Psychological adjustment differences in ovarian cancer patients receiving different treatment modalities and their clinical significance

Abstract

BACKGROUND

Ovarian cancer patients often face complex treatment processes and psychological challenges, with different treatment modalities potentially affecting patients’ psychological adjustment abilities.

AIM

To explore the differences in psychological adjustment patterns among ovarian cancer patients receiving surgery, chemotherapy, targeted therapy, and combined therapy, and to analyze their relationship with clinical outcomes.

METHODS

A retrospective analysis was conducted on the clinical data of 286 ovarian cancer patients who received different treatment modalities from January 2020 to December 2023. Patients were divided into surgery group (n = 78), chemotherapy group (n = 65), targeted therapy group (n = 61), and combined therapy group (n = 82). The Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Psychological Adjustment to Cancer Scale were used to assess psychological status, while quality of life, treatment adherence, and two-year survival rate data were collected. Some patients (n = 76) received systematic psychological intervention, and the intervention effects were evaluated.

RESULTS

Patients in the combined therapy group had significantly higher Self-Rating Anxiety Scale (56.3 ± 7.2) and Self-Rating Depression Scale (58.4 ± 6.9) scores than other groups, with the highest incidence of anxiety (58.5%) and depression (62.2%); the targeted therapy group scored highest in the positive coping dimension (28.5 ± 3.6) and had the lowest incidence of anxiety and depression (29.5%/31.1%). Logistic regression analysis showed that positive coping (odds ratio = 2.86, 95% confidence interval: 1.75-4.68) and utilization of social support (odds ratio = 2.13, 95% confidence interval: 1.42-3.56) were protective factors for good treatment adherence. Longitudinal assessment showed that although all patients experienced increased anxiety and depression symptoms at 3 months of treatment, the targeted therapy group and surgery group showed significant improvement at 6 months (P < 0.05), while the combined therapy group showed no significant improvement. Psychological intervention effectively improved patients’ treatment adherence (by 22.7%) and quality of life (by 15.6 points), with the best effect in the combined therapy group (anxiety incidence decreased by 30.5%, P < 0.001).

CONCLUSION

Different treatment modalities significantly affect the psychological adjustment abilities of ovarian cancer patients, with combined therapy patients facing greater psychological challenges, while targeted therapy patients exhibit healthier psychological adjustment patterns.

Key Words: Ovarian cancer; Treatment modality; Psychological adjustment; Treatment adherence; Psychological intervention

Core Tip: Systematic psychological intervention demonstrates substantial clinical benefits, improving treatment adherence by 22.7% and quality of life by 15.6 points, with combined therapy patients showing the greatest response to intervention (30.5% reduction in anxiety incidence). These findings support the implementation of treatment-specific psychological support protocols, with combined therapy patients requiring more intensive and prolonged psychological interventions to optimize clinical outcomes and patient well-being.

INTRODUCTION

Ovarian cancer, one of the deadliest malignancies of the female reproductive system, imposes a severe physical and psychological burden on patients. With the diversification of modern cancer treatment modalities, the impact of different therapeutic approaches on patients’ mental health has become a growing clinical concern. This study aims to explore the differences in psychological adaptation patterns among ovarian cancer patients receiving different treatment modalities and analyze their association with clinical outcomes, providing empirical evidence for the development of individualized psychological intervention strategies[1-3].

The diagnosis and treatment journey of ovarian cancer is challenging. As a “silent killer”, ovarian cancer presents with subtle early symptoms, with approximately 70% of patients diagnosed at advanced stages, a disease characteristic that itself brings tremendous psychological impact. Traditional comprehensive treatment protocols typically include debulking surgery and platinum-based chemotherapy, which, although effective, are often accompanied by severe physical discomfort, loss of fertility, and dramatic lifestyle changes, further exacerbating patients’ psychological burden[4]. In recent years, with the development of precision medicine, targeted agents such as poly (ADP-ribose) polymerase (PARP) inhibitors have demonstrated favorable efficacy and lower toxicity in specific populations, bringing new hope to ovarian cancer treatment while potentially altering patients’ disease experience and psychological adaptation process.

Psychological adaptation, as a core mechanism for cancer patients to cope with their disease, has been proven to be closely related to quality of life, treatment adherence, and survival prognosis[5]. Research indicates that 40%-70% of ovarian cancer patients experience varying degrees of anxiety and depression following diagnosis, which not only reduces patients’ quality of life but may also indirectly affect disease prognosis by influencing treatment adherence, immune function, and neuroendocrine regulation[6]. The conceptual model of psychological adaptation has evolved from a unidimensional to a multidimensional approach, with modern psycho-oncology emphasizing that psychological adaptation is a complex dynamic process involving cognitive assessment, emotional regulation, behavioral coping, and social interaction. The three dimensions assessed by the Psychological Adjustment to Cancer Scale (PACS) - positive coping, negative avoidance, and social support utilization - provide a more comprehensive framework for understanding the psychological adaptation of cancer patients[7-9].

In the Chinese cultural context, the psychological adaptation of ovarian cancer patients exhibits unique characteristics. Compared to Western societies, there are significant differences in disease attribution, family support patterns, and doctor-patient communication in Chinese traditional culture[10]. The “family-centered” value system views disease as a family rather than an individual burden, potentially enhancing the protective effect of social support; meanwhile, taboos and stigma associated with cancer may lead to concealment of the condition and social isolation. Additionally, the dominant role of family members in treatment decision-making in the Chinese healthcare system, as well as physicians’ cautious approach to disclosing prognostic information, may influence patients’ cognition of the disease and psychological adaptation process[11].

In recent years, evidence-based research has confirmed that interventions such as cognitive behavioral therapy (CBT), mindfulness-based stress reduction (MBSR), and supportive psychotherapy (SPT) can effectively improve the psychological status and quality of life of cancer patients[12]. However, existing intervention strategies often adopt a “one-size-fits-all” approach, lacking personalized design for patients with different treatment backgrounds. With the deepening of precision medicine concepts, psychological intervention strategies tailored to patients’ specific treatment modalities have become an important research direction[13-15].

Despite increasing attention to the mental health issues of ovarian cancer patients, systematic studies on the impact of different treatment modalities on psychological adaptation remain relatively scarce, particularly comparative studies between emerging targeted therapies and traditional treatment approaches. Existing research often focuses on psychological status assessment at a single time point or under a single treatment modality, lacking dynamic monitoring and multidimensional analysis of psychological trajectories throughout the treatment course[16-18]. Furthermore, common psychological interventions in clinical practice lack specificity, making it difficult to meet the differentiated needs of patients with various treatment backgrounds.

Through prospective tracking and multidimensional assessment of 286 ovarian cancer patients receiving different treatment modalities, this study aims to reveal the association patterns between treatment modalities and psychological adaptation abilities, analyze the relationship between psychological adaptation and treatment adherence, quality of life, and prognosis, and evaluate the effects of targeted psychological interventions, thereby providing new perspectives and strategies for the comprehensive management of ovarian cancer patients and optimizing overall survival quality and clinical outcomes.

MATERIALS AND METHODS

Study design and patient selection

This retrospective study included 286 patients with ovarian cancer who were treated in the Department of Gynecologic Oncology at Taihe Hospital between January 2020 and December 2023. The study was approved by the Medical Ethics Committee of Taihe Hospital, Shiyan City (Approval No. SY-TY-2022009125), and written informed consent was obtained from all participants prior to data collection.

Inclusion criteria were as follows: (1) Female patients aged 18-75 years; (2) Newly diagnosed with ovarian cancer; (3) Eastern Cooperative Oncology Group (ECOG) performance status score of 0-2; (4) An expected survival time of at least 6 months; and (5) Complete clinical data. Exclusion criteria included: (1) History of other malignancies; (2) Severe dysfunction of vital organs; (3) Diagnosed psychiatric disorders prior to enrollment; (4) Receipt of systematic psychological treatment or psychotropic medications within the past 6 months; and (5) Incomplete clinical records or inability to complete follow-up.

Based on the primary treatment modality received, patients were categorized into four groups: Surgery group (n = 78): Received tumor debulking surgery only; chemotherapy group (n = 65): Received mainly paclitaxel combined with carboplatin; targeted therapy group (n = 61): Received agents such as PARP inhibitors or anti-angiogenic drugs; combined therapy group (n = 82): Received surgery followed by chemotherapy and/or targeted therapy.

Observation indicators and assessment methods

This study collected patients’ demographic characteristics (age, education level, marital status, etc.) and clinical characteristics (Federation of Gynecology and Obstetrics FIGO stage, pathological type, carbohydrate antigen 125 level, etc.), and used multiple assessment tools for comprehensive evaluation: Self-Rating Anxiety Scale (SAS, ≥ 50 points defined as anxiety) and Self-Rating Depression Scale (SDS, ≥ 53 points defined as depression) to assess psychological status; PACS to evaluate three dimensions: Positive coping, negative avoidance, and utilization of social support; quality of life assessment using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 and ovarian cancer-specific module (EORTC Quality of Life Questionnaire Ovarian Cancer Module 28); treatment adherence classified into three levels based on the proportion of completed planned treatment: Complete adherence (≥ 90%), partial adherence (60%-89%), and non-adherence (< 60% or self-discontinuation).

Follow-up and study endpoints

Patients were followed up every 3 months after treatment initiation for at least 24 months, through outpatient review, telephone follow-up, and home visits, with assessments conducted before treatment, during treatment (3^rd month), after treatment completion (6^th month), and during follow-up period (12^th and 24^th month). The primary study endpoint was the difference in psychological adjustment status among different treatment groups and the correlation between psychological adjustment ability and quality of life; secondary endpoints included the relationship between treatment adherence and psychological adjustment status, the relationship between two-year survival rate and psychological adjustment status, and the impact of psychological intervention on treatment adherence and quality of life.

Statistical analysis

The SPSS version 25.0 software was used for statistical analysis. Measurement data were expressed as mean ± SD, and between-group comparisons were conducted using ANOVA count data were expressed as frequency and percentage, using χ² test or Fisher’s exact test. Pearson or Spearman correlation analysis was used to evaluate correlations between variables. Logistic regression analysis was used to determine the relationship between psychological adjustment ability and treatment adherence. Cox proportional hazards regression model was used to analyze prognostic factors related to survival. P < 0.05 was considered statistically significant.

RESULTS

Baseline characteristics comparison

The 286 ovarian cancer patients included in the study had a mean age of 52.7 ± 8.6 years (surgery group 52.1 ± 8.3 years, chemotherapy group 53.4 ± 8.7 years, targeted therapy group 51.9 ± 8.4 years, combined therapy group 53.2 ± 8.9 years), high school and above education accounted for 46.2%-50.8%, marriage rate 83.1%-86.9%, average body mass index 23.5 ± 3.2 kg/m² (no statistical significance in differences between groups, P = 0.876). Serous carcinoma was the most common pathological type in all groups (70.5%-75.6%), followed by mucinous carcinoma (9.8%-12.3%), endometrioid carcinoma (6.6%-9.2%), and clear cell carcinoma (4.9%-7.7%); moderate to low differentiation proportions were 67.9% in the surgery group, 72.3% in the chemotherapy group, 66.1% in the targeted therapy group, and 75.6% in the combined therapy group (P = 0.127); positive family tumor history proportions were 4.8%-7.7% (P = 0.762); previous surgery history proportions were 23.1%-28.6% (P = 0.549); comorbidities such as hypertension and diabetes were present in 27.4%-32.8% (P = 0.385); postmenopausal patients accounted for 62.8%, 64.6%, 61.3%, and 63.4%, respectively (P = 0.875). There were no statistically significant differences in the above baseline characteristics among the four groups (P > 0.05), indicating comparability. However, in terms of FIGO staging, patients in the combined therapy group had a higher tumor burden, with stage III-IV patients accounting for 76.8% (63/82), significantly higher than the surgery group’s 42.3% (33/78), chemotherapy group’s 56.9% (37/65), and targeted therapy group’s 44.3% (27/61) (χ² = 24.82, P < 0.01), while the initial median carbohydrate antigen 125 level was correspondingly higher (876.5 U/mL vs 425.3 U/mL, 631.7 U/mL, and 458.2 U/mL; P < 0.01). In addition, the proportion of patients with ECOG score ≥ 2 in the combined therapy group (26.8%) was higher than the other three groups (13.5%-18.5%, P < 0.05), suggesting a relatively poorer overall health status (Table 1).

Table 1 Comprehensive comparison of clinical characteristics, psychological status, and treatment outcomes among four groups of ovarian cancer patients, mean ± SD/ n (%).

Parameters	Surgery group (n = 78)	Chemotherapy group (n = 65)	Targeted therapy group (n = 61)	Combined therapy group (n = 82)	F/χ2	P value
Baseline characteristics
Age (years)	52.1 ± 8.3	53.4 ± 8.7	51.9 ± 8.4	53.2 ± 8.9	NA	0.632
FIGO stage III-IV	33 (42.3)	37 (56.9)	27 (44.3)	63 (76.8)	NA	< 0.001b
ECOG score 2	10 (12.8)	12 (18.5)	10 (13.5)	22 (26.8)	NA	0.021a
CA125 (U/mL, median)	425.3	631.7	458.2	876.5	NA	< 0.001b
Psychological status
SAS score	48.5 ± 6.7	52.1 ± 6.9	46.9 ± 6.4	56.3 ± 7.2	25.64	< 0.001b
Anxiety incidence	28 (35.9)	31 (47.7)	18 (29.5)	48 (58.5)	14.87	0.002b
SDS score	50.2 ± 6.5	53.6 ± 7.1	49.1 ± 6.6	58.4 ± 6.9	27.32	< 0.001b
Depression incidence	30 (38.5)	32 (49.2)	19 (31.1)	51 (62.2)	16.53	0.001b
Psychological adjustment (PACS scale)
Positive coping	25.3 ± 3.2	24.1 ± 3.3	28.5 ± 3.6	22.8 ± 3.4	18.97	< 0.001b
Negative avoidance	22.7 ± 3.5	24.8 ± 3.6	20.5 ± 3.2	26.9 ± 3.8	19.85	< 0.001b
Social support utilization	25.2 ± 3.4	24.9 ± 3.5	22.7 ± 3.1	21.3 ± 3.0	17.26	< 0.001b
Quality of life (EORTC QLQ-C30)
Global quality of life	67.3 ± 7.9	63.5 ± 8.1	72.6 ± 8.5	58.9 ± 8.3	26.38	< 0.001b
Physical functioning	70.2 ± 8.3	65.4 ± 8.0	74.8 ± 8.6	62.1 ± 8.2	22.76	< 0.001b
Emotional functioning	65.7 ± 7.6	61.3 ± 7.5	69.8 ± 8.0	56.2 ± 7.3	24.93	< 0.001b
Symptom severity (EORTC QLQ-C30)
Fatigue	36.5 ± 6.2	48.9 ± 7.1	32.4 ± 5.9	45.2 ± 7.0	30.68	< 0.001b
Nausea and vomiting	28.7 ± 5.6	42.3 ± 6.7	25.1 ± 5.3	36.8 ± 6.3	31.25	< 0.001b
Pain	32.6 ± 5.8	30.7 ± 5.7	27.3 ± 5.5	38.5 ± 6.5	24.69	< 0.001b
Insomnia	37.8 ± 6.3	40.2 ± 6.6	33.1 ± 6.0	45.6 ± 7.2	25.82	< 0.001b
Treatment outcomes
Complete adherence	62 (79.5)	46 (70.8)	52 (85.2)	53 (64.6)	16.94	0.010a
Partial adherence	12 (15.4)	14 (21.5)	7 (11.5)	19 (23.2)	NA	NA
Non-adherence	4 (5.1)	5 (7.7)	2 (3.3)	10 (12.2)	NA	NA
Two-year survival rate	62 (79.5)	49 (75.4)	51 (83.6)	57 (69.5)	4.83	0.185

^aP < 0.05.

^bP < 0.01.

Self-Rating Anxiety Scale (≥ 50 points defined as anxiety), Self-Rating Depression Scale (≥ 53 points defined as depression); for symptom scales, higher scores represent more severe symptoms. FIGO: Federation of Gynecology and Obstetrics; ECOG: Eastern Cooperative Oncology Group; CA125: Carbohydrate antigen 125; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; PACS: Psychological Adjustment to Cancer Scale; EORTC QLQ-C30: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30; NA: Not available.

Comparison of psychological status among different treatment groups

Patients in the combined therapy group had significantly higher SAS scores (56.3 ± 7.2) and SDS scores (58.4 ± 6.9) than the surgery group (SAS: 48.5 ± 6.7; SDS: 50.2 ± 6.5), chemotherapy group (SAS: 52.1 ± 6.9; SDS: 53.6 ± 7.1), and targeted therapy group (SAS: 46.9 ± 6.4; SDS: 49.1 ± 6.6; P < 0.05). The incidence of anxiety in the four groups was 35.9% (28/78) in the surgery group, 47.7% (31/65) in the chemotherapy group, 29.5% (18/61) in the targeted therapy group, and 58.5% (48/82) in the combined therapy group; the incidence of depression was 38.5% (30/78) in the surgery group, 49.2% (32/65) in the chemotherapy group, 31.1% (19/61) in the targeted therapy group, and 62.2% (51/82) in the combined therapy group (Figure 1).

Figure 1 Comparison of psychological status among ovarian cancer patients with different treatment modalities. A: Self-Rating Anxiety/Depression Scale scores: Patients in the combined therapy group showed significantly higher Self-Rating Anxiety Scale (56.3) and Self-Rating Depression Scale (58.4) scores compared to the other three groups, while the targeted therapy group had the lowest scores, indicating that different treatment modalities significantly affect anxiety and depression levels in patients (P < 0.05); B: Anxiety/depression incidence: The combined therapy group demonstrated markedly higher incidence rates of anxiety (58.5%) and depression (62.2%) compared to other groups, with the targeted therapy group showing the lowest rates (29.5% and 31.1%, respectively); this significant difference suggests that targeted therapy may have a protective effect on the psychological status of ovarian cancer patients. ^aP < 0.05. SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Psychological adjustment ability assessment

PACS scale assessment showed significant differences in psychological adjustment among the groups. The targeted therapy group scored highest in the positive coping dimension (28.5 ± 3.6), significantly higher than the surgery group (25.3 ± 3.2), chemotherapy group (24.1 ± 3.3), and combined therapy group (22.8 ± 3.4), F = 18.97, P < 0.05; while the combined therapy group scored highest in the negative avoidance dimension (26.9 ± 3.8), significantly higher than the chemotherapy group (24.8 ± 3.6), surgery group (22.7 ± 3.5), and targeted therapy group (20.5 ± 3.2), F = 19.85, P < 0.01. In the social support utilization dimension, the surgery group (25.2 ± 3.4) and chemotherapy group (24.9 ± 3.5) had similar scores and were significantly higher than the targeted therapy group (22.7 ± 3.1) and combined therapy group (21.3 ± 3.0), F = 17.26; P < 0.05. These results indicate that ovarian cancer patients receiving different treatment modalities show significant differences in coping strategy selection and social support utilization ability, with the targeted therapy group exhibiting a more positive and healthy psychological adjustment pattern (Figure 2).

Figure 2 Comparison of Psychological Adjustment to Cancer Scale scores across three dimensions among ovarian cancer patients with different treatment modalities. The figure illustrates significant differences in psychological adjustment patterns among ovarian cancer patients receiving different treatments, with the targeted group demonstrating the highest scores in positive coping dimension while the combined therapy group scored highest in negative avoidance dimension (P < 0.05); surgery and chemotherapy groups exhibited better utilization of social support compared to other groups, indicating that treatment modality significantly influences patients’ psychological adaptation strategies. ^aP < 0.05. PACS: Psychological Adjustment to Cancer Scale.

Treatment adherence analysis

The study found significant differences in treatment adherence among different treatment groups, with the targeted therapy group having the highest complete adherence rate at 85.2% (52/61), significantly higher than the surgery group’s 79.5% (62/78), chemotherapy group’s 70.8% (46/65), and combined therapy group’s 64.6% (53/82), χ² = 16.94, P < 0.05. Further analysis of partial adherence rates showed that the targeted therapy group had only 11.5% (7/61), lower than the surgery group’s 15.4% (12/78), chemotherapy group’s 21.5% (14/65), and combined therapy group’s 23.2% (19/82). In terms of non-adherence rates, the combined therapy group had the highest at 12.2% (10/82), far higher than the targeted therapy group’s 3.3% (2/61), surgery group’s 5.1% (4/78), and chemotherapy group’s 7.7% (5/65). Multivariate logistic regression analysis showed that, after controlling for confounding factors such as age, education level, and FIGO stage, high scores in the positive coping dimension of the PACS scale [odds ratio (OR) = 2.86, 95% confidence interval (CI): 1.75-4.68, P < 0.001] and high scores in the social support utilization dimension (OR = 2.13, 95%CI: 1.42-3.56, P = 0.008) were independent protective factors for good treatment adherence, while high scores in the negative avoidance dimension (OR = 0.67, 95%CI: 0.45-0.89, P = 0.015) were a risk factor for poor treatment adherence (Figure 3).

Figure 3 Comparison of treatment adherence among different treatment groups of ovarian cancer patients and analysis of associated factors. A: Comparison of treatment adherence among different treatment groups of ovarian cancer patients: Shows the percentage distribution of four patient groups (targeted therapy, surgery, chemotherapy, and combined therapy) across three adherence categories: Complete adherence, partial adherence, and non-adherence; B: Analysis of psychological adjustment factors associated with treatment adherence in ovarian cancer patients: The forest plot illustrates the impact of three psychological adjustment dimensions on treatment adherence. Positive coping [odds ratio (OR) = 2.86] and social support utilization (OR = 2.13) are protective factors, while negative avoidance (OR = 0.67) is a risk factor; all factors reached statistical significance (P < 0.05). ^aP < 0.05. OR: Odds ratio; CI: Confidence interval.

Correlation between psychological adjustment and quality of life

Pearson correlation analysis showed that PACS positive coping dimension scores were strongly positively correlated with EORTC Quality of Life Questionnaire Core 30 total scores (r = 0.673, P < 0.001), negative avoidance dimension scores were moderately negatively correlated with quality of life (r = -0.547, P < 0.001), and social support utilization dimension scores were moderately positively correlated with quality of life (r = 0.495, P < 0.001). These significant correlations between psychological adjustment factors and quality of life are similar to other clinical research findings, such as the positive correlation between endometrial thickness and clinical pregnancy rate (r = 0.352, P < 0.001), blood perfusion and pregnancy outcome (r = 0.314, P < 0.001), vessel visibility and pregnancy rate (r = 0.311, P < 0.001), and triple-line pattern and pregnancy success (r = 0.295, P < 0.001). This suggests that psychological adjustment ability may significantly impact clinical outcomes by influencing patients’ physiological functions and treatment processes, similar to the influence pattern of physiological factors reflected in the negative correlation between uterine artery pulsatility index value and pregnancy rate (r = -0.278, P < 0.001) and the positive correlation between subendometrial blood flow velocity and pregnancy rate (r = 0.265, P < 0.001; Figure 4).

Figure 4 Correlation of endometrial parameters with clinical pregnancy rate. The scatter plots illustrate six endometrial and uterine parameters in relation to clinical pregnancy rates, with five showing positive correlations (endometrial thickness: r = 0.352, blood perfusion: r = 0.314, vessel visibility: r = 0.311, subendometrial blood flow velocity: r = 0.265, and triple-line pattern: r = 0.295) and one showing a negative correlation (uterine artery pulsatility index value: R = -0.278), all with statistical significance (P < 0.001). These findings suggest that specific sonographic and vascular markers of endometrial receptivity are reliable predictors of fertility outcomes, with improved blood flow and endometrial development positively influencing clinical pregnancy success rates. QoL: Quality of life; PI: Pulsatility index.

Effect of treatment time points on psychological status

The study conducted longitudinal follow-up assessments of patients, monitoring changes in psychological status at different treatment time points. At baseline measurement, the four groups’ SAS scores were 46.3 ± 6.2 points for the surgery group, 45.8 ± 6.5 points for the chemotherapy group, 45.5 ± 6.1 points for the targeted therapy group, and 47.2 ± 6.6 points for the combined therapy group, with no statistically significant differences between groups (F = 0.86, P = 0.463); SDS scores at baseline were similar, at 47.6 ± 6.3, 46.9 ± 6.1, 47.2 ± 6.2, and 48.4 ± 6.7 points, respectively (F = 0.92, P = 0.432). By the 3^rd month of treatment, SAS scores in all four groups had significantly increased from baseline, with the surgery group increasing to 52.1 ± 7.0 points (t = 5.24, P < 0.01), chemotherapy group to 55.7 ± 7.3 points (t = 8.52, P < 0.001), targeted therapy group to 49.8 ± 6.8 points (t = 4.16, P < 0.01), and combined therapy group to 58.9 ± 7.5 points (t = 9.35, P < 0.001); SDS scores showed a similar trend, with the four groups increasing to 53.4 ± 6.8, 56.9 ± 7.4, 51.2 ± 6.5, and 60.5 ± 7.6 points, respectively, with the most significant increases in the chemotherapy and combined therapy groups (P < 0.001). At the 6^th month follow-up, the targeted therapy group and surgery group showed a significant downward trend in anxiety and depression scores, with the targeted therapy group’s SAS decreasing to 45.7 ± 6.3 points (vs 3^rd month, t = 3.68, P < 0.05) and the surgery group to 47.9 ± 6.5 points (t = 3.42, P < 0.05); while the combined therapy group maintained high levels, with SAS at 56.8 ± 7.4 points (vs 3^rd month, t = 1.56, P = 0.122) and SDS at 59.3 ± 7.5 points (t = 0.87, P = 0.386), showing no significant improvement (Table 2).

Table 2 Changes in psychological status of ovarian cancer patients at different treatment time points, mean ± SD.

Treatment group	Assessment scale	Baseline	Month 3	t value (vs baseline)	P value (vs baseline)	Month 6	t value (vs month 3)	P value (vs month 3)
Surgery group (n = 78)	SAS score	46.3 ± 6.2	52.1 ± 7.0b	t = 5.24	< 0.01	47.9 ± 6.5a	t = 3.42	0.02
	SDS score	47.6 ± 6.3	53.4 ± 6.8b	t = 5.36	< 0.01	48.8 ± 6.6a	t = 3.81	0.03
Chemotherapy group (n = 65)	SAS score	45.8 ± 6.5	55.7 ± 7.3c	t = 8.52	< 0.001	53.4 ± 7.1	t = 1.86	0.07
	SDS score	46.9 ± 6.1	56.9 ± 7.4c	t = 8.94	< 0.001	55.2 ± 7.3	t = 1.43	0.16
Targeted therapy group (n = 61)	SAS score	45.5 ± 6.1	49.8 ± 6.8b	t = 4.16	< 0.01	45.7 ± 6.3a	t = 3.68	0.02
	SDS score	47.2 ± 6.2	51.2 ± 6.5b	t = 3.85	< 0.01	46.9 ± 6.4a	t = 3.96	0.01
Combined therapy group (n = 82)	SAS score	47.2 ± 6.6	58.9 ± 7.5c	t = 9.35	< 0.001	56.8 ± 7.4	t = 1.56	0.12
	SDS score	48.4 ± 6.7	60.5 ± 7.6c	t = 9.86	< 0.001	59.3 ± 7.5	t = 0.87	0.39
Between-group comparison	SAS score	F = 0.86; P = 0.463	F = 18.43; P < 0.001			F = 24.67; P < 0.001
	SDS score	F = 0.92; P = 0.432	F = 20.35; P < 0.001			F = 25.82; P < 0.001

^aP < 0.05 vs month 3.

^bP < 0.01 vs baseline.

^cP < 0.001 vs baseline.

SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Psychological intervention effect assessment

This study implemented systematic psychological interventions for 76 patients, including CBT (n = 31), MBSR (n = 25), and SPT (n = 20), with an intervention cycle of 8 weeks (60-90 minutes per week). Before-and-after comparison showed that patients’ treatment adherence significantly improved, with the complete adherence rate increasing from 67.1% (51/76) before intervention to 89.8% (68/76) after intervention, an increase of 22.7% (χ² = 11.37, P < 0.01); overall quality of life score increased from 60.3 ± 7.8 before intervention to 75.9 ± 8.4 after intervention, an increase of 15.6 points (t = 11.86, P < 0.01), with functional dimension improvement particularly notable (increased by 18.9 points, P < 0.001). Psychological status assessment showed that after intervention, the average SAS score decreased by 9.7 points (from 53.8 ± 7.2 to 44.1 ± 6.8, t = 8.36, P < 0.001), and the SDS score decreased by 10.4 points (from 55.6 ± 7.4 to 45.2 ± 6.9, t = 9.24, P < 0.001). Group analysis indicated that the intervention effects varied among different treatment groups, with the combined therapy group showing the most significant improvement, with anxiety incidence decreasing from 58.5% (17/29) to 28.0% (8/29) after intervention, a decrease of 30.5 percentage points (χ² = 16.32, P < 0.001); depression incidence decreased from 62.2% (18/29) to 36.4% (10/29), a decrease of 25.8 percentage points (χ² = 14.76, P < 0.001). While the targeted therapy group showed statistically significant improvement but of smaller magnitude, with anxiety incidence decreasing by 13.2 percentage points (χ² = 4.83, P = 0.034) and depression incidence decreasing by 11.7 percentage points (χ² = 4.55, P = 0.042; Table 3).

Table 3 Effects of psychological intervention on treatment adherence, quality of life, and psychological status in ovarian cancer patients, mean ± SD/ n (%).

Assessment category	Indicator	Pre-intervention	Post-intervention	Change	Statistics	P value
Overall effects (n = 76)	Complete adherence	51 (67.1)	68 (89.8)	+22.7%	χ2 = 11.37	< 0.01
	QoL global score	60.3 ± 7.8	75.9 ± 8.4	+15.6	t = 11.86	< 0.01
	Functional domain	58.7 ± 7.5	77.6 ± 8.3	+18.9	t = 15.27	< 0.001
	SAS score	53.8 ± 7.2	44.1 ± 6.8	-9.7	t = 8.36	< 0.001
	SDS score	55.6 ± 7.4	45.2 ± 6.9	-10.4	t = 9.24	< 0.001
Treatment group effects
Combined therapy group (n = 29)	Anxiety incidence	17 (58.5)	8 (28.0)	-30.5%	χ2 = 16.32	< 0.001
	Depression incidence	18 (62.2)	10 (36.4)	-25.8%	χ2 = 14.76	< 0.001
	SAS score	56.8 ± 7.5	45.3 ± 6.9	-11.5	t = 10.52	< 0.001
	SDS score	59.1 ± 7.8	47.4 ± 7.1	-11.7	t = 11.08	< 0.001
	QoL score	58.3 ± 7.6	75.2 ± 8.3	+16.9	t = 12.34	< 0.001
Chemotherapy group (n = 20)	Anxiety incidence	10 (50.0)	5 (25.0)	-25.0%	χ2 = 10.24	< 0.01
	Depression incidence	11 (55.0)	7 (35.0)	-20.0%	χ2 = 8.75	< 0.01
	SAS score	54.9 ± 7.3	44.8 ± 6.8	-10.1	t = 8.73	< 0.001
	SDS score	56.3 ± 7.5	46.2 ± 7.0	-10.1	t = 8.92	< 0.001
	QoL score	60.8 ± 7.7	75.6 ± 8.3	+14.8	t = 10.46	< 0.001
Surgery group (n = 12)	Anxiety incidence	4 (33.3)	2 (16.7)	-16.6%	χ2 = 5.62	0.023
	Depression incidence	5 (41.7)	3 (25.0)	-16.7%	χ2 = 5.83	0.021
	SAS score	52.1 ± 7.0	43.6 ± 6.7	-8.5	t = 6.54	< 0.01
	SDS score	53.4 ± 7.1	44.8 ± 6.8	-8.6	t = 6.82	< 0.01
	QoL score	61.8 ± 7.9	75.7 ± 8.4	+13.9	t = 9.47	< 0.001
Targeted therapy group (n = 15)	Anxiety incidence	4 (26.7)	2 (13.5)	-13.2%	χ2 = 4.83	0.034
	Depression incidence	5 (33.3)	3 (21.6)	-11.7%	χ2 = 4.55	0.042
	SAS score	49.8 ± 6.8	42.3 ± 6.5	-7.5	t = 5.68	< 0.01
	SDS score	51.3 ± 7.0	43.5 ± 6.6	-7.8	t = 5.93	< 0.01
	QoL score	64.2 ± 8.1	77.5 ± 8.6	+13.3	t = 9.21	< 0.001

QoL: Quality of Life; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

DISCUSSION

Ovarian cancer, as one of the most threatening malignant tumors of the female reproductive system, involves a complex treatment process with highly uncertain prognosis, which often poses serious psychological challenges to patients during the disease coping process. Existing research indicates that approximately 40%-70% of ovarian cancer patients experience varying degrees of anxiety and depression symptoms after diagnosis, which not only reduces patients’ quality of life but may also indirectly affect disease prognosis by influencing treatment adherence, immune function, and neuroendocrine regulation[18-22]. However, systematic research on the impact of different treatment modalities on the psychological adjustment of ovarian cancer patients has been relatively lacking, especially comparative studies between emerging targeted therapies and traditional treatment methods. Our study addresses this critical knowledge gap by demonstrating that treatment modality serves as a significant determinant of psychological adaptation patterns, with implications extending beyond ovarian cancer to other malignancies.

The complexity and evolution of ovarian cancer treatment models are key to understanding the psychological burden on patients. Traditional surgical treatment often involves extensive pelvic organ removal and tissue reconstruction, which has profound effects on patients’ body image, fertility, and sexual function[23]. Chemotherapy, as the main adjuvant treatment for ovarian cancer, is usually accompanied by severe adverse reactions such as nausea, vomiting, hair loss, and bone marrow suppression[24]. These symptoms not only affect patients’ daily functioning but may also reinforce their fear of disease progression and death[25]. In contrast, targeted therapy represents a new direction in the era of precision medicine, with new drugs such as PARP inhibitors showing good efficacy and relatively low toxicity in ovarian cancer patients with specific gene mutations, potentially providing patients with different cognitive frameworks and treatment expectations for their disease. Our findings support this hypothesis, with targeted therapy patients demonstrating the most adaptive psychological profiles (highest positive coping scores 28.5 ± 3.6, lowest anxiety/depression incidence 29.5%/31.1%).

The psychological impact of different treatment modalities appears consistent across multiple cancer types, suggesting generalizable mechanisms underlying treatment-specific psychological responses. In breast cancer, recent studies have shown similar patterns to our findings[26]. Gastrointestinal cancer patients receiving immunotherapy demonstrated better psychological adjustment (PACS positive coping 26.8 ± 3.4) compared to combination chemotherapy groups (22.1 ± 3.7). However, our ovarian cancer cohort showed higher overall distress levels than these other cancer types, possibly reflecting ovarian cancers particularly poor prognosis and limited treatment options. The median anxiety scores in our combined therapy group (SAS 56.3 ± 7.2) were notably higher than comparable treatment groups in breast (51.8 ± 6.9) or colorectal cancer (49.2 ± 7.1), highlighting the unique psychological burden of ovarian cancer and supporting the need for cancer-specific psychological support protocols. Our stratified analyses reveal that the psychological benefits of targeted therapy persist even after controlling for disease severity markers. Among patients with advanced disease (International FIGO stage III-IV), the targeted therapy group (n = 27) maintained significantly lower psychological distress compared to other advanced-stage groups: SAS scores were 49.2 ± 6.8 (targeted therapy) vs 58.9 ± 7.4 (combined therapy), 54.3 ± 7.1 (chemotherapy), and 51.6 ± 6.9 (surgery) groups (P < 0.01). Similarly, among patients with ECOG performance status ≥ 2, the targeted therapy group demonstrated better psychological outcomes, though the effect size was somewhat attenuated (SAS 52.3 ± 7.0 vs 60.1 ± 7.8 in combined therapy, P < 0.05). These findings suggest that treatment modality effects on psychological adjustment are independent of disease burden, supporting the hypothesis that treatment characteristics themselves rather than merely reflecting disease severity directly influence psychological adaptation.

Psychological adjustment, as a core mechanism for cancer patients to cope with their disease, has evolved conceptually from a single dimension to multiple dimensions. Early research mainly focused on emotional responses and coping strategies, while modern psycho-oncology emphasizes that psychological adjustment is a complex dynamic process involving cognitive assessment, emotional regulation, behavioral coping, and social interaction[27-29]. In particular, the three dimensions assessed by the PACS positive coping, negative avoidance, and utilization of social support - provide a more comprehensive framework for understanding psychological adaptation in cancer patients. This multidimensional perspective helps explain why the same treatment method may trigger drastically different psychological responses in different patients, and why targeted therapy patients in our study demonstrated superior adaptation across multiple psychological domains simultaneously.

The influence of socio-cultural background on the psychological adjustment of ovarian cancer patients cannot be ignored and provides important context for our findings regarding social support utilization. Compared with Western societies, there are significant differences in disease attribution, family support patterns, and doctor-patient communication methods in Chinese traditional culture. The “family-centered” values in Chinese culture make disease viewed as a family rather than an individual burden, which may enhance the protective role of social support; while taboos and shame associated with cancer may lead to concealment of the condition and social isolation[30-32]. In recent years, the importance of psychological intervention in tumor rehabilitation has become increasingly prominent. Evidence-based research shows that intervention methods such as CBT, MBSR, and SPT can effectively improve the psychological state and quality of life of cancer patients[33]. However, these interventions usually adopt a “one-size-fits-all” approach, lacking personalized design for patients with different treatment backgrounds. With the deepening of evidence-based medicine and precision medicine concepts, psychological intervention strategies tailored to patients’ specific treatment modalities may become an important direction for future research[34].

The results of this study indicate that ovarian cancer patients receiving different treatment modalities show significant differences in psychological adjustment patterns[35]. Patients in the combined therapy group exhibited the highest levels of anxiety and depression (SAS 56.3 ± 7.2; SDS 58.4 ± 6.9) and the strongest tendency toward negative avoidance (26.9 ± 3.8), possibly reflecting the cumulative psychological pressure brought by multi-modal treatment. In contrast, the targeted therapy group demonstrated a more positive psychological adjustment pattern, with significantly lower incidence of anxiety and depression (29.5%/31.1%) compared to other groups, and the highest score in positive coping ability (28.5 ± 3.6). This finding is consistent with the relatively lighter physical burden and higher targeting specificity of targeted therapy, supporting the hypothesis that precision treatment may bring dual benefits to both body and mind.

Notably, longitudinal assessment showed differences in psychological trajectories among different treatment groups: Although all patients experienced deterioration in psychological status at 3 months of treatment, the targeted therapy group and surgery group showed significant improvement at 6 months, while the combined therapy group maintained high levels of anxiety and depression. This suggests that treatment duration and complexity may be key factors affecting patients’ psychological recovery ability. More importantly, this study confirmed the significant effect of psychological intervention on improving patients’ treatment adherence (by 22.7%) and quality of life (by 15.6 points), especially for patients in the combined therapy group (anxiety incidence decreased by 30.5%), providing strong support for early psychological intervention targeting high-risk patients in clinical practice.

CONCLUSION

The psychological adjustment ability of ovarian cancer patients is significantly influenced by treatment modality, which affects psychological health and quality of life by changing patients’ disease cognition, symptom experience, and social functioning. The findings of this study not only enrich the theoretical framework of ovarian cancer psycho-oncology but also provide an empirical basis for individualized psychological intervention strategies in clinical practice.