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\begin{document}

\title{Investigating harms of testing for ovarian cancer - psychological
outcomes and cancer conversion rates in women with symptoms of ovarian
cancer: a cohort study embedded in the multicentre ROCkeTS prospective
diagnostic study}



\author[1]{Audrey Kwong}%
\author[2]{Caroline Kristunas}%
\author[1]{Clare Davenport}%
\author[1]{Ridhi Aggarwal}%
\author[1]{Jonathan Deeks}%
\author[3]{Sue Mallett}%
\author[4]{Sean Kehoe}%
\author[5]{Dirk Timmerman}%
\author[6]{Tom Bourne}%
\author[7]{Hilary Stobart}%
\author[8]{Richard Neal}%
\author[3]{Usha Menon}%
\author[3]{Alexandra Gentry-Maharaj}%
\author[1]{Lauren Sturdy}%
\author[1]{Ryan Ottridge}%
\author[9]{Sudha Sundar}%
\affil[1]{University of Birmingham Institute of Applied Health Research}%
\affil[2]{University of Birmingham Institute of Cancer and Genomic Sciences}%
\affil[3]{University College London}%
\affil[4]{University of Oxford}%
\affil[5]{Katholieke Universiteit Leuven}%
\affil[6]{Imperial College London}%
\affil[7]{Birmingham Public Health}%
\affil[8]{University of Exeter}%
\affil[9]{Sandwell and West Birmingham Hospitals NHS Trust}%


\vspace{-1em}



  
  \date{May 22, 2024}


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\begin{abstract}
\textbf{Objectives:} To investigate psychological correlates in women
referred with suspected ovarian cancer via the fast-track pathway,
explore how anxiety and distress levels change 12 months post-testing
and report cancer conversion rates by age and referral pathway.
\textbf{Design:} Single arm prospective cohort study \textbf{Setting:}
Multicentre. Secondary care including outpatient clinics and emergency
admissions. \textbf{Participants:} 2596 newly presenting symptomatic
women with a raised CA125 level, abnormal imaging or both.
\textbf{Methods:} Women completed anxiety and distress questionnaires at
recruitment and at 12 months for those who had not undergone surgery or
a biopsy within 3 months of recruitment. \textbf{Main outcome measures:}
Anxiety and distress levels measured using STAI-6 and IES-r
questionnaires. OC conversion rates by age, menopausal status and
referral pathway. \textbf{Results:} 1355/2596 (52.1\%) and 1781/2596
(68.6\%) experienced moderate-to-severe distress and anxiety at
recruitment. Younger age and emergency presentations had higher distress
levels. Clinical category for anxiety and distress remained
unchanged/worsened in 76\% at 12 months despite a non-cancer diagnosis.
OC rates by age were 1.6\% (95\% CI 0.5 to 5.9) under 40 and 10.9 \%
(95\% CI 8.7 to 13.6) over 40 years. In women referred through
fast-track pathways, 3.3\% (95\% CI 1.9 to 5.7) of pre- and 18.5\% (95\%
CI 16.1 to 21.0) of postmenopausal women were diagnosed with OC.
\textbf{Conclusions:} Women undergoing diagnostic testing display severe
anxiety and distress. Younger women are especially vulnerable and should
be targeted for support. Women under 40 have low conversion rates and we
advocate reducing testing in this group to reduce harms of testing.%
\end{abstract}%



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\verb`Fig 1.docx`  available at \url{https://authorea.com/users/564928/articles/686776-investigating-harms-of-testing-for-ovarian-cancer-psychological-outcomes-and-cancer-conversion-rates-in-women-with-symptoms-of-ovarian-cancer-a-cohort-study-embedded-in-the-multicentre-rockets-prospective-diagnostic-study}

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\verb`Fig 2.docx`  available at \url{https://authorea.com/users/564928/articles/686776-investigating-harms-of-testing-for-ovarian-cancer-psychological-outcomes-and-cancer-conversion-rates-in-women-with-symptoms-of-ovarian-cancer-a-cohort-study-embedded-in-the-multicentre-rockets-prospective-diagnostic-study}

\textbf{Hosted file}

\verb`Table 1.docx`  available at \url{https://authorea.com/users/564928/articles/686776-investigating-harms-of-testing-for-ovarian-cancer-psychological-outcomes-and-cancer-conversion-rates-in-women-with-symptoms-of-ovarian-cancer-a-cohort-study-embedded-in-the-multicentre-rockets-prospective-diagnostic-study}

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\verb`Table 2.docx`  available at \url{https://authorea.com/users/564928/articles/686776-investigating-harms-of-testing-for-ovarian-cancer-psychological-outcomes-and-cancer-conversion-rates-in-women-with-symptoms-of-ovarian-cancer-a-cohort-study-embedded-in-the-multicentre-rockets-prospective-diagnostic-study}

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\verb`Table 3.docx`  available at \url{https://authorea.com/users/564928/articles/686776-investigating-harms-of-testing-for-ovarian-cancer-psychological-outcomes-and-cancer-conversion-rates-in-women-with-symptoms-of-ovarian-cancer-a-cohort-study-embedded-in-the-multicentre-rockets-prospective-diagnostic-study}

\textbf{Hosted file}

\verb`Table 4.docx`  available at \url{https://authorea.com/users/564928/articles/686776-investigating-harms-of-testing-for-ovarian-cancer-psychological-outcomes-and-cancer-conversion-rates-in-women-with-symptoms-of-ovarian-cancer-a-cohort-study-embedded-in-the-multicentre-rockets-prospective-diagnostic-study}

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