Margaret Fitch, RN, PhD, Head, Oncology Nursing and Supportive Care; Director, Psychosocial and Behavioural Research Unit,Toronto Sunnybrook Regional Cancer Centre, Toronto, ON.

Ovarian cancer has more than a physical impact.There are also emotional, psychosocial, spiritual, and practical consequences for those women diagnosed with the disease. These women face many challenges— lives are changed irrevocably with the diagnosis, and life becomes a series of transitions. In caring for women with ovarian cancer, health care providers must be sensitive to myriad concerns these patients may have and try to understand the issues from the perspective of those experiencing them.
Structures and processes need to be established within care facilities that allow patients to have regular comprehensive assessment, good symptom management, effective communication, and individually tailored support.The availability of timely and relevant referral to other experts when needed is of key importance at moments of care transition.
Keywords: supportive care, ovarian cancer, older women, psychosocial concerns, emotion.

Natalie S. Gould MD, Fellow and Clinical Instructor
D. Scott McMeekin MD, Assistant Professor Section of Gynecologic Oncology,
Department of Obstetrics and Gynecology
University of Oklahoma Medical Center, Oklahoma City, OK, USA.

Ovarian cancer is a disease of older women, with 48% over the age of 65 at diagnosis.¹ It is also the most deadly of gynecologic malignancies, accounting for more deaths than cervical and endometrial carcinoma combined in the US. An estimated 23,400 new cases of ovarian cancer will be diagnosed in 2001 with 13,900 deaths in the US.² As our population ages, the number of women affected by ovarian cancer will increase. Cancer limited to an ovary is typically silent and discovered incidentally on exam or at surgical exploration for other reasons. Patients with disease that has spread beyond the ovaries may present with vague gastrointestinal symptoms, bloating, diarrhea, pain and changes in bowel or bladder habits. On physical exam, patients will have a pelvic mass and often ascites. Due to the absence of symptoms until the malignancy has spread beyond the ovaries, and the lack of good screening tests, approximately 70% of patients present with advanced disease and overall survival is poor.³ (Table 1).

Initial management involves cytoreductive surgery aimed at removal of the greatest volume of tumour (Table 2).