Advanced stage ovarian cancer is treated by a combination of surgery and chemotherapy. In contrast to other cancers, ovarian cancer is a ‘surface spreader’, where cancer deposits are present on the surface of intra-abdominal organs and is treated surgically even when cancer has spread to organs outside the ovary. The aim of surgery is to reduce cancer inside the abdomen. This is because patients who have no visible cancer remaining after surgery have a lower risk of death than patients having > 2 cm of visible cancer remaining after surgery.
Standard surgery comprises removal of the uterus, tubes and ovaries and omentum (fatty apron of stomach), whereas extensive surgery may be needed to remove cancer deposits on the liver, spleen, diaphragm, and/or bowel. Recent research suggests that using extensive surgery may help surgeons remove all visible cancer during surgery and this may help women live longer. However using extensive surgery does increase complications.
However, there is little robust evidence suggesting which surgery is more effective and the impact of extensive surgery on quality of life and survival is unknown. This multicentre study will help to address this challenging question.
The study is being carried out to help us understand how the quality of a patient’s life is affected by surgery for suspected or confirmed ovarian cancer. We are interested to find out how your quality of life is before and after undergoing surgery and whether this is different in patients undergoing more extensive surgery. We hope this would help us to understand the effect of surgery and/or chemotherapy on our patients’ daily lives. We also want to understand whether patients undergoing extensive surgery live longer. The National Institute of Health and Care Excellence has commissioned us to conduct this study to understand these issues better.
Currently, there is considerable variation within UK centres as to whether a patient with ovarian cancer receives the standard or additional surgery; the choice of surgical approach is based on the surgeon’s beliefs rather than robust trial evidence or patient participation in informed decision-making. We need further data from multiple centres to establish what side effects and quality of life patients undergoing ovarian cancer surgery experience. The study will also collect survival data to obtain a greater understanding of the potential gain from such surgery, compared to its adverse impact.
SOCQER-2 will provide good quality prospective evidence on the impact of surgery on Quality of life and survival in patients with ovarian cancer in large, multiple UK gynaecological cancer centres. Surgeons will derive benefit from this in informing their practice; it will also enable patients to have a fuller understanding of the impact of surgery balanced against the potential survival benefit. This research may facilitate patients to make informed choices in decisions on health care.
Understanding the quality of life in patients undergoing such surgery will allow doctors to fully understand the holistic impact of these procedures as well as support patients fully if specific needs were identified.
Further, this is an exploratory study which will help us plan a more definitive study in the future.