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Item Associations between lifestyle factors and quality of life among older long-term breast, prostate, and colorectal cancer survivors(Wiley, 2009) Mosher, Catherine E.; Sloane, Richard; Morey, Miriam C.; Snyder, Denise Clutter; Cohen, Harvey J.; Miller, Paige E.; Demark-Wahnefried, WendyBACKGROUND: Older cancer survivors are at increased risk for secondary cancers, cardiovascular disease, obesity, and functional decline and, thus, may benefit from health-related interventions. However, to the authors' knowledge, little is known regarding the health behaviors of older cancer survivors and the associations of those behaviors with quality-of-life outcomes, especially during the long-term post-treatment period. METHODS: In total, 753 older (aged ≥65 years) long-term survivors (≥5 years postdiagnosis) of breast, prostate, and colorectal cancer completed 2 baseline telephone interviews to assess their eligibility for a diet and exercise intervention trial. The interviews assessed exercise, diet, weight status, and quality of life. RESULTS: Older cancer survivors reported a median of 10 minutes of moderate-to-vigorous exercise per week, and only 7% had Healthy Eating Index scores >80 (indicative of healthful eating habits relative to national guidelines). Despite their suboptimal health behaviors, survivors reported mental and physical quality of life that exceeded age-related norms. Greater exercise and better diet quality were associated with better physical quality-of-life outcomes (eg, better vitality and physical functioning; P < .05), whereas greater body mass index was associated with reduced physical quality of life (P < .001). CONCLUSIONS: The current results indicated a high prevalence of suboptimal health behaviors among older, long-term survivors of breast, prostate, and colorectal cancer who were interested in lifestyle modification. In addition, the findings pointed to the potential negative impact of obesity and the positive impact of physical activity and a healthy diet on physical quality of life in this population. Cancer 2009.Item Cancer, Cognitive Impairment, and Work-Related Outcomes: An Integrative Review(ONS, 2016-09) Von Ah, Diane; Storey, Susan; Tallman, Eileen; Nielsen, Adele; Johns, Shelley A.; Pressler, Susan J.; IU School of NursingProblem Identification: Cancer survivors often report concerns regarding their memory, attention, and ability to process information and make decisions. These problems, which have also been demonstrated on objective neuropsychological assessments, may have a significant impact on work-related outcomes. Literature Search: A literature review was conducted using the following electronic databases: Ovid (MEDLINE®), PubMed, CINAHL®, and Web of Science. Search terms included cancer, survivors, cognitive, work, and work ability. Empirical research published in English from January 2002 to August 2015 that focused on cognitive impairment in adult cancer survivors was included in the review. Data Evaluation: Articles were evaluated by two independent researchers. Synthesis: Twenty-six studies met the inclusion criteria. Ten were qualitative, 15 were quantitative, and 1 had a mixed-methods design. Quantitative articles were synthesized using the integrative methodology strategies proposed by Whittemore and Knafl. Synthesis of qualitative articles was conducted using the criteria established by the Swedish Agency for Health Technology Assessment and Assessment of Social Services. Conclusions: To date, research in this context has been limited by cognitive assessments focusing primarily on patient self-assessments of attention, concentration, and memory. Additional research is needed to examine the impact of cognitive performance and to expand work-related outcomes measures to include perceived work ability, productivity, and actual performance. Implications for Nursing: Lack of information regarding cognitive impairment inhibits survivors’ ability to prepare, understand, and accept impending cognitive changes and how they may affect work ability. Oncology nurses can assist cancer survivors by preparing and educating them on how to better manage impairment associated with cancer and its treatment.Item Comparative responsiveness and minimally important difference of Fatigue Symptom Inventory (FSI) scales and the FSI-3 in trials with cancer survivors(Springer, 2022-07) Mosher, Catherine E.; Secinti, Ekin; Johns, Shelley A.; Kroenke, Kurt; Rogers, Laura O.; Psychology, School of ScienceBackground Fatigue is a highly prevalent and disabling symptom in cancer survivors. Although many measures have been developed to assess survivors’ fatigue, their ability to accurately capture change following intervention has rarely been assessed in post-treatment survivors. Ultra-brief fatigue measures are preferable in clinical practice but have limited evidence supporting their use with cancer survivors. We examined the psychometric properties of four Fatigue Symptom Inventory (FSI) measures, including the new FSI-3, in cancer survivors. Examined properties included responsiveness to change and minimally important differences (MIDs). Methods We analyzed data from three randomized controlled trials with post-treatment cancer survivors (N = 328). Responsiveness to change was evaluated by comparing standardized response means for survivors who reported their fatigue as being better, the same, or worse at 2–3 months. Responsiveness to intervention was assessed via effect sizes, and MIDs were estimated by using several methods. We also computed area under the curve (AUC) values to assess FSI measures’ discriminative accuracy compared to an established cut-point. Results All FSI measures differentiated survivors who reported improvement at 2–3 months from those with stable fatigue, but did not uniformly differentiate worsening fatigue from stable fatigue. Measures showed similar levels of responsiveness to intervention, and MIDs ranged from 0.29 to 2.20 across FSI measures. AUC analyses supported the measures’ ability to detect significant fatigue. Conclusions Four FSI scales show similar responsiveness to change, and estimated MIDs can inform assessment of meaningful change in fatigue. The FSI-3 shows promise as an ultra-brief fatigue measure for survivors.Item Medical Care Disruptions During the First Six-Months of the COVID19 Pandemic: The Experience of Older Breast Cancer Survivors(Springer, 2021) Dilawari, Asma; Rentscher, Kelly; Zhai, Wanting; Ahles, Tim A.; Ahn, Jaeil; Bethea, Traci; Carroll, Judith E.; Cohen, Harvey; Graham, Deena; Jim, Heather; McDonald, Brenna C.; Nakamura, Zev; Patel, Sunita; Root, James; Small, Brent; Saykin, Andrew; Tometich, Danielle; VanDyk, Kathleen; Mandelblatt, Jeanne; Radiology and Imaging Sciences, School of MedicinePurpose Older cancer survivors required medical care during the COVID-19 pandemic despite infection risks, but there are limited data on medical care in this age group. Methods. We evaluated care disruptions in a longitudinal cohort of non-metastatic breast cancer survivors ages 60-98 from five US regions (n=321). Survivors completed a web-based or telephone survey from May 27, 2020 to September 11, 2020. Care disruptions included self-reported interruptions in ability to see doctors, receive treatment or supportive therapies, or fill prescriptions. Logistic regression models evaluated bivariate and multivariate associations between care disruptions and education, medical, psychosocial and COVID-19-related factors. Multivariate models included age, county COVID-19 rates, comorbidity and post-diagnosis time. Results. There was a high response rate (n=262, 81.6%). Survivors were 32.2 months post-diagnosis (SD 17.5, range 4-73). Nearly half (48%) reported a medical disruption. The unadjusted odds of care disruptions were significantly higher with more education (OR 1.23 per one-year increase, 95% CI 1.09-1.39, p =0.001) and greater depression (OR 1.04 per one-point increase in CES-D score, CI 1.003-1.08, p=0.033); tangible support decreased the odds of disruptions (OR 0.99, 95% CI 0.97-0.99 per one-point increase, p=0.012). There was a trend for associations between disruptions and comorbidity (unadjusted OR 1.13 per 1 added comorbidity, 95% CI 0.99-1.29, p=0.07). Adjusting for covariates, only higher education (p=0.001) and tangible social support (p=0.006) remained significantly associated with having care disruptions. Conclusions. Older breast cancer survivors reported high rates of medical care disruptions during the COVID-19 pandemic and psychosocial factors were associated with care disruptions.