Prophylactic Surgery for Patients at High Risk of Ovarian Cancer Decreases Sexual Function, Quality of Life
Key findings
- In this study 155 patients at high genetic risk of ovarian cancer completed at least one patient-reported outcome questionnaire
- 72 patients also underwent risk-reducing bilateral salpingo-oophorectomy, including 36 who completed questionnaires both pre- and post-operatively
- As compared to pre-operatively, those 36 patients reported significantly less tension and worry about their health post-operatively and reported that surgery did not significantly impact their family life or finances, sleep, concentration or mood
- However, these patients did report decreased levels of overall health and short-term quality of life, and endorsed more cognitive symptoms and sexual dysfunction
- These 73 patients who underwent prophylactic surgery were then compared to 455 patients diagnosed with ovarian cancer. The latter reported more worry, disease-related life interference and treatment burden, and worse quality of life and overall health
Women who have mutations in tumor suppressor genes BRCA1 or BRCA2 are advised to undergo risk-reducing bilateral salpingo-oophorectomy between ages 35 and 45. This prophylactic surgery is also offered to other women at high risk such as patients with other high-risk genetic mutations, Lynch syndrome, or a strong family history of ovarian cancer.
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In the first study of its kind, Lauren Philp, MD, a fellow in the Center for Gynecologic Oncology at Massachusetts General Hospital, Rachel C. Sisodia, MD, a gynecologic oncologist in the center and senior medical director for Specialty Care Patient-Reported Outcomes at Mass General Brigham, and colleagues examined serial patient-reported outcomes (PROs) among patients at high risk of ovarian cancer who underwent prophylactic surgery.
The team's report in Gynecologic Oncology presents both cautionary and reassuring data that will help patients and their clinicians engage in shared decision-making about this surgery.
Methods
The study included 195 patients at high risk of ovarian cancer who sought care at the Mass General Gynecologic Oncology practice between January 2018 and December 2019. They were asked to complete several PRO questionnaires at their new patient visit as well as at follow-up, chemotherapy, and post-operative appointments.
At-Risk Patients Who Chose Surgery
155 of the high-risk patients (80%) completed at least one PRO questionnaire. 72 of them underwent prophylactic surgery during the PRO study period, including 36 who completed both pre- and post-operative PRO measures. After surgery, compared with before, those 36 patients reported significantly:
- Less tension
- Less worry about their future health
- More difficulty with memory and other cognitive symptoms
- More health-related interference with social activities
- Decreased level of health in the past week
- Decreased quality of life in the past week
- Less interest in sex
- Reduced frequency of sexual activity
- Reduced feelings of physical attractiveness
There were no differences by age group in post-operative sexual dysfunction, suggesting both pre- and post-menopausal women experienced this effect.
Patients reported no impact of surgery on family life or finances, did not consider the procedure to be a burden, and did not report post-operative difficulties with sleep, concentration or depression.
Patients with Ovarian Cancer
The researchers then compared the PROs of the 72 high-risk patients who chose prophylactic surgery with the PRO data of 455 patients who had a diagnosis of ovarian cancer.
The patients with ovarian cancer reported significantly more worry, disease-related life interference and treatment burden, and significantly worse quality of life and overall health.
Those results represent the "alternate future" for many of the women in the at-risk group had they not undergone prophylactic surgery. They highlight the tradeoffs patients at high risk of ovarian cancer must weigh when contemplating surgery.
Counseling Patients
Previous work indicates sexual dysfunction affects >70% of patients who have risk-reducing bilateral salpingo-oophorectomy and can persist indefinitely. Cognitive impairment has also been reported previously, and both effects appear to result from post-operative endocrine changes.
This study from routine practice can guide better patient-centered counseling about the risks and benefits of this prophylactic procedure. Both should be presented in the context of the significantly worse quality of life among patients with malignancies.
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