Differences in physical and emotional distress amongst patients undergoing neoadjuvant chemotherapy versus surgery for advanced ovarian cancer: Patient-reported outcomes at diagnosis.

person Shilpa Mokshagundam Mayo Clinic, Rochester, MN info_outline Shilpa Mokshagundam, Michaela E McGree, Angela J Fought, Karen P Ishitani, Minji K Lee, Amanika Kumar

Authors person Shilpa Mokshagundam Mayo Clinic, Rochester, MN info_outline Shilpa Mokshagundam, Michaela E McGree, Angela J Fought, Karen P Ishitani, Minji K Lee, Amanika Kumar Organizations Mayo Clinic, Rochester, MN Abstract Disclosures Research Funding No funding sources reported Background: Advanced ovarian cancer (OC) is managed with cytoreductive surgery and platinum-based chemotherapy. Prehabilitation is a multimodal intervention to improve physical and mental health prior to oncologic surgery. This study evaluates baseline differences in clinical characteristics, functional status, and patient-reported outcomes (PROs) between patients undergoing primary cytoreductive surgery (PCS) versus neoadjuvant chemotherapy (NACT) who enrolled in a prospective prehabilitation trial. Methods: This was a single-institution, non-randomized prospective behavioral intervention trial of patients with suspected advanced stage (IIIC/IV) OC. Baseline functional testing included the Short Physical Performance Battery (SPPB), Fried Frailty Index (FFI), gait speed, and grip strength. Patient-Reported Outcomes Measurement Information System (PROMIS) metrics, the Mindfulness Attention Awareness Scale (MAAS), and the Perceived Stress Scale (PSS-10) were used to evaluate PROs. Comparisons between cohorts utilized two-sample t-test or Kruskal Wallis test for continuous variables and chi-square or Fisher’s exact test for categorical variables. T-scores were obtained for PROMIS data using the HealthMeasures Scoring Service; validated cut points for PROMIS, MAAS, and PSS-10 were used for categorization. Results: Amongst the 53 enrolled patients, physical and emotional distress was higher amongst OC patients compared to population means. When compared to PCS patients, NACT patients were more likely to report “severe” in at least one PROMIS domain (emotional distress and anxiety, pain interference, physical function, and fatigue, p<0.01). NACT patients reported significantly higher levels of perceived stress (p<0.01). NACT patients were more likely to have stage IV disease, albumin <3.5 g/dL, and lower gait speed and grip strength (all p<0.01). Despite differences in clinical variables and PROs including physical function, there were no measurable differences in physical function based on SPPB and FFI. Conclusions: Advanced OC patients have high psychosocial needs, with NACT patients reporting severe perceived symptoms on PRO measures. The PSS-10 may be a valuable screening tool for patients undergoing NACT to prioritize supportive care services. Clinical trial information: NCT05047926. Characteristic Total NACT PCS P-value Severe in one or more PROMIS domain (excluding emotional support), N (%) 14/48 (29.2) 14/32 (43.8) 0/16 (0.0) <0.01 Perceived Stress Scale Score, Mean (SD) 16.3 (8.0) 18.9 (7.6) 11.3 (6.2) <0.01 Short Performance Physical Battery, N (%) 0.21 ≤8 7/43 (16.3) 6/26 (23.1) 1/17 (5.9) >8 36/43 (83.7) 20/26 (76.9) 16/17 (94.1) Fried Frailty Index, N (%) 0.28 Non-frail 13/43 (30.2) 8/26 (30.8) 5/17 (29.4) Pre-frail 20/43 (46.5) 10/26 (38.5) 10/17 (58.8) Frail 10/43 (23.3) 8/26 (30.8) 2/17 (11.8)

Clinical