title: Older women in Appalachia: experiences with gynecological cancer.
abstract: OBJECTIVE
  The purpose of this study was to explore how older women in rural Appalachia with gynecological cancer construct and interpret their experience with cancer.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Human Development, Virginia Tech, Blacksburg. kallen@vt.edu.
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Allen
authors.affiliation: Center for Gerontology and The Institute for Society, Culture and Environment, Virginia Tech, Blacksburg.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Roberto
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D001061:Appalachian Region; D001294:Attitude to Health; D005260:Female; D005833:Genital Neoplasms, Female / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008016:Life Change Events; D008875:Middle Aged; D010465:Perception; D036301:Qualitative Research; D012424:Rural Population; D017741:Survivors / Q000523:psychology*
keywords: Appalachia; Cancer survivorship; Gyneco logical cancer; Middle aged; Women