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Investigating harms of testing for ovarian cancer - psychological outcomes and cancer conversion rates in women with symptoms of ovarian cancer: a cohort study embedded in the multicentre ROCkeTS prospective diagnostic study
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  • Audrey Kwong,
  • Caroline Kristunas,
  • Clare Davenport,
  • Ridhi Aggarwal,
  • Jonathan Deeks,
  • Sue Mallett,
  • Sean Kehoe,
  • Dirk Timmerman,
  • Tom Bourne,
  • Hilary Stobart,
  • Richard Neal,
  • Usha Menon,
  • Alexandra Gentry-Maharaj,
  • Lauren Sturdy,
  • Ryan Ottridge,
  • Sudha Sundar
Audrey Kwong
University of Birmingham Institute of Applied Health Research
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Caroline Kristunas
University of Birmingham Institute of Cancer and Genomic Sciences
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Clare Davenport
University of Birmingham Institute of Applied Health Research
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Ridhi Aggarwal
University of Birmingham Institute of Applied Health Research
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Jonathan Deeks
University of Birmingham Institute of Applied Health Research
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Sue Mallett
University College London
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Sean Kehoe
University of Oxford
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Dirk Timmerman
Katholieke Universiteit Leuven
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Tom Bourne
Imperial College London
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Hilary Stobart
Birmingham Public Health
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Richard Neal
University of Exeter
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Usha Menon
University College London
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Alexandra Gentry-Maharaj
University College London
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Lauren Sturdy
University of Birmingham Institute of Applied Health Research
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Ryan Ottridge
University of Birmingham Institute of Applied Health Research
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Sudha Sundar
Sandwell and West Birmingham Hospitals NHS Trust

Corresponding Author:[email protected]

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Abstract

Objectives: To investigate psychological correlates in women referred with suspected ovarian cancer via the fast-track pathway, explore how anxiety and distress levels change 12 months post-testing and report cancer conversion rates by age and referral pathway. Design: Single arm prospective cohort study Setting: Multicentre. Secondary care including outpatient clinics and emergency admissions. Participants: 2596 newly presenting symptomatic women with a raised CA125 level, abnormal imaging or both. Methods: Women completed anxiety and distress questionnaires at recruitment and at 12 months for those who had not undergone surgery or a biopsy within 3 months of recruitment. Main outcome measures: Anxiety and distress levels measured using STAI-6 and IES-r questionnaires. OC conversion rates by age, menopausal status and referral pathway. Results: 1355/2596 (52.1%) and 1781/2596 (68.6%) experienced moderate-to-severe distress and anxiety at recruitment. Younger age and emergency presentations had higher distress levels. Clinical category for anxiety and distress remained unchanged/worsened in 76% at 12 months despite a non-cancer diagnosis. OC rates by age were 1.6% (95% CI 0.5 to 5.9) under 40 and 10.9 % (95% CI 8.7 to 13.6) over 40 years. In women referred through fast-track pathways, 3.3% (95% CI 1.9 to 5.7) of pre- and 18.5% (95% CI 16.1 to 21.0) of postmenopausal women were diagnosed with OC. Conclusions: Women undergoing diagnostic testing display severe anxiety and distress. Younger women are especially vulnerable and should be targeted for support. Women under 40 have low conversion rates and we advocate reducing testing in this group to reduce harms of testing.
14 Nov 2023Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
14 Nov 2023Submission Checks Completed
14 Nov 2023Assigned to Editor
14 Nov 2023Review(s) Completed, Editorial Evaluation Pending
25 Jan 2024Editorial Decision: Revise Major
25 Feb 20241st Revision Received
04 Mar 2024Editorial Decision: Accept