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

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.

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.

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.