered, were Caucasian, and had received at least some college education. The sample was equally stratified on income, geographic location (rural versus urban), and distance to healthcare services.

Methodologic Approach: A descriptive survey was used to investigate "worry" among women with ovarian cancer. Colaizzi's qualitative method was used to analyze the narrative responses.

Main Research Variables: Worries and fears of women with ovarian cancer stratified by age and development stage.

Findings: Consistent with previously published studies, worry about recurrence and fear of death were expressed by most women, regardless of age, ethnicity, or stage of life. Other worries expressed by study participants varied by age and development and were found to correlate with the last three stages of life as described in Erikson's Theory of Psychosocial Development.

Conclusions: Age and development stage are key determinants of the needs and concerns of women with ovarian cancer.

Interpretation: Age and development stage should be considered when developing an individualized plan of care. Because recurrence is common among this population, the fear of death exists regardless of age and should be explored by nurses, particularly during periods of remission.

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    References

    American Cancer Society. (2010). Cancer facts and figures, 2010. Atlanta, GA: Author.
    Andersen, M., Drescher, C., Zheng, Y., Bowen, D., Wilson, S., Young, A., … Urban, N. (2007). Changes in cancer worry associated with ovarian cancer screening. Psycho-Oncology, 16, 814-820.
    Anderson, W., Alexander, S., Rodriguez, K., Jeffreys, A., Olsen, M., Pollak, K., … Arnold, R. M. (2008). "What concerns me is …" Expression of emotion by advanced cancer patients during outpatient visits. Supportive Care in Cancer, 16, 803-811. doi: 10.1007/s00520-007-0350-8
    Baker, F., Denniston, M., Smith, T., & West, M. (2005). Adult cancer survivors: How are they faring? Cancer, 104(11, Suppl.), 2565-2576. doi: 10.1002/cncr.21488
    Bennett, P., Wilkinson, C., Turner, J., Edwards, R., France, B., Griffin, G., & Gray, J. (2008). Factors associated with intrusive cancer-related worries in women undergoing cancer genetic risk assessment. Familial Cancer, 8, 159-165. doi: 10.1007/s10689-008-9221-9
    Burnet, K., & Robinson, L. (2000). Psychological impact of recurrent cancer. European Journal of Oncology Nursing, 4, 29-38. doi: 10.1054/ejon.1999.0033
    Chan, J., Urban, R., Cheung, M., Osann, K., Husain, A., Teng, N., … Leiserowitz, G. S. (2006). Ovarian cancer in younger versus older women: A population-based analysis. British Journal of Cancer, 95, 1314-1320. doi: 10.1038/sj.bjc.6603457
    Colaizzi, P. F. (1978). Psychological research as the phenomenologist views it. In R. Valle and M. King (Eds.), Existential phenomenological alternatives for psychology (pp. 48-71). New York, NY: Oxford University Press.
    Crespi, C., Ganz, P., Petersen, L., Castillo, A., & Caan, B. (2008). Refinement and psychometric evaluation of the Impact of Cancer scale. Journal of the National Cancer Institute, 100, 1530-1541. doi: 10.1093/jnci/djn340
    de Gaetano, C., & Lichtman, S. (2004). Care of elderly women with ovarian cancer. Geriatric Nursing, 25, 329-335. doi: 10.1016/j.gerinurse.2004.09.015
    Ekwall, E., Ternestedt, B., & Sorbe, B. (2007). Recurrence of ovarian cancer—Living in limbo. Cancer Nursing, 30, 270-277. doi: 10.1097/01.NCC.0000281729.10362.3a
    Erikson, E. (1963). Chapter 7: Eight ages of man. In Childhood and society (pp. 247-274). New York, NY: W. W. Norton & Company, Inc.
    Ferrell, B., Cullinane, C., Ervin, K., Melancon, C., Uman, G., & Juarez, G. (2005). Perspectives on the impact of ovarian cancer: Women's views of quality of life. Oncology Nursing Forum, 32, 1143-1149. doi: 10.1188/05.ONF.1143-1149
    Ferrell, B., Ervin, K., Smith, S., Marek, T., & Melancon, C. (2002). Family perspectives of ovarian cancer. Cancer Practice, 10, 269-276. doi: 10.1046/j.1523-5394.2002.106001.x
    Fitch, M. (2003). Psychosocial management of patients with recurrent ovarian cancer: Treating the whole patient to improve quality of life. Seminars in Oncology Nursing, 19(1, Suppl.), 40-53.
    Gotay, C., & Pagano, I. (2007). Assessment of Survivor Concerns (ASC): A newly proposed brief questionnaire. Health and Quality of Life Outcomes, 13(5), 15-25. doi: 10.1186/1477-7525-5-15
    Hirai, K., Shiozaki, M., Motooka, H., Arai, H., Koyama, A., Inui, H., & Uchitomi, Y. (2008). Discrimination between worry and anxiety among cancer patients: Development of a Brief Cancer-Related Worry Inventory. Psycho-Oncology, 17, 1172-1179. doi: 10.1002/pon.1348
    Howell, D., Fitch, M., & Deane, K. (2003). Women's experiences with recurrent ovarian cancer. Cancer Nursing, 26, 1-9. doi: 10.1097/00002820-200302000-00001
    Huitt, W. (2008). Socioemotional development. In Educational psychology interactive. Valdosta, GA: Valdosta State University. Retrieved from http://chiron.valdosta.edu/whuitt/col/affsys/erikson.html http://chiron.valdosta.edu/whuitt/col/affsys/erikson.html
    Lehto, R., & Cimprich, B. (2009). Worry and the formation of cognitive representations of illness in individuals undergoing surgery for suspected lung cancer. Cancer Nursing, 32, 2-10. doi: 10.1097/01.NCC.0000343363.75752.f1
    Lobchuck, M., & Bokhari, S. (2008). Linkages among empathic behaviors, physical symptoms, and psychological distress in patients with ovarian cancer: A pilot study. Oncology Nursing Forum, 35, 808-814. doi: 10.1188/08.ONF.808-814
    Mahon, S., & Casperson, D. (1997). Exploring the psychosocial meaning of recurrent cancer: A descriptive study. Cancer Nursing, 20, 178-186. doi: 10.1097/00002820-199706000-00003
    Mitchell, T. (2007). The social and emotional toll of chemotherapy—Patients' perspectives. European Journal of Cancer Care, 16, 39-47. doi: 10.1111/j.1365-2354.2006.00701.x
    Mosher, C., Lipkus, I., Sloane, R., Kraus, W., Snyder, D., Peterson, B., … Demark-Wahnefried, W. (2008). Cancer survivors' health worries and associations with lifestyle practices. Journal of Health Psychology, 13, 1105-1112. doi: 10.1177/1359105308095964
    National Cancer Institute. (2010). Surveillance Epidemiology and End Results (SEER). Fast stats: Ovarian cancer. Retrieved from http://seer.cancer.gov/faststats/index.php
    National Ovarian Cancer Coalition. (2007). Ovarian cancer resource guide for women with recurrent disease. Retrieved from http://www.ovarian.org/Images/ResourceGuideRecurrentOvarianCancer.pdf
    Parkin, D., Bray, F., Ferlay, J., & Pisani, P. (2005). Global cancer statistics, 2002. CA: A Cancer Journal for Clinicians, 55, 74-108. doi: 10.3322/canjclin.55.2.74
    Posma, E., van Weert, J., Jansen, J., & Bensing, J. (2009). Older cancer patients' information and support needs surrounding treatment: An evaluation through the eyes of patients, relatives, and professionals. Retrieved from http://www.biomedcentral.com/1472-6955/8/1
    Power, J., Brown, L., & Ritvo, P. (2008). A qualitative study examining psychosocial distress, coping, and social support across the stages and phases of epithelial ovarian cancer. Health Care for Women International, 29, 366-383. doi: 10.1080/07399330701876521
    Reb, A. (2007). Transforming the death sentence: Elements of hope in women with advanced ovarian cancer [Online exclusive]. Oncology Nursing Forum, 34, E70-E81. doi: 10.1188/07.ONF.E70-E81
    Sherwood, P., Donovan, H., Rosenzweig, M., Hamilton, R., & Bender, C. (2008). A house of cards: The impact of treatment costs on women with breast and ovarian cancer. Cancer Nursing, 31, 470-477. doi: 10.1097/01.NCC.0000339255.75947.a8
    Steele, R., & Fitch, M. (2008). Supportive care needs of women with gynecologic cancer. Cancer Nursing, 31, 284-291. doi: 10.1097/01.NCC.0000305743.64452.30
    Stewart, D., Wong, F., Duff, S., Melancon, C., & Cheung, A. (2001). "What doesn't kill you makes you stronger:" An ovarian cancer survivor survey. Gynecologic Oncology, 83, 537-542. doi: 10.1006/gyno.2001.6437
    Svensson, H., Brandberg, Y., Einbeigi, Z., Hatschek, T., & Ahlberg, K. (2009). Psychological reactions to progression of metastatic breast cancer—An interview study. Cancer Nursing, 32, 55-63.
    Tian, Y., & Robinson, J. (2008). Incidental health information use and media complementarity: A comparison of senior and nonsenior cancer patients. Patient Education and Counseling, 71, 340-344. doi: 10.1016/j.pec.2008.02.006
    Vickberg, S. (2003). The Concerns About Recurrence Scale (CARS): A systematic measure of women's fears about the possibility of breast cancer recurrence. Annals of Behavioral Medicine, 25, 16-24. doi: 10.1207/S15324796ABM2501_03
    White, H., & Cohen, H. (2008). The older cancer patient. Nursing Clinics of North America, 43, 307-322. doi: 10.1016/j.cnur.2008.03.003