Maxine Denniston

Adult cancer survivors: how are they faring?

This study identified the psychosocial problems that 752 patients from 3 states who had been diagnosed with 1 of the 10 most commonly occurring cancers indicated concerned them the most. Approximately 1 year after being diagnosed with cancer, 68.1% of patients were concerned with their illness returning, and more than half were concerned with developing a disease recurrence (59.8%) or had fears regarding the future (57.7%). In addition to these psychological problems focused on fear, approximately two‐thirds (67.1%) of patients were concerned about a physical health problem, fatigue, and loss of strength. Two other physical health problems that concerned more than two‐fifths of patients were sleep difficulties (47.9%) and sexual dysfunction (41.2%). More problems were reported by younger survivors (ages 18–54 yrs), women, nonwhites, those who were not married, and those with a household income of less than

Do adults change their lifestyle behaviors after a cancer diagnosis

20,000 a year. Those patients currently in treatment for cancer reported on average significantly more problems (P < 0.001) and on average had a higher Cancer Problems in Living Scale (CPILS) total score (P < 0.001) compared with those not currently in treatment. In a comparison of respondents with one of the four most common cancers, the most concerns regarding problems in living and highest mean CPILS scores were reported by those diagnosed with lung cancer, followed by survivors of breast cancer, colorectal cancer, and prostate cancer. Cancer 2005.

Measurement of fatigue in cancer patients: Further validation of the Fatigue Symptom Inventory

OBJECTIVE To examine changes in lifestyle behaviors after a cancer diagnosis and medical and demographic influences on such changes. METHODS Adult cancer survivors (n = 352) completed a survey including demographic, medical, and lifestyle behavior change questions. RESULTS Results showed that since cancer diagnosis, 46% of smokers quit smoking, 47% improved their dietary habits, and 30.1% exercised less. Adult cancer survivors who changed their lifestyle behaviors varied, depending on various demographic and medical variables and physician recommendation. CONCLUSION It appears from our data that cancer diagnosis in adults may have a positive influence on smoking and diet and a negative influence on exercise.

Health‐related quality of life of cancer and noncancer patients in Medicare managed care

Fatigue is one of the most common and debilitating symptoms experienced by cancer patients, yet until recent years it has received little systematic attention, due in part to the lack of adequate instruments to measure fatigue. The primary aim of this report is to further validate a recently developed measure of fatigue for use with cancer patients: the Fatigue Symptom Inventory (FSI). This 13-item self-report measure was designed to measure the intensity and duration of fatigue and its interference with quality of life. The FSI was originally validated in a sample of breast cancer patients and a sample of healthy individuals. In this study, the FSI was evaluated in an outpatient sample that included male and female cancer patients, as well as some older patients, with a variety of cancer diagnoses. A seven-item interference scale was found to have good internal consistency, with α coefficients above 0.90. Convergent validity was demonstrated via comparisons with an existing measure of fatigue. Construct validity was demonstrated via comparisons with measure of life satisfaction and depression as well as comparisons among subgroups of patients expected to differ in their experience of fatigue. Overall, the FSI was further established as a valid and reliable measure of fatigue in cancer patients. The potential application of this measure in psychosocial oncology research is discussed.

The influence of social support on depressive symptoms in cancer patients: age and gender differences.

Data from the Health Care Financing Administrations (HCFA) Medicare Health Outcomes Survey (MHOS) of patients enrolled in managed care services through Medicare were analyzed. The MHOS provided baseline estimates of quality of life of cancer survivors in comparison to a frequency age‐matched cohort of noncancer patients.

Association between current lifestyle behaviors and health-related quality of life in breast, colorectal, and prostate cancer survivors

PURPOSE The relationship between social support and depressive symptomatology in cancer patients is well established, yet the extent to which patient variables impact this relationship is not well known. The purpose of this study was to examine whether the relationship of social support to the severity of depressive symptoms varies by patient age and gender. DESCRIPTION OF THE STUDY A sample of 342 cancer outpatients were administered self-report measures of depressive symptoms, perceived adequacy of social support, satisfaction with family functioning, and the size of their social support network. RESULTS There were no significant differences by gender or age in the relationship of the social support variables to depressive symptoms. Although not statistically significant, interesting differences did emerge: a larger social support network was associated with less severe depression for female patients and for younger patients but not for male patients or older patients. For the entire sample, greater perceived adequacy of support and more satisfaction with family functioning were related to less severe depression. CONCLUSIONS The findings of the study suggest that interventions to alleviate depressive symptoms in cancer patients may be designed with consideration of demographic characteristics such as age and gender to maximize the beneficial impact on quality of life.

Validation of a Modified Rotterdam Symptom Checklist for use with cancer patients in the United States

The purpose of the present study was to compare cancer survivors on three different lifestyle behaviors (i.e., physical activity, fruit and vegetable (F&V) consumption, and smoking) and examine the association between these lifestyle behaviors and health-related quality of life (HRQOL). Breast (n = 123), colorectal (n = 86), and prostate (n = 107) cancer survivors completed a survey that included lifestyle behavior questions and the RAND-36 Health Status Inventory (HSI). Results showed that similar percentages of breast, colorectal, and prostate cancer survivors met the lifestyle behavior recommendations. Overall, 69.9 and 26.3% reported meeting the recommendations for physical activity and F&V consumption while 94.3% did not smoke. In addition, survivors who met the physical activity recommendation had significantly higher HRQOL than those who did not, however, meeting the F&V recommendation was not related to HRQOL. Nonetheless, survivors who met more than one lifestyle behavior recommendation had significantly higher HRQOL than those who only met one recommendation. Therefore, although it appears that F&V interventions are needed, it may be important to target more than one lifestyle behavior to obtain optimal HRQOL benefits. Importantly, results suggest that physical activity may be the key lifestyle behavior to include in multibehavioral interventions aimed at improving HRQOL.

Is absolute amount or change in exercise more associated with quality of life in adult cancer survivors

The Rotterdam Symptom Checklist (RSCL) is a well-known instrument for the assessment of symptom-related distress among cancer patients. Despite its broad application, the utility of the RSCL with patients of some cancers is hindered by the omission of several important physical symptoms and methodological limitations of previous validation studies. The aims of the present study were to modify the RSCL through the addition of several physical symptoms and to subsequently validate the modified version of the Rotterdam Symptom Checklist (RSCL-M) with a heterogeneous sample of cancer patients from the United States. A total of 1,005 male and female cancer patients from two midwestern states completed the RSCL-M and several other self-report instruments. Results indicated that the RSCL-M is a reliable and valid instrument for use with cancer patients in the United States and is sensitive to differences in physical distress across groups expected to have distinct symptom-related distress profiles.

Cancer Problems in Living and Quality of Life After Bone Marrow Transplantation

BACKGROUND The present study examined the association between quality of life (QOL) in adult cancer survivors and the (a) absolute current amount of exercise and (b) change in exercise since cancer diagnosis. METHODS Three hundred fifty-two (mean age = 59.6) adult cancer survivors recruited from outpatient clinics in four states (Iowa, Wisconsin, Minnesota, and Georgia) and a minority support groups completed a survey including demographic, medical, exercise behavior, and QOL questions. RESULTS Hierarchical multiple regression analyses controlling for important demographic and medical variables showed that adult cancer survivors who currently exercised three times per week had significantly higher QOL than those who did not (beta = 0.13, P < 0.05). Furthermore, compared to adult cancer survivors who exercised less since their cancer diagnosis, those who maintained (beta = 0.28, P < 0.08) or increased (beta = 0.24, P < 0.01) the amount of exercise they performed since their cancer diagnosis had significantly higher QOL. Finally, examination of the DeltaR(2)(adjusted) between the two exercise models showed that the absolute current amount of exercise explained an additional 1% (DeltaR(2)(adjusted) = 0.01 P < 0.05) of the variance in QOL whereas the change in exercise explained an additional 7% (DeltaR(2)(adjusted) = 0.07, P < 0.01). CONCLUSION Change in exercise since cancer diagnosis may be a more important correlate of QOL in adult cancer survivors than the absolute current amount of exercise.

Change in health-related quality of life of newly diagnosed cancer patients, cancer survivors, and controls*

This study was conducted to develop an objective problems-in-living scale to identify the needs of cancer survivors after a demanding treatment such as bone marrow transplantation (BMT). A total of 99 adult BMT survivors completed questionnaires containing the 29 items included in the Cancer Problems-In-Living Scale (CPILS). These BMT survivors were most concerned about return of their illness or relapsing, the future, fatigue, not physically being able to have sexual intercourse, changes in their physical appearance, being concerned about infection and crowds, difficulty in obtaining adequate insurance, losing health insurance by changing jobs, and difficulty in meeting medical expenses. The CPILS showed a good level of internal consistency (α = .91). The hypothesis that BMT survivors who had lower levels of physical functioning would experience more problems with living was supported by correlation (.48, p < .001) of the CPILS with the Self-Rated Karnofsky Performance Scale. The construct validity of the CPILS was further supported by a significant negative correlation (−.66, p < .002) with the scores of BMT survivors on a quality-of-life measure, the Satisfaction with Life Domains Scale for BMT.