Clinical Journal of Oncology Nursing • Volume 15, Number 6 • Anxiety and Knowledge of CA-125 After Ovarian Cancer 625
Amanda Reid, BS, MSN, RN, ANP-BC, Elizabeth Ercolano, DNSc, RN, AOCNS®,
Peter Schwartz, MD, and Ruth McCorkle, PhD, FAAN
This article describes the relationship among anxiety, distress, and serum CA-125 levels in women with ovarian cancer.
Women’s anxiety about monitoring their CA-125 levels during chemotherapy also is discussed. Data from a randomized
trial including self-reported anxiety and emotional distress of women following surgery after a primary diagnosis of ovarian
cancer, their recorded serum CA-125 levels, and knowledge about their CA-125 levels were analyzed. In the sample, 26 of 30
women had serum CA-125 levels above the normal range. At baseline, the sample had an elevated mean anxiety score and
an elevated distress score. A moderate association was found between a high serum CA-125 level and a high anxiety score
at baseline, but the finding was not statistically significant. A negative nonsignificant relationship was found between a high
serum CA-125 level and distress at baseline. The qualitative analysis revealed two themes: anxiety and lack of knowledge of
serum CA-125. Oncology nurses and nurse practitioners caring for these women should provide essential information and
strategies that can help guide women with ovarian cancer through the journey of their disease.
tissues of the ovary and is classified according to the type of ab-
normal cells present (epithelial, germ cell, stromal, granulosa,
and Sertoli-Leydig cell). Epithelial carcinoma composes 90%
of all new cases of ovarian cancer diagnosed each year (Chan,
Bast, Shih, Sokol, & Soletormos, 2009). Abdominal discomfort
and bloating are the two most common presenting symptoms.
Because these symptoms are common in many benign gyneco-
logic and gastrointestinal conditions, most ovarian epithelial
cancers are not diagnosed until they are at an advanced stage.
For this reason and the propensity of advanced-stage epithelial
carcinomas to metastasize, ovarian cancer has been labeled the
The Management of Anxiety
and Knowledge of Serum CA-125
After an Ovarian Cancer Diagnosis
At a Glance
? Women with ovarian cancer experience anxiety and distress
at diagnosis and during chemotherapy.
? Women with ovarian cancer who are informed of an elevated
serum CA-125 may experience more anxiety compared to
women who are uninformed about their CA-125 levels.
? Nurses should educate women with ovarian cancer about the
meaning of serum CA-125 and assess their anxiety related to
Amanda Reid, BS, MSN, RN, ANP-BC, is a nurse practitioner at Yale Cancer Center and Smilow Cancer Hospital in New Haven, CT; and Elizabeth
Ercolano, DNSc, RN, AOCNS®, is an associate research scientist in the School of Nursing, Peter Schwartz, MD, is the John Slade Ely Professor in
Obstetrics, Gynecology, and Reproductive Sciences in the School of Medicine, and Ruth McCorkle, PhD, FAAN, is the Florence Wald Professor
of Nursing in the School of Nursing, all at Yale University in New Haven. The authors take full responsibility for the content of the article. The
authors did not receive honoraria for this work. The content of this article has been reviewed by independent peer reviewers to ensure that it is
balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the
authors, planners, independent peer reviewers, or editorial staff. (Submitted March 2011. Accepted for publication April 15, 2011.)
Digital Object Identifier: 10.1188/11.CJON.625-632
varian cancer is the fourth most common cause of
death from malignancy in women. In the United
States, more than 21,990 new cases of ovarian
cancer are diagnosed each year, and more than
half of those cases result in death (American
Cancer Society, 2011). Ovarian cancer originates within the
“silent killer” (Devita, Hellman, & Rosenberg, 2000, p. 1598).
When ovarian cancer is suspected, a pelvic examination; trans-
vaginal ultrasound; and a computed tomography (CT) scan of
the chest, abdomen, and pelvis are used to assess whether the
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