The impact of treatment for gynecological cancer on health-related quality of life (HRQoL): A systematic review

American Journal of Obstetrics and Gynecology

Volumn 194, Issue 1, 2006, Pages 26-42

  Jones, Georgina L ^a,f   Ledger, William ^b   Bonnett, Tessa J ^c   Radley, Stephen ^d   Parkinson, Nancy ^e   Kennedy, Stephen H ^e  

^a Institute of General Practice and Primary Care   (United Kingdom)

^b Section of Reproductive and Developmental Medicine   (United Kingdom)

^c UNIVERSITY OF SHEFFIELD   (United Kingdom)

^d JESSOP HOSPITAL FOR WOMEN   (United Kingdom)

^e UNIVERSITY OF OXFORD   (United Kingdom)

^f NORTHERN GENERAL HOSPITAL   (United Kingdom)

Author keywords

Chemotherapy; Gynecologic cancer; Health related quality of life; Radiotherapy; Surgery

Indexed keywords

ALTRETAMINE; AMIFOSTINE; CARBOPLATIN; CISPLATIN; CYCLOPHOSPHAMIDE; DACTINOMYCIN; DOXORUBICIN; EPIRUBICIN; ETOPOSIDE; GLUTATHIONE; METHOTREXATE; OXALIPLATIN; PACLITAXEL; TOPOTECAN;

ANOREXIA; APPETITE DISORDER; ATTENTION DISTURBANCE; CANCER ADJUVANT THERAPY; CANCER CHEMOTHERAPY; CANCER PALLIATIVE THERAPY; CANCER RADIOTHERAPY; CANCER SURGERY; CANCER SURVIVAL; CLINICAL TRIAL; CONSTIPATION; DATA BASE; DIARRHEA; DYSPNEA; EMOTION; ENDOMETRIUM CANCER; FATIGUE; GYNECOLOGIC CANCER; GYNECOLOGIC SURGERY; HAIR LOSS; HUMAN; HYSTERECTOMY; INSOMNIA; INTERMETHOD COMPARISON; MENTAL CONCENTRATION; NAUSEA AND VOMITING; NEUROTOXICITY; OVARY CANCER; PRIORITY JOURNAL; QUALITY OF LIFE; QUESTIONNAIRE; REVIEW; SKIN TINGLING; SYSTEMATIC REVIEW; TREATMENT OUTCOME; UTERINE CERVIX CANCER; VAGINA CANCER;

EID: 29544447373     PISSN: 00029378     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.ajog.2005.04.060     Document Type: Article

References (109)

1. M.N. Levine, and P.A. Ganz Beyond the development of quality of life instruments: where do we go from here? J Clin Oncol 20 2002 2215 2216
2. B. Anderson, and S. Lutgendorf Quality of life as an outcome measure in gynecologic malignancies Curr Opin Obstet Gynecol 12 2000 21 26
3. D. Osoba What has been learned from measuring health-related quality of life in clinical oncology Eur J Cancer 35 1999 1565 1570
4. G.M. Kiebert, and S. Kaasa Quality of life in clinical cancer trials: experience and perspective of the European Organization for Research and Treatment of Cancer J Natl Cancer Inst Monogr 20 1996 91 95
5. C.M. Moinpour, P. Feigel, and B. Metch Quality of life end points in cancer clinical trials: review and recommendations J Natl Cancer Inst 81 1989 486 495
6. C. Romagnolo Quality of life in gynaecological oncology Clin Exp Obstet Gyn 3 1991 203 205
7. C.M. Saunders, and M. Baum Quality of life during treatment for cancer Br J Hosp Med 48 1992 119 123
8. G.H. Guyatt, D.H. Feeny, and D.L. Patrick Measuring health-related quality of life Ann Intern Med 118 1993 622 629
9. P.M. Fayers, and D. Machin Quality of life: assessment, analysis and interpretation 2000 John Wiley Chichester
10. J.C. Nunnally Psychometric theory 1978 Tate McGraw Hill New Dehli
11. C. Jenkinson, and H. McGee Patient assessed outcomes: measuring health status and quality of life C. Jenkinson Assessment and evaluation of health and medical care: a methods text 1997 Open University Press Buckingham 64 84
12. D.L. Streiner, and G. Norman Health measurement scales: a practical guide to their development and use 2nd ed. 1995 Oxford University Press Oxford
13. D.L. Patrick, and M. Bergner Measurement of health status in the 1990s Annu Rev Public Health 11 1990 165 183
14. P. Maguire, and P. Selby Assessing the quality of life in cancer patients Br J Cancer 60 1989 437 440
15. P. Selby Measuring the quality of life of patients with cancer S.R. Walker R.M. Rosser Quality of life assessment: key issues in the 1990s 1993 Kluwer Academic Dordrecht
16. A. Bowling Measuring Disease: a review of disease specific quality of life measurement scales 1995 Open University Press Buckingham
17. D.F. Cella, D.S. Tulsky, G. Gray, B. Sarafian, E. Linn, and A. Bonomi The Functional Assessment of Cancer Therapy scale: development and validation of the general measure J Clin Oncol 11 1993 570 579
18. N.K. Aaronson, S. Ahmedzai, B. Bergman, M. Bullinger, A. Cull, and N.J. Duez The European Organisation for Research and Treatment of Cancer QLQ-C30: a quality of life instrument for use in international clinical trials in oncology J Natl Cancer Inst 85 1993 365 376
19. S.E. Waggoner Cervical cancer Lancet 361 2003 2217 2225
20. T. Pearman Quality of life and psychosocial adjustment in gynecologic cancer survivors Health Qual Life Outcomes 1 2003 33
21. R. Fitzpatrick, C. Davey, M. Buxton, and D.R. Jones Patient-assessed outcome measures N. Black J. Brazier R. Fitzpatrick B. Reeves Health services research methods 1998 BMJ Publications London 13 22
22. A. Montazeri, J. McEwen, and C.R. Gillis Quality of life in patients with ovarian cancer: current state of research Support Care Cancer 4 1996 169 179
23. G. Jones, S. Kennedy, and C. Jenkinson Health-related quality of life measurement in women with common benign gynecological conditions: a systematic review Am J Obstet Gynecol 187 2002 501 511
24. L. Elit, M.J. Esplen, K. Butler, and S. Narod Quality of life and psychosexual adjustment after prophylactic oophorectomy for a family history of ovarian cancer Fam Cancer 1 2001 149 156
25. D.J. Feuer, and K.E. Broadley Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer (Cochrane Review) The Cochrane Library, Issue 2 2004 John Wiley & Sons Ltd Chicester, UK
26. C. Lhomme, P. Vennin, N. Callet, T. Lesimple, J.L. Achard, and J. Chauvergne A multicenter phase II study with triptorelin (sustained-release LHRH agonist) in advanced or recurrent endometrial carcinoma: a French anti-cancer federation study Gynecol Oncol 75 1999 187 193
27. J. Rohl, D. Kushner, and M. Markman Chronic administration of single agent paclitaxel in gynecologic malignancies Gynecol Oncol 81 2001 201 205
28. N.M. Spirtos, J.B. Schlaerth, G.M. Gross, T.W. Spirtos, A.C. Schlaerth, and S.C. Ballon Cost and quality-of-life analyses of surgery for early endometrial cancer: laparotomy versus laparoscopy Am J Obstet Gynecol 174 1996 1795 1799
29. M.S. Green, R.W. Naumann, M. Elliot, J.B. Hall, R.V. Higgins, and J.H. Grigsby Sexual dysfunction following vulvectomy Gynecol Oncol 77 2000 73 77
30. B. Sorbe, A.M. Berglind, and K. De Bruijn Tropisetron, a new 5-HT3 receptor antagonist, in the prevention of irradiation-induced nausea, vomiting and diarrhoea Eur J Gynaecol Oncol 13 1992 382 389
31. M.I. Fitch, R.E. Gray, and E. Franssen Women's perspectives regarding the impact of ovarian cancer Cancer Nurs 23 2000 359 366
32. C.J. Furst, S. Johansson, M. Fredrikson, T. Hursti, G. Steineck, and C. Peterson Control of cisplatin induced emesis - a multidisciplinary intervention strategy Med Oncol Tumor Pharmacother 9 1992 81 86
33. M. Tamburini, A. Filiberti, V. Ventafridda, and G. de Palo Quality of life after radical vulvectomy J Psychosom Obstet Gynaecol 5 1986 263 269
34. M. Eisemann, and A. Lalos Psychosocial determinants of well-being in gynecologic cancer patients Cancer Nurs 22 1999 303 306
35. A.K. Matthews, J.E. Aikens, S.P. Helmrich, D.D. Anderson, A.L. Herbst, and S.E. Waggoner Sexual functioning and mood among long term survivors of clear cell adenocarcinoma of the vagina or cervix J Psychosoc Oncol 17 1999 27 45
36. J.G. Blythe, and T.P. Wahl Debulking surgery: does it increase the quality of survival? Gynecol Oncol 14 1982 396 408
37. G.A. Feuer, R. Fruchter, E. Seruri, M. Maiman, J.C. Remy, and J.G. Boyce Selection for percutaneous nephrostomy in gynecologic cancer patients Gynecol Oncol 42 1991 60 63
38. M.I. Feng, G.C. Bellman, and C.E. Shapiro Management of ureteral obstruction secondary to pelvic malignancies J Endourol 13 1999 521 524
39. M. Gropp, M.D. Meier, and H. Hepp Treosulfan as an effective second line therapy in ovarian cancer Gynecol Oncol 71 1998 94 98
40. G.H. Eltabbakh, M.I. Shamonki, J.M. Moody, and L.L. Garafano Laparoscopy as the primary modality for the treatment of women with endometrial carcinoma Cancer 91 2001 378 387
41. K.M. Van Nostrand, J.A. Lucci, M. Schell, M.L. Berman, A. Manetta, and P. DiSaia Primary vaginal melanoma: improved survivial with radical pelvic surgery Gynecol Oncol 55 1994 234 237
42. C. Emmert, J. Rassler, and U. Kohler Survival and quality of life after percutaneous nephrostomy for malignant ureteric obstruction in patients with terminal cervical cancer Arch Gynecol Obstet 259 1997 147 151
43. S.A. Butler-Manuel, K. Summerville, A. Ford, P. Blake, A.J. Riley, and A.H. Sultan Self assessment of morbidity following radical hysterectomy for cervical cancer J Obstet Gynaecol 19 1999 180 183
44. R. Herwig, F. Bruns, H. Strasser, G.M. Pinggera, O. Micke, and P. Rehder Late urologic effects after adjuvant irradiation in stage I endometrial carcinoma Urology 63 2004 354 358
45. M. Ersek, B.R. Ferrell, K.H. Dow, and C.H. Melancon Quality of life in women with ovarian cancer West J Nurs Res 19 1997 334 350
46. M. Speca, J.W. Robinson, E. Goodey, and B. Frizzell Patients evaluate a quality of life scale: whose life is it anyway? Cancer Pract 2 1994 365 370
47. C. Li, G. Samsioe, and C. Iosif Quality of life in endometrial cancer survivors Maturitas 31 1999 227 236
48. H. Meden, A. Metz, and E. Monkeberg-Tun Quality of Life of patients with ovarian cancer after surgery and chemotherapy Onkologie 17 1994 50 56
49. G. Bos-Branolte, E.M. Zielstra, Y.M. Rijshouwer, and H.J. Duivenvoorden Psychotherapy in patients cured of gynecological cancers Recent Results Cancer Res 108 1988 277 288
50. H.T. Thaler, R.M. McQuellon, D.H. Moore, J.P. Donnelly, and D.F. Cella Longitudinal assessment of quality of life in advanced cervical cancer Qual Life Res 9 2000 253
51. D. Bodurka-Bevers, K. Basen-Engquist, C.L. Carmack, M.A. Fitzgerald, J.K. Wolf, and C. de Moor Depression, anxiety, and quality of life in patients with epithelial ovarian cancer Gynecol Oncol 78 2000 302 308
52. L. Butler, M. Bacon, M. Carey, B. Zee, D. Tu, and A. Bezjak Determining the relationship between toxicity and quality of life in an ovarian cancer chemotherapy clinical trial J Clin Oncol 22 2004 2461 2468
53. E.A. Calhoun, E.E. Welshman, C.H. Chang, J.R. Lurain, D.A. Fishman, and T.L. Hunt Psychometric evaluation of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (Fact/GOG-Ntx) questionnaire for patients receiving systemic chemotherapy Int J Gynecol Cancer 13 2003 741 748
54. J. Carter, A. Saltzman, D. Chen, P. Carney, P. Johnson, and E. Hartenbach Quality of life assessment in gynaecological cancer patients Aust NZ J Obstet Gynaecol 35 1995 293 297
55. J.R. Carter, M.D. Chen, J.M. Fowler, L.F. Carson, and L.B. Twiggs The effect of prolonged cycles of chemotherapy on quality of life in gynaecologic cancer patients J Obstet Gynaecol Res 23 1997 197 203
56. G. Oliverio, D. Canuti, A. Tononi, M. Scarpellini, I. Panzini, and I. Galli Paclitaxel efficacy and tolerability in second-line treatment of refractory and relapsed ovarian cancer patients J Chemother 11 1999 301 305
57. W. ten Bokkel Huinink, S.R. Lane, and G.A. Ross for the International Topotecan Study Group. Long-term survival in a phase III, randomised study of topotecan versus paclitaxel in advanced epithelial ovarian carcinoma Ann Oncol 15 2004 100 103
58. H. Zhao, K. Kanda, S.J. Liu, and X.Y. Mao Evaluation of quality of life in Chinese patients with gynaecological cancer: assessments by patients and nurses Int J Nurs Pract 9 2003 40 48
59. A. du Bois, H.J. Luck, W. Meier, H.P. Adams, V. Mobus, and S. Costa A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first line treatment of ovarian cancer J Natl Cancer Inst 95 2003 1320 1329
60. F. Guidozzi Living with ovarian cancer Gynecol Oncol 50 1993 202 207
61. E.M. Hartenbach, L.S. Harris, H.H. Bailey, E.A. Grosen, E. Larrison, and D. Chen Paclitaxel, carboplatin, and hexamethyl-melamine (taxchex) as first-line therapy for ovarian cancer Cancer J Sci Am 5 1999 348 355
62. T. Le, A. Leis, P. Pahwa, K. Wright, K. Ali, and B. Reeder Quality of life evaluations in patients with ovarian cancer during chemotherapy treatment Gynecol Oncol 92 2004 839 844
63. J.F. Smyth, A. Bowman, T. Perren, P. Wilkinson, R.J. Prescott, and K.J. Quinn Glutathione reduces the toxicity and improves quality of life of women diagnosed with ovarian cancer treated with cisplatin: results of a double-blind, randomised trial Ann Oncol 8 1997 569 573
64. Y.M. Chan, T.Y. Ng, H.Y. Ngan, and L.C. Wong Quality of life in women treated with neoadjuvant chemotherapy for advanced ovarian cancer: a prospective longitudinal study Gynecol Oncol 88 2003 9 16
65. F. Kayikcioglu, M.F. Kose, N. Boran, E. Caliskan, and G. Tulunay Neoadjuvant chemotherapy or primary surgery in advanced epithelial ovarian carcinoma Int J Gynecol Cancer 11 2001 466 470
66. C. Doyle, M. Crump, M. Pintilie, and A.M. Oza Does palliative chemotherapy palliate? Evaluation of expectations, outcomes and costs in women receiving chemotherapy for advanced ovarian cancer J Clin Oncol 19 2001 1266 1274
67. M.C. Klee, M.T. King, D. Machin, and H.H. Hansen A clinical model for quality of life assessment in cancer patients receiving chemotherapy Ann Oncol 11 2000 23 30
68. M.J. Piccart, J.A. Green, A.J. Lacave, N. Reed, I. Vergote, and P. Benedetti-Panici Oxaliplatin or paclitaxel in patients with platinum-pretreated advanced ovarian cancer: a randomized phase II study of the European Organization for Research and Treatment of Cancer Gynecology Group J Clin Oncol 18 2000 1193 1202
69. C.M. Lakusta, M.J. Atkinson, J.W. Robinson, J. Nation, P.A. Taenzer, and M.G. Campo Quality of life in ovarian cancer patients receiving chemotherapy Gynecol Oncol 81 2001 490 495
70. A. Bye, T. Ose, and S. Kaasa Quality of life during pelvic radiotherapy Acta Obstet Gynecol Scand 74 1995 147 152
71. A. Bye, C. Trope, J.H. Loge, M. Hjermstad, and S. Kaasa Health-related quality of life and occurrence of intestinal side effects after pelvic radiotherapy - evaluation of long-term effects of diagnosis and treatment Acta Oncol 39 2000 173 180
72. P. Huguenin, B. Baumert, U.M. Lutolf, E. Wight, and C. Glanzmann Curative radiotherapy in elderly patients with enodmtrial cancer: patterns of relapse, toxicity and quality of life Strahlenther Onkol 175 1999 309 314
73. P.T. Jensen, M. Groenvold, M.C. Klee, I. Thranov, M.A. Petersen, and D. Machin Longitudinal study of sexual function and vaginal changes after radiotherapy for cervical cancer Int J Radiat Oncol Biol Phys 56 2003 937 949
74. M. Klee, and D. Machin Health-related quality of life of patients with endometrial cancer who are disease-free following external irradiation Acta Oncol 40 2001 816 824
75. M. Klee, I. Thranov, and D. Machin The patients' perspective on physical symptoms after radiotherapy for cervical cancer Gynecol Oncol 76 2000 14 23
76. M. Klee, I. Thranov, and D. Machin Life after radiotherapy: the psychological and social effects experienced by women treated for advanced stages of cervical cancer Gynecol Oncol 76 2000 5 13
77. L.M. Nail, K.B. King, and J.E. Johnson Coping with radiation treatment for gynecologic cancer: mood and disruption in usual function J Psychosom Obstet Gynaecol 5 1986 271 281
78. M. Hockel, K. Sclenger, H. Hamm, P.G. Knapstein, R. Hohenfellner, and H.P. Rosler Five year experience with combined operative and radiotherapeutic treatment of recurrent gynecologic tumors infiltrating the pelvic wall Cancer 77 1996 1918 1933
79. C. Faul, K. Gerszten, R. Edwards, S. Land, G. D'Angelo, and J. Kelley 3rd A phase I/II study of hypofractionated whole abdominal radiation therapy in patients with chemoresistant ovarian carcinoma: Karnofsky score determines treatment outcome Int J Radiat Oncol Biol Phys 47 2000 749 754
80. B.L. Andersen, X.A. Woods, and L.J. Copeland Sexual self-schema and sexual morbidity among gynecologic cancer survivors J Consult Clin Psychol 65 1997 221 229
81. S. Hawighorst-Knapstein, G. Schonefub, S. Hoffman, and P.G. Knapstein Pelvic exenteration: effects of surgery on quality of life and body image-a prospective study Gynecol Oncol 66 1997 495 500
82. M. Hockel Laterally extended endopelvic resection: novel surgical treatment of locally recurrent cervical carcinoma involving the pelvic side wall Gynecol Oncol 91 2003 369 377
83. C. Li, G. Samsioe, and C. Iosif Quality of life in long-term survivors of cervical cancer Maturitas 32 1999 95 102
84. S.K. Lutgendorf, B. Anderson, P. Ullrich, E.L. Johnsen, R.E. Buller, and A.K. Sood Quality of life and mood in women with gynecologic cancer: a one year prospective study Cancer 94 2002 131 140
85. K. Maughan, and C. Clarke The effect of a clinical nurse specialist in gynaecological oncology on quality of life and sexuality J Clin Nurs 10 2001 221 229
86. A.J. Nordin, S. Dixon, D.J. Chinn, I. Moloney, R. Naik, and A. De Barros Lopes Attitudes to radical gynecological oncology surgery in the elderly: a pilot study Int J Gynecol Cancer 10 2000 323 329
87. A.K. Sood, I. Nygaard, M.S. Shahin, J.I. Sorosky, S.K. Lutgendorf, and S.S. Rao Anorectal dysfunction after surgical treatment for cervical cancer J Am Coll Surg 195 2002 513 519
88. A. Cull, V.J. Cowie, D.I.M. Farquharson, J.R.B. Livingstone, G.E. Smart, and R.A. Elton Early stage cervical cancer: psychosocial and sexual outcomes of treatment Br J Cancer 68 1993 1216 1220
89. M.G. Nair Quality of life in cancer of the cervix patients Int Clin Psychopharmacol 15 Suppl 3 2000 S47 S49
90. L.B. Wenzel, J.P. Donnnelly, J.M. Fowler, R. Habbal, T.H. Taylor, and N. Aziz Resilience, reflection and residual stress in ovarian cancer surviorship: a gynecologic oncology group study Psychooncology 11 2002 142 153
91. G. Capelli, R.I. De Vincenzo, A. Addamo, F. Bartolozzi, N. Braggio, and G. Scambia Which dimensions of health-related quality of life are altered in patients attending the different gynecologic oncology health care settings? Cancer 15 2002 2500 2507
92. S.K. Lutgendorf, B. Anderson, N. Rothrock, R.E. Buller, A.K. Sood, and J.I. Sorosky Quality of life and mood in women receiving extensive chemotherapy for gynecologic cancer Cancer 89 2000 1402 1411
93. M. Carlsson, P. Strang, and C. Bjurstrom Treatment modality affects long term quality of life in gynaecological cancer Anticancer Res 20 2000 563 568
94. Y.M. Chan, H.Y. Ngan, B.Y. Li, A.M. Yip, T.Y. Ng, and P.W. Lee A longitudinal study on quality of life after gynecologic cancer treatment Gynecol Oncol 83 2001 10 19
95. B.E. Miller, M.D. Pittman, D. Case, and R.P. McQuellon Quality of life after treatment for gynecologic malignancies: a pilot study in an outpatient clinic Gynecol Oncol 87 2002 178 184
96. B.E. Miller, B. Pittman, and C. Strong Gynecologic cancer patients' psychosocial needs and their views on the physician's role in meeting those needs Int J Gynecol Cancer 13 2003 111 119
97. D.R. Zacharias, C.A. Gilg, and M.J. Foxall Quality of life and coping in patients with gynecologic cancer and their spouses Oncol Nurs Forum 21 1994 1699 1706
98. W. Boling, R.T. Fouladi, and K. Baseb-Enquist Health-related quality of life in gynecological oncology: instruments and psychometric properties Int J Gynecol Cancer 13 2003 5 14
99. E. Greimel, A. Bottomley, A. Cull, A.C. Waldenstrom, J. Arraras, and L. Chauvenet An international field study of the reliability and validity of a disease-specific questionnaire module (the QLQ-OV28) in assessing the quality of life of patients with ovarian cancer Eur J Cancer 39 2003 1402 1408
100. G. Velikova, D. Stark, and P. Selby Quality of life instruments in oncology Eur J Cancer 35 1999 1571 1580
101. L.R. Derogatis, and P.M. Spencer Psychometric issues in the psychological assessment of the cancer patient Cancer 53 1984 2228 2232
102. The Cochrane Collaboration. Glossary of Cochrane Collaboration Terms. April 2000. Available at: http://www.cochrane.org/resources/glossary.htm. Accessed on February 22, 2005.
103. J. Neijt, and A. du Bois Paclitaxel/carboplatin for the initial treatment of advanced ovarian cancer Semin Oncol 26 1999 78 83
104. A. du Bois, H.J. Luck, W. Meier, H.P. Adams, V. Mobus, and S. Costa A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first line treatment of ovarian cancer J Natl Cancer Inst 95 2003 1320 1329
105. H. Zhao, and K. Kanda Translation and validation of the standard Chinese version of the EORTC QLQ-C30 Qual Life Res 9 2000 129 137
106. D.S. Albets Clinical pharmacology of carboplatin Semin Oncol 17 1990 6 8
107. B.R. Ferrell, and K.H. Dow Quality of life among long-term cancer survivors Oncology 11 1997 565 571
108. W. Schroder, A. DuBois, and W. Kuhn Treatment of patients with advanced ovarian cancer (FIGO IIb-IV) with cisplatin/paclitaxel or carboplatin/paclitaxel - an interim analysis of the ago study protocol ovar-3 Eur J Cancer 35 Suppl 4 1999 231
109. S.D. Costa, A. Du Bois, H.J. Lueck, W. Meier, V. Moebus, and T. Bauknecht Cisplatin/paclitaxel vs. carboplatin/paclitaxel in 798 patients with ovarian cancer FIGO IIB-IV randomized phase III study the AGO study group (Ovar-3 trial) Eur J Cancer 37 Suppl 6 2001 235