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Purpose Many low-income patients enroll in Medicaid at the time of cancer diagnosis, which improves survival outcomes. Medicaid enrollment before cancer diagnosis may confer additional benefits. Our objective was to compare stage at diagnosis and overall mortality between women with and without Medicaid enrollment before gynecologic cancer diagnosis. Methods and Materials Women younger than 65 years with a gynecologic cancer (2003 to 2008) were identified through the North Carolina Central Cancer Registry and linked to state Medicaid enrollment files. Those with and without Medicaid enrollment within 6 months before diagnosis were identified. Propensity matching was used to balance the exposure groups. Stage at diagnosis was evaluated by using logistic regression, and all-cause mortality was assessed with Cox proportional hazard models. Results Of 564 women, one half (n = 282) had prediagnosis Medicaid enrollment. Disease sites included the cervix (44%), uterus (25%), ovary (26%), and vulva/vagina (5%). More than one half (51%) of cancers were advanced stage. Women without prediagnosis Medicaid had an increased odds of advanced-stage disease (hazard ratio, 1.46; 95% CI, 1.03 to 2.05). Crude survival outcomes differed significantly between the groups; however, when adjusted for stage at diagnosis, lack of prediagnosis Medicaid coverage had a hazard ratio of 1.19 (95% CI, 0.92 to 1.53). Conclusion Medicaid enrollment before gynecologic cancer diagnosis is associated with an earlier stage at presentation. Given the existence of a cervical cancer screening program in North Carolina and lack of Medicaid expansion, these data suggest that screening programs alone are not sufficient to counteract the delay in diagnosis that is common for uninsured individuals. [ABSTRACT FROM AUTHOR]

Purpose of the Study: The purpose of this study was to explore how older women in rural Appalachia with gynecological cancer construct and interpret their experience with cancer. Design and Methods: Grounded in social constructionist theory, semistructured in-depth interviews were conducted with 20 women, aged 51–82, who had been treated for gynecological cancer. Transcripts were analyzed using the constant comparative method. Results: Although women narrated their experience along a common trajectory from symptoms to diagnosis to treatment, four distinct patterns of posttreatment perceptions were described: (a) positive: women believed they were cancer survivors, (b) cautious: women saw themselves as survivors but not risk free, (c) distanced: women viewed themselves as cured and equated survivor with victim, and (d) resigned: women refused more treatment. All of the women acknowledged an inner strength in how they experienced cancer, requiring a more nuanced framework for understanding how negative and positive feelings coexist with faith in a higher power and the capacity to endure a devastating threat to life and health. Implications: The findings expand the concept of survivor identity, suggesting that the women’s perception that they had met life’s challenges with fortitude and inner strength may have more resonance in later life than the concept of survivorship. Family members and medical and public health professionals need to support older women’s individual response to cancer recovery and acknowledge their complicated reactions to a cancer diagnosis and prognosis. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: Depression is common in cancer patients but frequently undetected. Consensus regarding validity and optimal thresholds of screening measures is lacking. We investigated the validity of the Hospital Anxiety and Depression Scale (HADS-D) and Center for Epidemiological Studies Depression Scale (CES-D) relative to a referent diagnostic standard in women with breast or gynecologic cancer. Method: Participants were 100 patients who completed the CES-D and HADS-D within a larger study. The Mini International Neuropsychiatric Interview was the criterion standard. Sensitivity, specificity, predictive values and likelihood ratios for various thresholds were calculated using receiver operating characteristics. Participants were assigned to two diagnostic groups: ‘major depressive disorder’ or ‘any depressive disorder’. Results: Separate analyses were conducted whereby participants found to be receiving depression/anxiety treatment at the time of validation (n=28) were excluded. Both measures had good internal consistency and criterion validity. There were no statistical differences in global accuracy between the measures for detecting either group. For optimal sensitivity and specificity in both groups, generally recommended thresholds were lowered for the HADS-D. For the CES-D, the threshold was lowered for ‘any depressive disorder’ and raised for ‘major depressive disorder’. Negative predictive values associated with our recommended cutoffs were excellent, but positive predictive values were poor. Conclusions: The HADS-D and CES-D have acceptable properties and are equivalent for detecting depression in this population. Depending on the purpose of screening, the CES-D may be more suitable for identifying major depression. Threshold choice may have serious implications for screening program effectiveness, and the use of generally recommended thresholds should be cautious. [Copyright &y& Elsevier]

Background. Diffusion weighted imaging (DWI) has gained interest as an imaging modality for assessment of tumor extension and response to cancer treatment. The purpose of this study is to assess the impact of the choice of b-values on the calculation of the Apparent Diffusion Coefficient (ADC) for locally advanced gynecological cancer and to estimate a stable interval of diffusion gradients that allows for best comparison of the ADC between patients and institutions. Material and methods. Six patients underwent a high resolution single shot EPI based DWI scan with 16 different diffusion gradients on a 3 Tesla Philips Achieva MR-scanner. Data analysis was performed by applying a monoexponential and a biexponential model to the acquired data. The biexponential function models the effect of both perfusion and diffusion. Results and conclusion. ADC changes of up to 40% were seen with the use of different b-values. Using a lower b-value ≥ 150 s/mm2 and an upper b-value ≥ 700 s/mm2 limited the variation to less that 10% from the reference ADC value. By eliminating the contribution of perfusion the uncertainty of quantitative ADC values were significantly reduced. [ABSTRACT FROM AUTHOR]

Aim: The expression of Dkk-3, as a number of the Dkk family was different in different cancer. Because Dkk-3 encodes a secreted protein, we investigated whether the Dkk-3 protein is secreted into the sera of patients with gynecological cancer. Material & Methods: The levels of Dkk-3 protein were assessed by enzyme-linked immunosorbent assay in the sera of 104 patients with gynecological cancer: 36 with ovarian, 40 with cervical and 28 with endometrial cancers. Results: The serum levels of Dkk-3 protein in patients with ovarian cancer [25.54 (7.99) pg/mL] was lower than in normal individuals [42.08 (14.89) pg/mL] ( P = 0.000). But serum levels of Dkk-3 protein in patients with cervical [166.39 (300.68) pg/mL] ( P = 0.013) and endometrial cancers [73.64 (23.36) pg/mL] ( P = 0.000) were higher than in normal individuals. The serum levels of Dkk-3 protein were associated with clinical stage in patients with cervical and endometrial cancers. In patients with ovarian cancer, the serum levels of Dkk-3 protein were associated with lymphatic metastasis. In patients with cervical cancer, the serum levels of Dkk-3 protein were associated with tumor diameters. Conclusion: Dkk-3 protein detection using enzyme-linked immunosorbent assay as molecular markers can contribute to detection and diagnosis of gynecological cancer, especially for ovarian cancer and endometrial cancer. [ABSTRACT FROM AUTHOR]