There is no effective screening test for ovarian cancer and the symptoms are non-specific resulting in the majority (85%) of women with ovarian cancer being diagnosed with late stage (regional or distant cancer) disease. Women diagnosed with ovarian cancer at a late stage have a relatively poor prognosis (5-year survival: 72% for regional cancer, 27% for distant cancer), with the disease and resulting treatment negatively impacting quality of life (QOL). Ovarian cancer survivors diagnosed with late stage disease have frequently been found to have perturbed diurnal cortisol patterns. Normally, cortisol levels decline over the course of the day, that is levels are highest upon waking and lowest in the evening;people who have a perturbed diurnal pattern show a less than expected decline in cortisol level over the course of the day (i.e. a flatter slope). Perturbed cortisol profiles have been associated with fatigue, vegetative depression and greater functional disability in ovarian cancer survivors and poorer survival in later stage breast cancer survivors. Recently a small randomized study in Stage II-IV breast cancer survivors has shown that yoga beneficially affects both cortisol patterns and fatigue. A large ongoing randomized trial at the Yale School of Public Health, which is testing the efficacy of a home-based 6-month exercise intervention to improve QOL and reduce fatigue in ovarian cancer survivors, gives us a unique cost effective opportunity to explore whether exercise effects cortisol patterns. At enrollment women are relatively inactive, and those randomized to the exercise group increase their exercise to150 minutes per week (primarily walking) during the 6-month intervention. All women in the study are contacted once a week by an exercise trainer (exercise group) or a health educator (control group). The two groups receive equal contact time from study personnel, an essential component to effectively explore the effect of exercise, as attention itself can affect some aspects of QOL. In the proposed study we plan to i) explore whether a 6-month home-based exercise intervention will alter the diurnal cortisol patterns in ovarian cancer survivors compared to similar survivors n the control group and ii) explore the association between diurnal cortisol patterns and QOL, depression and fatigue in ovarian cancer survivors. Since perturbed cortisol patterns have been associated with poorer survival in breast cancer survivors, exploring how exercise affects cortisol could provide important information on the mechanisms through which exercise may impact prognosis for cancer survivors. The impact of cortisol on survival among ovarian cancer survivors has not been studied. If we find that exercise beneficially alters diurnal cortisol patterns in ovarian cancer survivors, this would warrant further research to investigate the effect of exercise on survival in women diagnosed with ovarian cancer;a group of understudied cancer survivors.
The proposed study will investigate the efficacy of a home-based 6-month exercise intervention to improve diurnal cortisol dysregulation in ovarian cancer survivors. Diurnal cortisol dysregulation has been associated with a poorer prognosis in breast cancer patients and lower quality of life in ovarian cancer patients. An ongoing randomized trial affords the opportunity to explore the effect of exercise on diurnal cortisol patterns in ovarian cancer patients and may provide evidence to warrant research into the effect of exercise on prognosis in ovarian cancer patients.