Tertiary prevention: lifestyle in ovarian cancer

Tertiary prevention focuses on restoring health after illness. The aim of tertiary prevention (rehabilitation) is to prevent or alleviate relapse, chronification or consequential damage. In oncology in particular, tertiary prevention plays an important role in improving long-term survival and quality of life.

What is Long Term Survival?

Thanks to advances in medicine, survival rates are increasing, and cancer can more and more often be viewed as a chronic disease. In the western world, more than 65% survive cancer for more than five years. In Germany alone there are around four million long-term survivors after cancer. Long-term survivors increasingly include women with or after ovarian cancer: around a third of women become long-term survivors. Despite the increasing number of long-term survivors, the topic of long-term survival has received very little attention in both the lay press and scientifically.

How is long-term survival after gynecological cancer defined?

The definition of long-term survival in the literature is very inconsistent. For this reason, the following formulation was established at the 2019 specialist congress in Athens of the global community of gynecological-oncological study groups: Long-term survival is defined as survival of at least five years after the initial diagnosis of gynecological cancer.

The group of long-term ovarian cancer survivors is very heterogeneous. On the one hand, there are women who have developed ovarian cancer once in their life and are considered cured and, on the other hand, there are women who have had a relapse or even several relapses and are currently receiving therapy.

Are Long Term Survivors Healthier?

Long-term survivors are often considered healthier and the literature has repeatedly described that certain pre-existing conditions, such as diabetes mellitus or pre-existing cardiovascular disease, are associated with a poorer prognosis. As part of a Charité study “Carolin meets HANNA”, long-term survivors were compared with patients who died within five years of the initial diagnosis. No differences in previous illnesses or medication intake could be determined.

For your information:
For a long life — regardless of cancer — the following apply among others. the regular consumption of cruciferous vegetables (broccoli, pointed cabbage, sweet potatoes), berries, nuts, pomegranate, avocado, green tea, flax seeds, whole grains, green leafy vegetables and tomatoes as cheap. A low-meat or vegetarian diet seems to reduce the risk of cancer; for example, the risk of developing breast cancer is 23% higher with regular consumption of red meat. There is therefore evidence that a healthy diet has a positive effect on the course of the disease, but so far there are no scientific studies on the diet of long-term survivors with ovarian cancer.

What role does the psyche play?

The psyche and related personal resilience also seem to play a role in the course of the disease. It is not without reason that every cancer patient is offered psycho-oncological counseling or support. You can find more information on this in the article on supportive offers.

Cured but not healthy?

52% of all long-term survivors see themselves as cancer patients. Even among women without current therapy, 28% still see themselves as cancer patients. This could include related to the fact that more than half of long-term survivors still have symptoms.

Aftercare and then?

In Germany, patients with ovarian cancer usually present for five years — after that, cancer patients are usually considered cured. Although this mostly applies to cancer as such, it does not necessarily apply to possible long-term side effects and fears, e.g. of a late relapse of the disease.

The Survivorship Clinic — a novelty

So far there have been no special consultation hours for long-term survivors in Germany, which is why there is currently a consultation hour for long-term survivors after or with gynecological tumor disease (ovarian, fallopian tube) , Peritoneal, cervical and uterine body cancer). The aim of the consultation is to improve the quality of life and the state of health of long-term survivors, the (early) detection and treatment of long-term side effects and the creation of a multimodal and interprofessional therapy module. Each patient should receive an individual “survivorship care plan”, as recommended in the current guideline, which also includes advice on lifestyle aspects such as diet and physical activity. The establishment of this “survivorship consultation” is funded by the innovation fund of the Federal Joint Committee of Health Insurance Funds.