{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:41:17Z","timestamp":1787013677382,"version":"build-2736575974"},"reference-count":45,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,3,31]],"date-time":"2024-03-31T00:00:00Z","timestamp":1711843200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate psychological correlates in women referred with suspected ovarian cancer via the fast\u2010track pathway, explore how anxiety and distress levels change at 12\u2009months post\u2010testing, and report cancer conversion rates by age and referral pathway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Single\u2010arm prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Multicentre. Secondary care including outpatient clinics and emergency admissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>A cohort of 2596 newly presenting symptomatic women with a raised CA125 level, abnormal imaging or both.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Women completed anxiety and distress questionnaires at recruitment and at 12\u2009months for those who had not undergone surgery or a biopsy within 3\u2009months of recruitment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Anxiety and distress levels measured using a six\u2010item short form of the State\u2013Trait Anxiety Inventory (STAI\u20106) and the Impact of Event Scale \u2013 Revised (IES\u2010r) questionnaire. Ovarian cancer (OC) conversion rates by age, menopausal status and referral pathway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 1355\/2596 (52.1%) and 1781\/2596 (68.6%) experienced moderate\u2010to\u2010severe distress and anxiety, respectively, at recruitment. Younger age and emergency presentations had higher distress levels. The clinical category for anxiety and distress remained unchanged\/worsened in 76% of respondents at 12\u2009months, despite a non\u2010cancer diagnosis. The OC rates by age were 1.6% (95%\u2009CI 0.5%\u20135.9%) for age &lt;40\u2009years and 10.9% (95%\u2009CI 8.7%\u201313.6%) for age \u226540\u2009years. In women referred through fast\u2010track pathways, 3.3% (95%\u2009CI 1.9%\u20135.7%) of pre\u2010 and 18.5% (95%\u2009CI 16.1%\u201321.0%) of postmenopausal women were diagnosed with OC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Women undergoing diagnostic testing display severe anxiety and distress. Younger women are especially vulnerable and should be targeted for support. Women under the age of 40\u2009years have low conversion rates and we advocate reducing testing in this group to reduce the harms of testing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.17813","type":"journal-article","created":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:18:35Z","timestamp":1711930715000},"page":"1400-1410","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Investigating harms of testing for ovarian cancer \u2013 psychological outcomes and cancer conversion rates in women with symptoms of ovarian cancer: A cohort study embedded in the multicentre\n                    <scp>ROCkeTS<\/scp>\n                    prospective diagnostic study"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6245-2358","authenticated-orcid":false,"given":"Fong Lien","family":"Kwong","sequence":"first","affiliation":[{"name":"Institute of Applied Health Research University of Birmingham  Birmingham UK"},{"name":"Pan Birmingham Gynaecological Cancer Centre, City Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Kristunas","sequence":"additional","affiliation":[{"name":"Institute of Cancer and Genomic Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Davenport","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ridhi","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Deeks","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Mallett","sequence":"additional","affiliation":[{"name":"Centre for Medical Imaging University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Kehoe","sequence":"additional","affiliation":[{"name":"St Peter's College University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Timmerman","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynaecology University Hospitals KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Bourne","sequence":"additional","affiliation":[{"name":"Department of Metabolism, Digestion and Reproduction, Faculty of Medicine Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Stobart","sequence":"additional","affiliation":[{"name":"Patient Representative  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Neal","sequence":"additional","affiliation":[{"name":"University of Exeter Medical School University of Exeter  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usha","family":"Menon","sequence":"additional","affiliation":[{"name":"Institute of Clinical Trials and Methodology University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Gentry\u2010Maharaj","sequence":"additional","affiliation":[{"name":"Institute of Clinical Trials and Methodology University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Sturdy","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Ottridge","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5843-3015","authenticated-orcid":false,"given":"Sudha","family":"Sundar","sequence":"additional","affiliation":[{"name":"Pan Birmingham Gynaecological Cancer Centre, City Hospital  Birmingham UK"},{"name":"Institute of Cancer and Genomic Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the ROCkeTS collaborators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,31]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Cancer Research UK.Ovarian cancer statistics. 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