Persistent Long-Term Fatigue and Impact on Quality of Life Among Epithelial Ovarian Cancer Survivors


Key Points

  • Epithelial ovarian cancer survivors had poorer FACIT-F scores, lower functional well-being scores, poorer FACT-O scores, and poorer FACT-Ntx scores. 
  • Epithelial ovarian cancer survivors also reported more severe long-term, poorer sleep quality, and more depression. 

A study among epithelial ovarian cancer survivors from 25 cooperative Gynecologic Cancer Intergroup centers in France showed similar quality of life compared to healthy controls who were randomly selected from the electoral rolls, but persistent long-term fatigue. The researchers found depression, neuropathy, and sleep disturbance as the main conditions associated with severe long-term fatigue. These findings were published by Joly et al in Annals of Oncology.

Few data are available on patient-reported outcomes in this population, including quality of life and symptoms during posttreatment periods, and the results are conflicting. The physical and psychological consequences of epithelial ovarian cancer and its treatments were shown to be negatively associated with quality of life, including fatigue, sleep problems, pain, anxiety, depression, negative self-concept, and reduced feelings of sexuality. But other studies have reported that most epithelial ovarian cancer survivors were satisfied with their global quality of life, despite persistent psychological and physical symptoms. 

Long-term fatigue has been described as one of the most common and distressing adverse effects of cancer and its treatment. Little is known about the prevalence of long-term fatigue in epithelial ovarian cancer survivors several years after treatment in comparison with age-matched healthy women. 

Study Methods

The factors associated with severe long-term fatigue have not yet been assessed in a large group of long-term relapse-free epithelial ovarian cancer survivors, which prompted French investigators to perform a case-control study on long-term fatigue, symptoms, and several quality-of-life domains in a population of epithelial ovarian cancer survivors who are relapse-free more than 3 years after first-line treatment. 

All participants in this study completed validated self-reported questionnaires: FACIT-F in terms of fatigue, FACT-G/O for quality of life, FACT-Ntx for neurotoxicity, HADS for anxiety/depression, ISI for sleep disturbance, and IPAQ for physical activity. Severe long-term fatigue was defined as a FACIT-F score less than 37/52. Univariate and multivariate logistic regression were conducted to analyze severe long-term fatigue and its influencing factors in epithelial ovarian cancer survivors. 

A total of 318 epithelial ovarian cancer survivors and 318 controls were included in the study. Epithelial ovarian cancer survivors were 63 years old on average; 50% had International Federation of Gynecologists and Obstetricians (FIGO) stage I/II disease, and 48% had FIGO stage III/IV disease. Nearly all (99%) had received platinum and taxane chemotherapy, with an average 6-year follow-up. There were no differences between the two groups in sociodemographic characteristics and global quality of life. 


Epithelial ovarian cancer survivors had poorer FACIT-F scores (P < .0001), lower functional well-being scores (P = .0002), poorer FACT-O scores (P < .0001), and poorer FACT-Ntx scores (P < .0001). Epithelial ovarian cancer survivors also reported more severe long-term fatigue (26% vs 13%, P = .0004), poorer sleep quality (63% vs 47%, P = .0003), and more depression (22% vs 13%, P = .01). Fewer than 20% of epithelial ovarian cancer survivors and controls exercised regularly. 

In multivariate analyses, epithelial ovarian cancer survivors with high levels of depression, neurotoxicity, and sleep disturbance had an increased risk of developing severe long-term fatigue (P < .01).

The authors concluded that even if epithelial ovarian cancer survivors present a good global quality of life, they report persistent long-term side effects including chronic fatigue, ovarian cancer–related symptoms, neurotoxicity, depression, and sleep disturbances.

Disclosure: The study authors' full disclosures can be found at

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.