{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T06:12:17Z","timestamp":1782540737342,"version":"3.54.5"},"reference-count":53,"publisher":"Wiley","issue":"20","license":[{"start":{"date-parts":[[2015,7,31]],"date-time":"2015-07-31T00:00:00Z","timestamp":1438300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"The National Cancer Institute of the National Institutes of Health","award":["R25CA116339"],"award-info":[{"award-number":["R25CA116339"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2015,10,15]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Adults aged \u226565 years who are dually enrolled in Medicare and Medicaid are an at\u2010risk group in health care. However, to the best of the authors' knowledge, the outcomes of women with gynecologic cancers in this population are unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The current study was a population\u2010based cohort study of North Carolina state cancer registry cases of uterine, ovarian, cervical, and vulvar\/vaginal cancers (2003\u20102009), with linked enrollment in Medicare and state Medicaid. Outcomes of all\u2010cause mortality and stage of disease at the time of diagnosis were analyzed as a function of enrollment status using multivariate analysis and survival curves.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Of 4522 women aged \u226565 years (3702 of whom were enrolled in Medicare [82%] and 820 of whom were dually enrolled [18%]), there were 2286 cases of uterine (51%), 1587 cases of ovarian (35%), 302 cases of cervical (7%), and 347 cases of vulvar\/vaginal (8%) cancers. Dual enrollees had increased all\u2010cause mortality overall (adjusted hazard ratio [aHR], 1.34; 95% confidence interval [95% CI], 1.19\u20101.49), and within each cancer site (uterine: aHR, 1.22 [95% CI, 1.02\u20101.47]; ovarian: aHR, 1.25 [95% CI, 1.05\u20101.49]; cervical: aHR, 1.34 [95% CI, 0.96\u20101.87]; and vulvar\/vaginal: aHR, 1.93 [95% CI, 1.36\u20102.72]). Increased odds of advanced\u2010stage disease at the time of diagnosis among dual enrollees was only present in patients with uterine cancer (adjusted odds ratio, 1.38; 95% CI, 1.06\u20101.79). Stratified survival curves demonstrated the strongest disparities among women with early\u2010stage uterine and early\u2010stage vulvar\/vaginal cancers.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Women aged \u226565 years who were dually enrolled in Medicare and Medicaid were found to have an overall 34% increase in all\u2010cause mortality after diagnosis with a gynecologic cancer compared with the non\u2010dually enrolled Medicare population. Women with early\u2010stage uterine and vulvar\/vaginal cancers appeared to have the most disparate outcomes. Because these malignancies are generally curable, they have the most potential for benefit from targeted interventions. <jats:bold><jats:italic>Cancer<\/jats:italic> 2015;121:3591\u20133599<\/jats:bold>. \u00a9 <jats:italic>2015 American Cancer Society<\/jats:italic>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.29541","type":"journal-article","created":{"date-parts":[[2015,7,31]],"date-time":"2015-07-31T10:25:21Z","timestamp":1438338321000},"page":"3591-3599","source":"Crossref","is-referenced-by-count":22,"title":["Gynecologic cancer outcomes in the elderly poor: A population\u2010based study"],"prefix":"10.1002","volume":"121","author":[{"given":"Kemi M.","family":"Doll","sequence":"first","affiliation":[{"name":"Division of Gynecologic Oncology University of North Carolina at Chapel Hill School of Medicine Chapel Hill North Carolina"},{"name":"Division of Health Policy and Management, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina"},{"name":"Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Meng","sequence":"additional","affiliation":[{"name":"Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan M.","family":"Basch","sequence":"additional","affiliation":[{"name":"Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola A.","family":"Gehrig","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology University of North Carolina at Chapel Hill School of Medicine Chapel Hill North Carolina"},{"name":"Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy R.","family":"Brewster","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology University of North Carolina at Chapel Hill School of Medicine Chapel Hill North Carolina"},{"name":"Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne\u2010Marie","family":"Meyer","sequence":"additional","affiliation":[{"name":"Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,7,31]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.20.8983"},{"key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.ajog.2011.02.067","article-title":"Morbidity and mortality of surgery for endometrial cancer in the oldest old","volume":"205","author":"Wright JD","year":"2011","journal-title":"Am J Obstet Gynecol."},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26589"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2011.08.027"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2014.02.021"},{"key":"e_1_2_7_7_1","volume-title":"SEER Cancer Statistics Review, 1975\u20132012","author":"Howlander N","year":"2015"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.coc.0000143049.05090.12"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2011.02.040"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2008.06.026"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2015.01.543"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/IGC.0b013e318234f8d5"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/IGC.0000000000000418"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2004.52169.x"},{"key":"e_1_2_7_15_1","unstructured":"Department of Health and Human Services.Medicare. 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