Cervical cancer survivorship in a population based sample
ABSTRACT Though cervical cancer is preventable, this cancer nonetheless poses serious mortality and morbidity threats to American women and women globally. The purpose of this study is to utilize a multidimensional framework to assess Health-related Quality of Life (HRQOL) and its salient predictors among a population based sample of cervical cancer survivors.
A cross-sectional design was used with a population-based sample ascertained from the California Cancer Surveillance Program. Descriptive, bivariate and multivariate regression analyses were conducted.
Participants were 560 cervical cancer survivors: English-speaking Latina- (n=88), Spanish-speaking Latina- (n=199) and European- (n=273) Americans. The greatest concerns were documented for family/social and emotional well-being, and body image and sexual health. In general, Latina-Americans reported poorer overall HRQOL, functional, emotional, and social/family wellbeing compared to European-Americans. Differences in HRQOL persisted by ethnic/language group after controlling for covariates. Radiation, comorbidity, role limitations, perceived health status, psychological wellbeing, body image, sexual impact, doctor-patient relationship, and social support were significant predictors of overall HRQOL. The regression model explained 58% of the variance in predicting HRQOL.
These cervical cancer survivors reported poor to moderate HRQOL with persistent psychosocial challenges. Our findings indicate that lower SES, monolingual Latinas are at greatest risk for poor HRQOL outcomes. Clinicians should pay attention to their patients' socio-ecological context as a risk factor for poorer outcomes; and provide early referrals to resources that are low cost and culturally and linguistically appropriate.
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ABSTRACT: This study investigates the association between health-related quality of life (HRQOL) outcomes and survival status among a population-based cohort diagnosed with invasive cancer of the cervix uteri. This study is based on data from 353 multiethnic cervical cancer survivors (CCS) recruited through the California Cancer Surveillance Program. The independent variable is HRQOL measured by the FACT-CX (FACT-G plus additional items) and the SF-12. The dependent variable is survival from date of the HRQOL survey. Kaplan-Meier estimates and univariate and multivariate Cox Proportional Hazards Regression models were used to examine the relationship between HRQOL and survival. In the Kaplan-Meier analyses, the FACT-CX functional well-being score equal to or above the median score was significantly associated with improved overall survival (X(2)=7.19; p=0.007). Significant differences in survival were observed for the SF-12 physical and mental health component scores. In the multivariate Cox regression analyses, the final model indicated that the FACT-CX total scores, functional well-being, and additional cervical cancer concerns subscales, and the SF-12 physical and mental component summary scores significantly influenced survival, after controlling for medical characteristics. However, the FACT components that do not include cervical cancer specific items including mean standardized FACT-G and physical, emotional, and social/family well-being subscales were not predictors of survival before and after adjustment for covariates. The results of this study advance the current scientific knowledge by confirming that HRQOL outcomes, in particular the physical, function and mental health dimensions are associated with survival for CCS. These findings highlight the utility of cancer site specific HRQOL data to inform the psychosocial and symptom management aspects, as well as the medical follow-up care practice and research that may extend life.Gynecologic Oncology 04/2010; 118(1):35-42. DOI:10.1016/j.ygyno.2010.02.027 · 3.69 Impact Factor
Conference Paper: TFT circuit integration in a-Si:H technology[Show abstract] [Hide abstract]
ABSTRACT: Although hydrogenated amorphous silicon (a-Si:H) is inherently disadvantaged in terms of speed and stability compared to polycrystalline or crystalline Si, there is an overwhelming need for this mature technology in several newly emerging and significant application areas. Here, the question arises as to whether circuit techniques can be employed to compensate for its intrinsic material shortcomings so as to meet performance requirements. The paper reviews precisely these challenges. Specifically, it addresses the development of compact thin film transistor (TFT) circuit models and examines design considerations pertinent to thin film circuits, such as on-pixel current drivers and amplifiers, whose integration requires nonconventional design solutions to deal with the high material resistivity and high instability. The family of circuits presented here are critical to two application areas: the active matrix organic light emitting diode (AMOLED) display and digital fluoroscopy for medical applications.Microelectronics, 2002. MIEL 2002. 23rd International Conference on; 02/2002
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ABSTRACT: The number of cancer survivors experiencing disease progression (DP) is increasing with the number of cancer survivors. However, little is known whether DP affects health-related quality of life (HRQL) of long-term cancer survivors. We aimed therefore to compare the health status (HS) and HRQL of DP and disease-free (DF) survivors up to 15 years after initial diagnosis. 232 cancer survivors with DP identified through the Eindhoven Cancer Registry were matched with 232 DF survivors of similar demographic and clinical characteristics. Patients completed generic HS (SF-36) and cancer-specific HRQL (QOL-CS) questionnaires 5-15 years after diagnosis. Compared with DF survivors, DP survivors exhibited significantly lower scores on all SF-36 and QOL-CS (except spiritual well-being) dimensions. DF survivors had better scores than the normative population on all SF-36 dimensions. Among survivors with DP, those with short survival (<5 years) had significantly poorer HS scores on all dimensions except bodily pain compared with the normative population. Comparatively, the long survival (>or=5 years) DP group had better HRQL than the short DP group but poorer HRQL than the normative population. In multivariate analyses, DP and DF survival time were independently associated with aspects of HS and HRQL in cancer survivors. DP cancer survivors have poorer long-term HS and HRQL compared with DF survivors. However, there is suggestion that HS and HRQL does improve over time following DP. IMPLICATION FOR CANCER SURVIVORS: Although DP survivors report poorer long-term HRQL compared with DF cancer survivors, results suggest that time can attenuate the distress of DP on HRQL. Psycho-educational programs could help to increase patients' sense of empowerment and personal control should DP occur.Journal of Cancer Survivorship 06/2009; 3(3):164-73. DOI:10.1007/s11764-009-0094-1 · 3.29 Impact Factor