Influence of delayed diagnosis on established prognostic factors in endometrial cancer.

To evaluate the influence of delayed diagnosis on prognostic factors in endometrial cancer, we conducted a retrospective chart analysis based on the data of 116 postmenopausal patients with FIGO stage I-IV endometrial carcinoma. The interval from the first episode of post-menopausal vaginal bleeding to definitive, histological diagnosis (bleeding interval) was compared with tumor stage and various histomorphologic features in endometrial cancer. The mean bleeding interval was 12.7 +/- 17.8 weeks in 74 patients with FIGO stage IA, IB endometrial carcinoma and 35.2 +/- 69.3 weeks in 42 patients with stage IC-IV disease (t-test, p: 0.011). FIGO stage IA, IB disease was diagnosed in 23/26 (88%) patients with a bleeding interval <4 weeks, and in 22/34 (64%) and 29/56 (51%) patients with bleeding intervals of 4-8 weeks and >8 weeks, respectively (Chi-square 10.358, p=0.006). The correlation with histologic grade, lymph-node status, vessel invasion and histologic subtypes did not reach statistical significance. Our data confirm the clinical impression that postmenopausal vaginal bleeding is an early symptom in patients with endometrial cancer, and that advanced disease in the majority of cases might come from delayed diagnosis in women with poor compliance.

[Psychosocial prognostic factors for refertilization or IvF after tubal sterilization]. / Psychosoziale Prognosefaktoren für Refertilisierung oder IvF nach Tubensterilisation.

In a psychosomatic study we interviewed 33 women who had undergone tubal anastomosis or IvF after tubal ligation. As a control group we chose a randomised sample of 45 women after elective tubal ligation. We used a semi-structured interview and the Giessen-test as psychometric instruments. According to the leading indication for reanastomosis, we allocated women to one of 2 groups: 21 patients had found a new partner (R-partner), 12 mentioned experiences of loss (R-loss). The groups were well comparable in respect of sociodemographic items, but showed relevant differences in psychological variables, like motivation for and time for deliberation to sterilisation or age difference between partners. Women of the R-partner group were highly satisfied with tubal reanastomosis as compared to R-loss subjects. Satisfaction with the procedure was basically independent of an actual pregnancy. Women experienced the two methods in different, rather specific ways. Cluster analysis of the Giessen-test result confirmed group allocation. We conclude that experiences of loss as a leading reason for tubal reanastomosis are unfavourable prognostic factors. IvF has an unfavourable prognosis in women with the intention to restore the mutilated body image. Preoperative counselling by a psychotherapeutically trained counsellor seems mandatory.

[Coping with illness and body image following different surgical techniques in breast cancer]. / Krankheitsbewältigung und Körperbild nach unterschiedlichen Operationstechniken bei Brustkrebs.

Coping and body image were studied in 80 patients with breast cancer. We compared three groups, who had undergone different operative strategies: temporary expander prothesis (n = 19), excisional biopsy (n = 20) and modified radical mastectomy (n = 40). Instruments were: the Herschbach coping questionnaire, the Strauss and Appelt body image questionnaire and a semi-structured interview. Patients after excisional biopsy showed significantly less illness-related stress than the other two groups, both in the number of all items named (p less than 0.02) and in the weighted total (p less than 0.05). Patients after modified mastectomy had chosen a different, "unfavourable" pattern of coping mechanisms than patients after expander prothesis or excisional biopsy: more resignation (p less than 0.05), less fighting and talking (p less than 0.05, respectively). In the body image questionnaire, no significant difference was found. However, in the semi-structured interview, patients after mastectomy mentioned more frequently that they avoided looking at the scar (p less than 0.05). These results underline the importance of preoperative counselling.