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Kathleen N. Moore and Joan L. Walker

abnormal cervical cytology and cervical cancer precursors: Arch Pathol Lab Med 2003 ; 127 : 950 – 957 . 16 Cox TJ Lorincz AT Schiffman MH . Gynecology: Human papillomavirus testing by hybrid capture appears to be useful in triaging women

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Robert W. Carlson

improve patient outcomes,” he explained. To this end, NCCN recognizes 4 levels of resources: basic, limited, enhanced, and maximal. Efforts are underway to resource-stratify the entire family of guidelines. A pilot project in cervical cancer shows how

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Howard A. Chang, Saro H. Armenian and Thanh H. Dellinger

The female lower genital tract (cervix, vulva, vagina) is a common cancer site within the general population. 1 Cervical cancer is the second most common cancer among women worldwide, while vulvar and vaginal cancers are much rarer, accounting

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Kristopher J. Kimball and Warner K. Huh

. Cervical Cancer Facts and Figures . Atlanta, GA : American Cancer Society ; 2005 : 1 – 61 . 2. Fleurence RL Dixon JM Milanova TF . Review of the economic and quality-of-life burden of cervical human papillomavirus disease . Am J Obstet

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Joseph G. Rajendran and Benjamin E. Greer

. Laparoscopic lower para-aortic staging lymphadenectomy in stage IB2, II, and III cervical cancer . Int J Gynecol Cancer 2002 ; 12 : 22 – 26 . 2. Goff BA Muntz HG Paley PJ . Impact of surgical staging in women with locally advanced cervical cancer

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Chizoba Nwankwo and Michael J. Doane

Background: Globally, CC is the fourth most common cancer in women, with 569,847 new cases and 311,365 deaths from CC reported in 2018. Little is known about the burden of living with CC, especially related to mental health. This study examined patient-reported outcomes, including symptoms of depression and anxiety, amongst women with and without a diagnosis of CC. Methods: Data were aggregated from the 2016–2018 U.S. National Health and Wellness Surveys, a nationally representative, self-administered, internet-based survey of adults (N=247,484). Women who reported a physician-diagnosis of CC were matched 1:1 by propensity scores to a sample of women who did not report any cancer diagnoses. Propensity score matching was conducted using the following sociodemographic characteristics: age, race, possession of health insurance, smoking status, comorbidity status, body mass index, income, and year of survey completion. Bivariate analyses (ie, chi-square and t-tests) assessed differences in mental health outcomes between these 2 matched groups of female respondents. Outcomes included the following: (1) depressive severity via the Patient Health Questionnaire (PHQ-9), (2) suicidal ideation via the PHQ-9 (ie, thoughts of being better off dead on several days or more during the past 2 weeks), (3) anxiety severity via the Generalized Anxiety Disorder 7-Item Scale (GAD-7), and (4) healthcare resource use for mental health services (ie, visits to psychologists and psychiatrists during past 6 months). Results: Analyses of the propensity score matched sample of 1,044 women with a CC diagnosis versus 1,044 without a CC diagnosis showed that CC respondents reported significantly more severe scores of both depression (7.3 vs 6.0; P<.001) and anxiety (5.7 vs 4.7; P<.001). Although not statistically significant, a numerically greater proportion of CC respondents reported suicidal ideation during the past 2 weeks (19.0% vs 16.0%; P=.158). Respondents with CC were marginally more likely to visit a psychologist (8.6% vs 6.4%; P=.056) and were significantly more likely to visit a psychiatrist (8.6% vs 6.2%; P=.037) at least once during the prior 6 months than respondents without CC. Conclusions: CC is associated with mental health burden, including more severe symptoms of depression and anxiety as well as greater use of mental health services. This study highlights the likely impact of CC for both patients as well as the healthcare system

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Amanda N. Fader

complications and similar survival outcomes compared with those staged using laparotomy. Cervical Cancer Although cervical cancer is less common than endometrial cancer, it still represents a significant clinical problem in the United States

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Chizoba Nwankwo, Shelby L. Corman, Ruchit Shah and Youngmin Kwon

Background: An estimated 12,820 women in the United States will be diagnosed with CxCa in 2018, with 4,210 deaths from the disease. The economic burden of CxCa, both in terms of healthcare costs and lost productivity, has not been adequately studied. Methods: This was a mixed-methods study that evaluated the direct and indirect costs of CxCa using data from the Medical Expenditure Panel Survey (MEPS) for prevalent CxCa cases and the National Center for Health Statistics (NCHS) for deaths due to CxCa. Total healthcare costs and number of work days missed were compared between CxCa cases and controls in MEPS, using propensity scores calculated from baseline demographics and comorbidities. Missed work was converted to costs using the average hourly wage for women in 2015. Per-patient incremental healthcare and lost work productivity costs were then multiplied by the number of prevalent cases of CxCa in 2015 obtained from the Surveillance, Epidemiology, and End Results Program (SEER). NCHS data on the age-stratified number of CxCa deaths per year (1935–2015) and life expectancy data from the Social Security Administration were then used to calcluate the number of women who would be alive in 2015 if they had not died from CxCa and the lost earnings resulting from early mortality. The primary study outcome was the total direct and indirect cost of CxCa in 2015, calculated as the sum of the incremental direct healthcare costs, incremental lost productivity costs due to missed work, and lost productivity costs resulting from early death due to CxCa. Results: An estimated 257,524 women were alive with CxCa in 2015. Total healthcare costs were $4,221 higher, and an additional 0.37 work days were missed in women with CxCa compared to propensity-matched controls. Of the 488,475 women who died of CxCa prior to 2015, 108,832 would be alive in 2015 and 38,540 would be part of the workforce. Lost earnings in 2015 attributable to these deaths totaled $2.19 billion. The total economic burden of CxCa in the United States in 2015 was thus estimated at $3.3 billion (Table 1). Conclusions: CxCa was responsible for nearly $3.3 billion in direct and indirect costs in 2015. Early death among women with CxCa was the biggest driver of total economic burden.

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Erin Reid, Gita Suneja, Richard F. Ambinder, Kevin Ard, Robert Baiocchi, Stefan K. Barta, Evie Carchman, Adam Cohen, Oxana V. Crysler, Neel Gupta, Chelsea Gustafson, Allison Hall, Kimberly L. Johung, Ann Klopp, Ann S. LaCasce, Chi Lin, Amitkumar Mehta, Manoj P. Menon, David Morgan, Nitya Nathwani, Ariela Noy, Lee Ratner, Stacey Rizza, Michelle A. Rudek, Julian Sanchez, Jeff Taylor, Benjamin Tomlinson, Chia-Ching J. Wang, Sai Yendamuri, Mary A. Dwyer, CGC and Deborah A. Freedman-Cass

sarcoma 12% Lung cancer 11% Anal cancer 10% Prostate cancer 7% Liver cancer 5% Colorectal cancer 5% Hodgkin lymphoma 4% Oral/pharyngeal cancer 4% Female breast cancer 2% Cervical cancer 1% The NCCN Guidelines for AIDS-Related Kaposi Sarcoma provide

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Erin Reid, Gita Suneja, Richard F. Ambinder, Kevin Ard, Robert Baiocchi, Stefan K. Barta, Evie Carchman, Adam Cohen, Neel Gupta, Kimberly L. Johung, Ann Klopp, Ann S. LaCasce, Chi Lin, Oxana V. Makarova-Rusher, Amitkumar Mehta, Manoj P. Menon, David Morgan, Nitya Nathwani, Ariela Noy, Frank Palella, Lee Ratner, Stacey Rizza, Michelle A. Rudek, Jeff Taylor, Benjamin Tomlinson, Chia-Ching J. Wang, Mary A. Dwyer and Deborah A. Freedman-Cass

), and invasive cervical cancer. 2 , 3 Dramatically improved treatment regimens for HIV during the past 2 decades has decreased the risk of AIDS development, improved immune function and survival, and led to a decline in AIDS-defining cancers in this