title: Survivors of gynecologic malignancies: impact of treatment on health and well-being.
abstract: OBJECTIVE
  While overall survival from gynecologic malignancies has greatly improved over the last three decades, required treatments can lead to multiple health issues for survivors. Our objective was to identify health concerns that gynecologic cancer survivors face.
  
  
  METHODS
  A systematic, stratified sample of women with gynecologic malignancies was surveyed for 18 health issues occurring before, during, or after treatment. The impact of clinical features and treatment modality on health issues was assessed through multivariate logistic regression models.
  
  
  RESULTS
  Of 2,546 surveys mailed, 622 were not received by eligible subjects secondary to invalid address, incorrect diagnosis, or death. Thus, 1924 survivors potentially received surveys. Of the 1,029 surveys (53.5%) completed, median age was 59 years; diagnoses included 29% cervical, 26% endometrial, 26% ovarian/primary peritoneal/fallopian tube, 12.1% vulvar, and 5.4% vaginal cancers. The most frequently reported health issues included fatigue (60.6%), sleep disturbance (54.9%), urinary difficulties (50.9%), sexual dysfunction (48.4%), neurologic issues (45.4%), bowel complaints (42.0%), depression (41.3%), and memory problems (41.2%). These rankings were consistent with patients' self-reported rankings of "highest impact" personal issues. After controlling for demographic and clinical variables, multivariate analyses revealed that treatment modality impacted the odds of experiencing a given health issue.
  
  
  CONCLUSIONS
  Our study demonstrates that gynecologic cancer survivors experience a high frequency of health conditions and highlights the association between treatment modality and specific health concerns.
  
  
  CONCLUSIONS
  The study findings highlight the multiple health concerns experienced by gynecologic cancer survivors and suggest the potential for developing interventions to mitigate these concerns in survivorship.
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Boulevard, Unit 1362, CPB6.3279, Houston, TX, 77030, USA. swestin@mdanderson.org.
authors.forename: Shannon N
authors.identifier: http://orcid.org/0000-0002-1922-0156
authors.initials: SN
authors.lastname: Westin
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Boulevard, Unit 1362, CPB6.3279, Houston, TX, 77030, USA.
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Sun
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Celestine S
authors.initials: CS
authors.lastname: Tung
authors.affiliation: Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA, USA.
authors.forename: Robin A
authors.initials: RA
authors.lastname: Lacour
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Boulevard, Unit 1362, CPB6.3279, Houston, TX, 77030, USA.
authors.forename: Larissa A
authors.initials: LA
authors.lastname: Meyer
authors.affiliation: Division of Quantitative Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Diana L
authors.initials: DL
authors.lastname: Urbauer
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Boulevard, Unit 1362, CPB6.3279, Houston, TX, 77030, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Frumovitz
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Boulevard, Unit 1362, CPB6.3279, Houston, TX, 77030, USA.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Lu
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Boulevard, Unit 1362, CPB6.3279, Houston, TX, 77030, USA.
authors.forename: Diane C
authors.initials: DC
authors.lastname: Bodurka
mesh_terms: D005260:Female; D005833:Genital Neoplasms, Female / Q000401:mortality* / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D016896:Treatment Outcome
keywords: Gynecologic malignancy; Health issues; Quality of life; Survivorship; Treatment