Karen F. Bowman

The health of older-adult, long-term cancer survivors.

Research indicates that cancer-related health problems persist for decades among survivors. The combination of late effects of cancer or its treatment and age-related health problems may add to the vulnerability of older survivors. This research reports on the health and functioning of a sample of long-term (5+years), older-adult (>60 years) survivors of breast, prostate, and colorectal cancer. Data were derived from 321 in-person interviews with a sample randomly selected from a tumor registry at a comprehensive cancer center. Descriptive data analyzed comorbid health conditions and continued cancer symptoms reported by survivors. Correlational analysis examined the association among demographic cancer-related factors and a range of health quality-of-life outcomes, including functioning and illness impact. Nearly 40% of respondents have at least 1 symptom attributed to cancer/treatment. Pain was the most commonly reported symptom, with 21% attributing it to cancer. More than 40% of breast cancer survivors and nearly 20% of prostate cancer survivors reported pain. Being African American or female was significantly associated with more current symptoms and greater functional difficulty. Survivors who had chemotherapy and survivors with more types of treatment reported significantly more symptoms both during treatment and currently. Many older-adult survivors are more vulnerable due to both cancer-related symptoms and comorbid health conditions. Women and African Americans are at special risk. This combined vulnerability is an important factor for clinicians treating long-term survivors.

Cancer survivorship and identity among long-term survivors.

This article examines the concept of survivorship and the adoption of the “survivor identity” by those who have been treated for cancer. First, we review recent and growing theoretical and empirical literatures on cancer and identity and identity transformation. With that review as background, we present our own research findings from 2 separate studies on survivorship and identity. Our data suggest that most older adults who have survived cancer for at least 5 years, identify as cancer survivors and/or as ex-patients rather than as victims or patients. Most also view being a survivor as an important part of who they are, do not see themselves as less whole, and are not overly concerned about how others view them. To the degree that a survivor orientation is associated with better mental health outcomes and encourages health promotion and appropriate symptom monitoring, it can reinforce the effects of the quality medical care provided by clinical staff. The support of clinicians encouraging this orientation, where it is appropriate, may further enhance the quality of life of individuals who living with a history of cancer.

The effects of cancer-related pain and fatigue on functioning of older adult, long-term cancer survivors.

This research examines the fatigue and pain reported by a sample of long-term (5 years), older adult (≥60 years) survivors of breast, prostate, and colorectal cancer. It also examines the importance of cancer and age-related factors as correlates of pain and fatigue as well as the relationship between pain and fatigue and functional difficulty. Data were derived from 321 in-person interviews with a sample of survivors randomly selected from a tumor registry at a comprehensive cancer center. The results of multivariate analysis indicate that the pain, energy level, and weakness reported by older adult cancer survivors are more strongly related to age-related factors than they are to cancer-related factors. Age-related factors accounted for 14% of the variance in pain compared with 2% for cancer-related factors. For energy level, age-related factors explained 4% of the variance, whereas cancer-related factors account for 2%. Age-related factors accounted for 9% of the variance in weakness compared with 6% for cancer-related factors. Furthermore, pain, energy, and weakness are all statistically significant predictors of functional difficulties (β = .20, −.16, and .11, respectively). Age-related factors explained 21% of the total variance, whereas cancer-related factors contributed 6%. This research points to the fact that both cancer and age-related factors contribute to the pain and fatigue of older adult survivors, although factors such as comorbidites and noncancer symptoms appear to be relatively more important. Because it is not unusual for those providing health care to older adults to be unaware of their cancer history and treatments, the role that cancer may play in symptoms such pain and fatigue may go unassessed and unaddressed.

Institutionalization: A Continuation of Family Care

It is often assumed that with institutionalization comes an end to family caregiving. The goal of this study is to show that family caregiving continues even after institutionalization of the care recipient. The data come from 81 families who institutionalized their elders. The findings indicate that families remain involved in the care of the elder after institutionalization, although to a lesser degree and in different ways. Involvement in personal care tasks is reduced, not termi nated ; involvement in the specialized needs of the elder, such as their financial and legal concerns, continues, along with the new role of advocacy. The effects of caregiving are still felt by the primary caregiver, as are the effects of institutionalizing the care recipient.

Functioning and Activity Participation Restrictions among Older Adult, Long-Term Cancer Survivors

This research examines how cancer and treatment sequelae combine with comorbidities to influence the physical functioning and activity participation restrictions reported by older adult (≥60), long-term survivors (5+ years) of breast, prostate, and colorectal cancer. The number of current comorbidities was the best predictor of functional difficulties and also a significant predictor of participation restrictions. Cancer stage at diagnosis and continuing cancer symptoms had direct effects on functional difficulties, and indirect effects through functional difficulties on participation restrictions. Clinicians working with older adult survivors need to be aware of the interplay between cancer and other health problems as they affect quality of life after cancer.

Functioning of older, long-term cancer survivors: The role of cancer and comorbidities

OBJECTIVES: To examine the relative effect of comorbidities, noncancer symptoms, and cancer‐related factors on the functioning of older adult long‐term survivors of breast, colorectal, and prostate cancers.

Patterns of adaptation in patients living long term with advanced cancer

With improved treatment, increasing proportions of patients with advanced cancer are surviving longer with their disease: into a second year after diagnosis and beyond. These longer term survivors face continuing challenges in selecting and shifting personal life goals and goals of care over years (rather than months) of life with incurable cancer. Studies are needed to explore adaptation over time in patients who are living longer term with late‐stage cancer, including anxiety, depression, and spiritual well being, which are conceptualized as indicators of psychospiritual well being in patients with advanced cancer.

Racial Differences in the Health of Older-Adult Long-Term Cancer Survivors

Abstract This article focuses on differences between African-American and White older adults who were long-term (five or more years postdiagnosis) survivors of cancer regarding reported health problems, symptoms of illness, functional difficulties, health worries and concerns, and overall perceptions of health. A conceptual model examined the relationship between demographic factors (e.g., race, age, cancer- and treatment-related factors) and perceptions of health (e.g., burden of disability, health concerns and worries, and self-rated global health). Regression analysis examined quantitative data from in-person interviews with 180 survivors of breast, colorectal, or prostate cancer obtained from the tumor registry of the Ireland Cancer Center at University Hospitals Health System of Cleveland. African Americans were oversampled to represent 50% of the total sample. The analysis indicated that African Americans experienced poorer functional health after cancer, even after disease and treatment factors were controlled for. However, compared with White survivors, African Americans did not report significantly more symptoms attributed to either cancer or its treatment, suggesting that their poorer health after cancer may not have been a result of either factor but to other comorbid conditions. Moreover, because the extensiveness of treatment is a significant predictor of functional disability, attention must be paid to the degree to which more extensive treatment among African Americans translates into greater disability.

Family caregiver engagement in a coping and communication support intervention tailored to advanced cancer patients and families.

We describe family caregiver (FCG) participation in a tailored coping and communication support intervention for advanced cancer patients and families. Preliminary descriptive data on characteristics and patterns of early engagement in the intervention for 132 FCGs are presented. Engagement assessed at an initial in-person meeting and the following 6 weeks includes problems raised, strategies used, and initiation, frequency, and mode of contact. A sizable proportion of FCGs were male, African American, and nonspouse. The FCGs had modest scores on a standard survey measure of burden yet volunteered caregiving demands as their primary problem. Other problems raised initially by more than 40% of the sample included psychological, practical, and communication with healthcare providers. Few reported physical and psychosocial difficulties. Engagement preferences expressed at the initial meeting largely mapped with actual engagement during the 6 weeks of intervention. Most FCGs were actively engaged during follow-up. Some (14%) did not opt for coping and communication support during this early treatment phase. This intervention is expected to affect quality of care and quality-of-life outcomes for FCGs over time from patient diagnosis to end of life. Findings will guide modification and dissemination of this intervention primarily in cancer clinics for the underserved.

Relationships and emotional wellbeing among African American and White advanced cancer caregivers.

OBJECTIVE Advanced cancer family caregivers who have good relationships with other family members and with patients health care providers (PHCPs) have less emotional distress than caregivers with poor relationships. Given a history of different experiences in medical settings among Whites and African Americans, we examined moderation effects by race. METHODS Baseline data from an ongoing study were collected via telephone interviews with 397 family caregivers of advanced cancer patients at two cancer clinics. Depressed mood and anxiety were measured with the 14-item Profile of Mood States. RESULTS Caregivers reporting good relationships with family (p<.001) and PHCPs (p<.001) had lower anxiety and less depressed mood (family, p<.01; PHCP, p<.001). Caregiver race moderated relationship quality: Whites with good PHCP relationships felt less depressed mood (p<.01) and anxiety (p<.01). African Americans with good family relationships showed less depressed mood (p<.05), but no association with anxiety. CONCLUSION Good relationships are important for caregivers, but PHCPs may have more influence on the wellbeing of White than of African American caregivers. PRACTICE IMPLICATIONS Developing relationships with caregivers of advanced cancer patients may improve wellbeing for caregivers. In addition, creating strategies to support family relationships may be a useful intervention, especially for African American advanced cancer caregivers.