Psychological distress and its correlates in ovarian cancer: A systematic review

Objective: Ovarian cancer is often diagnosed at an advanced stage, and consequently high levels of distress are often experienced. It is necessary to understand the factors associated with psychological distress in order to guide interventions to target those factors. The purpose of this systematic review was therefore to identify correlates of psychological distress in ovarian cancer. Methods: Included studies had to be quantitative and empirical, with standardized measures of psychological distress (anxiety or depression), and to present results for ovarian cancer patients specifically. Standard systematic search methods were used. Information about design, ovarian cancer sample size, disease stage, time since diagnosis, measures of distress used and findings was extracted from each study. The studies were quality assessed using experimenter-defined criteria as good, average and poor quality. Strength of the evidence (strong, some, inconclusive) was based on the quality and consistency of findings. Results: Eighteen studies meeting the inclusion criteria were identified. There was strong evidence for a relationship between younger age, being diagnosed with more advanced disease, more physical symptoms and shorter time since diagnosis with increased levels of anxiety and/or depression. Additional factors (e.g. immune) tested in a few studies also emerged as correlates of distress. Conclusions: Demographic, disease and quality of life factors correlated with distress. However, too few studies assessed possible psychological and immunological correlates, which could be potentially modified and should be assessed in future studies.