Health-related quality of life of African-American female breast cancer survivors,survivors of other cancers,and those without cancer

Purpose

The purpose of this study was to compare differences in health-related quality of life (HRQOL) between African-American female breast cancer survivors, African-American female survivors of other cancers, and African-American women with no history of cancer.

Methods

Using data from the 2010 National Health Interview Survey (NHIS), the HRQOL of African-American women aged 35 years or older was compared by cancer status. Physical and mental health items from the Patient-Reported Outcomes Measurement Information System (PROMIS) global health scale were used to assess differences in HRQOL.

Results

For summary physical and mental health measures, no significant differences were found between breast cancer survivors and women with no history of cancer; survivors of other cancers reported poorer physical and mental health than did women with no history of cancer. Similar differences were found at the item level. When we examined the two African-American female cancer survivor groups, we found that cancer survivors whose cancer was being treated reported substantially poorer physical health and mental health than did those whose cancer was not being treated. Survivors who had private insurance and were cancer free reported better physical and mental health than did those who did not have private insurance and those who were not cancer free. Breast cancer survivors reported slightly better physical and mental health than did survivors of other cancers.

Conclusions

Our findings highlight the need for public health agencies to adopt practices to improve the mental and physical health of African-American female survivors of cancer.

     

Engaging Latina cancer survivors,their caregivers,and community partners in a randomized controlled trial: Nueva Vida intervention

Introduction

Few studies have evaluated interventions to improve quality of life (QOL) for Latina breast cancer survivors and caregivers. Following best practices in community-based participatory research (CBPR), we established a multi-level partnership among Latina survivors, caregivers, community-based organizations (CBOs), clinicians, and researchers to evaluate a survivor–caregiver QOL intervention.

Methods

A CBO in the mid-Atlantic region, Nueva Vida, developed a patient–caregiver program called Cuidando a mis Cuidadores (Caring for My Caregivers), to improve outcomes important to Latina cancer survivors and their families. Together with an academic partner, Nueva Vida and three CBOs established a multi-level team of researchers, clinicians, Latina cancer survivors, and caregivers to conduct a national randomized trial to compare the patient–caregiver program to usual care.

Results

Incorporating team feedback and programmatic considerations, we adapted the prior patient–caregiver program into an 8-session patient- and caregiver-centered intervention that includes skill-building workshops such as managing stress, communication, self-care, social well-being, and impact of cancer on sexual intimacy. We will measure QOL domains with the patient-reported outcomes measurement information system, dyadic communication between the survivor and caregiver, and survivors’ adherence to recommended cancer care. To integrate the intervention within each CBO, we conducted interactive training on the protection of human subjects, qualitative interviewing, and intervention delivery.

Conclusion

The development and engagement process for our QOL intervention study is innovative because it is both informed by and directly impacts underserved Latina survivors and caregivers. The CBPR-based process demonstrates successful multi-level patient engagement through collaboration among researchers, clinicians, community partners, survivors, and caregivers.

     

The Minneapolis-Manchester Quality of Life Instrument: reliability and validity of the Adult Form in cancer survivors

Purpose

Childhood cancer survivors are at risk for deficits in health-related quality of life (HRQL) as they age. Youth (8–12 years) and adolescent (13–20 years) versions of the Minneapolis-Manchester Quality of Life Instrument (MMQL) have been developed to address survivor-specific issues and are currently in use; the MMQL-Adult Form has now been developed to assess HRQL in childhood cancer survivors aged 21–55 years.

Methods

The MMQL-Adult Form was administered to 499 adults: 65 cancer patients on-therapy, 107 off-therapy, and 327 healthy controls. Forty-four percent of patients were under 30 years old at cancer diagnosis. Principal components analysis was performed. We evaluated internal consistency reliability, stability (re-administration of the MMQL-Adult Form 2 weeks later), construct validity (concurrent administration of the SF-36), and known-groups validity (score comparisons across the three groups).

Results

Principal components analysis resulted in retention of 44 items across six scales: social functioning, physical functioning, cognitive functioning, outlook on life, body image, and psychological functioning. Internal consistency (Cronbach’s α) was 0.80–0.90 for individual scales and 0.95 overall. Strong intraclass correlations (0.98 overall) indicated high stability. The MMQL-Adult Form distinguished between known groups; healthy controls scored better than patients on four of six scales. The MMQL-Adult Form scales correlated highly with similar SF-36 scales, demonstrating construct validity.

Conclusions

The MMQL-Adult Form is a reliable and valid self-report instrument for measuring multidimensional HRQL in cancer survivors. Development of this instrument ensures availability of a tool enabling cross-sectional and longitudinal assessment of HRQL in childhood cancer survivors as they age.

     

Quality of life,problems, and needs of disease-free breast cancer survivors 5 years after diagnosis

Purpose

After cancer treatment, it is desirable to maintain or regain a high quality of life (QoL) and the ability to accomplish everyday tasks well. Therefore, we substantiated the scarce knowledge regarding long-term QoL after breast cancer, burdensome problems, and unmet needs for more support.

Methods

Disease-free breast cancer survivors (n?=?190) who had participated in two randomized controlled exercise trials during primary treatment were followed up to 5 years post-diagnosis. QoL-related functions and symptoms (EORTC QLQ-C30/-BR23), health problems, and support needs were assessed. EORTC-QLQ scores were compared with age-matched normative values from the general population in Germany.

Results

QoL-related functions and symptoms in patients during cancer treatment were worse compared to healthy references, but largely improved over time. Yet, cognitive function and sleep were still significantly impaired at 5-year follow-up. Other common long-term problems included sexual issues (45% of survivors), hot flashes (38%), pain (34%), fatigue (24%), and polyneuropathy (21%). Regression analyses indicated fatigue having the strongest impact on global QoL. Support needs were expressed mainly for menopausal disorders (43%), physical performance (39%), sleep problems (38%), arthralgia (37%), cognitive problems (36%), weight problems (32%), and fatigue (31%).

Conclusions

While QoL in disease-free breast cancer survivors 5 years post-diagnosis was largely comparable to the general population on average, still many survivors suffered from adverse effects. There appears to be a need for ongoing screening and support regarding fatigue, sleep problems, cognitive problems, arthralgia/pain, menopausal/sexual symptoms, physical performance, and weight problems during and several years following breast cancer therapy.

     

Match between culture and social support: Acculturation moderates the relationship between social support and well-being of Chinese American breast cancer survivors

Purpose

Social support does not always lead to health benefits; the outcomes depend on the match between the need and the provision of social support. Culture shapes individuals’ preference of social support types (e.g., supportive communication, social companionship, and tangible support). The present study examined how the association between social support and well-being may vary as a function of acculturation among minority cancer survivors.

Methods

One hundred and twenty-three Chinese American breast cancer survivors were invited to complete a questionnaire package.

Results

Findings showed that acculturation moderated the association of social support subtypes with psychological and physical well-being. Higher emotional/information support was associated with better quality of life and less physical symptoms among highly acculturated cancer survivors but more physical symptoms among those who were less acculturated. Tangible support was associated with more physical symptoms among highly acculturated cancer survivors but less physical symptoms among those who are less acculturated. Positive social interaction was associated with better quality of life and less physical symptoms among less acculturated cancer survivors but not associated with quality of life or physical symptoms among their highly acculturated counterparts.

Conclusion

The findings pointed to the significance of acculturation in breast cancer experience among minority women, especially its interplay with social support transactions.

     

Long-term QALY-weights among spouses of dependent and independent midlife stroke survivors

Purpose

The aim of this study was to investigate whether the dependency of midlife stroke survivors had any long-term impact on their spouses’ QALY-weights.

Method

Data on stroke survivors, controls, and spouses were collected from the 7-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke. Health-related quality of life was assessed by the SF-36, and the preference-based health state values were assessed with the SF-6D. Spouses of dependent and independent stroke survivors were categorized according to their scores on the modified Rankin Scale. An ordinary least squares regression analysis was used to evaluate whether the dependency of the stroke survivors had any impact on the spouses’ QALY-weights.

Result

Cohabitant dyads of 247 stroke survivors aged <70 at stroke onset and 245 dyads of controls were included in the study. Spouses of dependent stroke survivors (n = 50) reported a significant lower mean QALY-weight of 0.69 in comparison to spouses of independent stroke survivors (n = 197) and spouses of controls, (n = 245) who both reported a mean QALY-weight of 0.77. The results from the regression analysis showed that higher age of the spouse and dependency of the stroke survivor had a negative association with the spouses’ QALY-weights.

Conclusion

The QALY-weights for spouses of dependent midlife stroke survivors were significantly reduced compared to spouses of independent midlife stroke survivors. This indicates that the inclusion of spouses’ QALYs in evaluations of early treatment and rehabilitation efforts to reduce stroke patients’ dependency would capture more of the total effect in dyads of stroke survivors.

     

The role of mindfulness in distress and quality of life for men with advanced prostate cancer

Objective

To examine the extent to which mindfulness skills influence psychological distress and health-related quality of life (HRQOL) in men with metastatic or castration-resistant biochemical progression of prostate cancer.

Patients and methods

A cross-sectional survey of 190 men (46 % response; mean age 71 years, SD = 8.7, range 40–91 years) with advanced prostate cancer, assessed psychological and cancer-specific distress, HRQOL. Mindfulness skills were assessed as potential predictors of adjustment outcomes.

Results

Overall, 39 % of men reported high psychological distress. One third had accessed psychological support previously although only 10 % were under current psychological care. One quarter had accessed a prostate cancer support group in the past six months.Higher HRQOL and lower cancer-specific and global psychological distress were related to non-judging of inner experience (p < 0.001).Higher HRQOL and lower psychological distress were related to acting with awareness (p < 0.001). Lower distress was also related to higher non-reactivity to inner experience and a lower level of observing (p < 0.05).

Conclusions

Men with advanced prostate cancer are at risk of poor psychological outcomes. Psychological flexibility may be a promising target for interventions to improve adjustment outcomes in this patient group.

Clinical Trial Registry

Trial Registration: ACTRN12612000306819

     

Adverse Childhood Experiences,Coping Resources,and Mental Health Problems among Court-Involved Youth

Background

Mental health problems are gaining attention among court-involved youth with emphasis on the role of childhood adversity, but assessment lags.

Objective

The present study uses a commonly delivered assessment tool to examine mental health problems (current mental health problem, mental health interfered with probation goals, and suicide ideation) as a function of an expanded set of adverse childhood experiences (ACEs; childhood maltreatment, family dysfunction, and social disadvantage). Adaptive coping resources–impulse control, aspirations, and social support–were tested as both direct contributors and moderators of the influence of ACEs on mental health.

Methods

Using a diverse sample of youth on probation (N = 5378), this study utilized logistic regression models to test contributions of the three domains of childhood adversity–childhood maltreatment, family dysfunction, and social disadvantage. These models also examined the moderating roles of coping resources.

Results

Childhood maltreatment emerged as the strongest contributor to mental health problems, with significant moderation from social support. Youth aspirations were inversely related to mental health problems and moderated the relation with ACEs and mental health problems that interfered with probation.

Conclusions

Assessment and mitigation of the detrimental effects of childhood maltreatment are important considerations in the intervention programs that target mental health outcomes of court-involved youth. Intervention programs to prevent recidivism and improve mental health should improve impulse control and aspirations.

     

Gender,race, BMI,and social support in relation to the health-related quality of life of cancer survivors: a report from the American Cancer Society’s Study of Cancer Survivors II (SCS-II)

Purpose

We examined the main and interactive effects of race, BMI, and social support on physical and mental health-related quality of life (HRQoL) among male and female cancer survivors using the stress and coping theory to inform findings.

Methods

HRQoL issues among 1768 cancer survivors were examined using the American Cancer Society’s cross-sectional Study of Cancer Survivors II. Two-step multiple linear regressions were conducted to assess the physical and mental HRQoL of male and female cancer survivors, respectively.

Results

The average age of participants was 67.36 (SD = 11.51); the majority were female (53.3 %; n = 941) and non-Hispanic White (85.9 %; n = 1517). The average BMI measurement for participants was 28.33 (SD = 5.90), with 41.3 % (n = 729) overweight and 30.3 % (n = 535) obese. Higher BMI was significantly associated with lower physical HRQoL across gender, while social support had significant main effects on physical and mental HRQoL across gender. Race moderated the relationship between social support and physical HRQoL among female cancer survivors and between BMI and mental HRQoL for both genders.

Conclusions

The results of this study contribute a unique gender- and racial-specific perspective to cancer survivorship research. While the buffering hypothesis of the stress and coping theory was not supported, the main effects of BMI and social support on HRQoL were different across gender and race.

     

Nachstationärer Verlauf bei überlebter Sepsis

Background

Currently, there is a deficiency in the care of people who have survived sepsis. One reason may be that there is little information on the post discharge process of sepsis survivors.

Objectives

To examine and assess current results about the post discharge process of surviving sepsis.

Methods

The method of the literature study corresponds to a scoping review. Because of the public health focus of this literature study, PubMed library, Cochrane library, Cinahl library and Gesis Sowiport library were chosen. Included publications were evaluated with the Critical Appraisal Skills Programme (CASP).

Results

The authors identified 53 studies that make statements concerning the post discharge process of surviving sepsis. Survivors frequently suffer from chronic diseases such as polyneuropathies and experience a reduction in health-related quality of life compared to the time before the disease. The mortality one year after discharge is estimated to be up to 43%. An important social aspect of the post-discharge process is that survivors often need help in coping with their everyday life and are dependent on the support of family members. In the course of sepsis, relatives can suffer illnesses too, such as depression, which seriously impacts the rehabilitation of the survivor. It is currently unclear how affected persons and relatives cope with such crises.

Conclusion

The 53 identified studies on the post-discharge process of survived sepsis cover a wide range of health-related topics. In addition to researching the physical and psychological effects of those affected and their relatives, future work should also address issues of a management-oriented nature.

     

Quality Rating and Improvement Systems and Children’s Cognitive Development

Background

Providing enriched learning environments is important to stimulating children’s development in early childhood. Early child-care policymakers in many states in the US have adopted Quality Rating and Improvement Systems (QRIS) as a way to verify quality of child care and to support children’s school readiness.

Objective

The purpose of this study was to examine associations between QRIS, a statewide government-funded early childhood care and education policy which integrates structural quality of child-care, and children’s cognitive skills.

Methods

A sample of randomly selected 313 children (mean age = 54.9 months, SD = 6.7) from 36 QRIS-participating early child-care programs was included in this study.

Results

Multilevel analysis with a latent variable (i.e., observed cognitive skills consisting of vocabulary, phonological awareness, and mathematical skills) revealed that children in the highest level of QRIS programs demonstrated better cognitive skills after controlling for child demographics, and home and neighborhood environments. In addition, QRIS moderated a negative association between family socioeconomic risk and children’s cognitive skills.

Conclusions

The results suggest that policymakers may expect positive returns on QRIS investments in terms of children’s early cognitive achievements that support their school readiness in later life.

     

Sickness absence and return to work rates in women with breast cancer

Purpose

Most women are diagnosed with breast cancer when they are of working age. How long are breast cancer patients absent? How many of them return to work?

Methods

ArboNed Occupational Health Services documents sickness absence data of 1 million workers of whom 40% were women. Between 2001 and 2005, 2,259 women had 2,361 episodes of sickness absence due to breast cancer. These absence episodes were followed for 2 years using Kaplan–Meier analysis.

Results

The mean ± standard error of mean duration of absence due to breast cancer was 349 ± 5 days. Thirty-seven percent of absences lasted longer than one year and 12% of absences lasted longer than 2 years particularly in women aged 25–34 years.

Conclusions

The mean duration of sickness absence due to breast cancer was nearly a year, but most women returned to work. The results of the study can be used as a reference for return to work of women following breast cancer.

     

Exploring measurement invariance by gender in the profile of mood states depression subscale among cancer survivors

Purpose

The Profile of Mood States-Short Form (POMS-SF) is a well-validated tool commonly used in medical/clinical research. Less attention has been paid to the measurement invariance of the POMS—the degree to which the structure and items behave similarly for different groups (e.g., women and men). This study investigated the measurement invariance of the POMS Depression subscale across gender groups in a sample of cancer survivors.

Methods

The POMS Depression subscale has 8 items (Unhappy, Sad, Blue, Hopeless, Discouraged, Miserable, Helpless, and Worthless). Invariance was measured using multigroup confirmatory factor analysis. This study used data from American Cancer Society Studies of Cancer Survivors-II, a population-based survey of adult cancer survivors (n = 9170).

Results

We found factor structures and factor loadings were invariant for gender groups, but moderate differential item functioning (DIF) in the question containing the word blue.

Conclusion

With regard to cancer survivors’ gender, we found the Depression subscale of the POMS-SF had configural invariance, and partial metric and scalar invariance. This suggests that results should be interpreted with caution, especially when gender is considered important. More broadly, our finding suggests that questions with the word blue may introduce DIF into other measures of depressive mood. More research is needed to replicate these findings in other samples and with other instruments.

     

Technology use and its association with health and depressive symptoms in older cancer survivors

Purpose

Acknowledging the expanding influence of technology in the promotion of health and wellness, this study assessed the role of information and communication technology (ICT) use in the lives of older cancer survivors.

Methods

A community sample of cancer survivors aged 65 and older (N?=?1411) was extracted from a 2011 U.S. National Health and Aging Trends Study dataset. Weighted multiple regression and multinomial logistic regression analyses were performed to explore the relationships between survey respondents’ ICT use and their self-rated health status and depressive symptoms.

Results

The majority of respondents reported rarely or never engaging in ICT use. Greater use of communication technology such as emailing or texting was associated with decreased risk for severe depressive symptoms and higher self-rated health status. Information technology use was not associated with depressive symptoms and self-rated health status.

Conclusions

Investigation into reasons behind older cancer survivors’ apparent low rates of engagement with ICT is warranted, particularly the examination of access as a potential barrier. Findings indicated that frequent use of communication technology was positively linked with mental and physical wellness. The nature of the relationships between communication technology use and physical and mental health merits further research, helping to determine whether community-based educational efforts to improve technology access and skills may benefit the growing population of older cancer survivors.

     

Impact of Alzheimer’s disease on the family caregiver’s long-term quality of life: results from an ALSOVA follow-up study

Purpose

To examine caregivers’ health-related quality of life (HRQoL) and well-being during the first 3 years after their family member’s Alzheimer’s disease (AD) diagnosis and assessed the relationship between caregivers’ HRQoL, well-being, and the severity of AD. Further, to compare of caregivers’ HRQoL to general population.

Methods

Longitudinal design (36 months) after AD diagnosis of 236 caregiver–patient dyads. Linear regression was used to assess age- and gender-adjusted association between repeated measurements of caregivers’ HRQoL and the severity of AD. For comparison with general population, the National Health 2011 Health Examination Survey data was utilized.

Results

Caregivers had significantly lower HRQoL than age- and gender-standardized counterparts. Severity of AD was significantly (p < 0.05) associated with the mobility and depression dimensions of caregiver’s HRQoL but not with the total HRQoL index score.

Conclusions

Caregivers’ HRQoL seems to deteriorate earlier than previously noted. The severity of AD has not that great impact on caregiver’s HRQoL as assumed.

     

Importance ratings on patient-reported outcome items for survivorship care: comparison between pediatric cancer survivors,parents, and clinicians

Purpose

To compare importance ratings of patient-reported outcomes (PROs) items from the viewpoints of childhood cancer survivors, parents, and clinicians for further developing short-forms to use in survivorship care.

Methods

101 cancer survivors, 101 their parents, and 36 clinicians were recruited from St. Jude Children’s Research Hospital. Participants were asked to select eight items that they deemed useful for clinical decision making from each of the four Patient-Reported Outcomes Measurement Information System Pediatric item banks. These item banks were pain interference (20 items), fatigue (23 items), psychological stress (19 items), and positive affect (37 items).

Results

Compared to survivors, clinicians rated more items across four domains that were statistically different than did parents (23 vs. 13 items). Clinicians rated five items in pain interference domain (ORs 2.33–6.01; p’s?<?0.05) and three items in fatigue domain (ORs 2.22–3.80; p’s?<?.05) as more important but rated three items in psychological stress domain (ORs 0.14–0.42; p’s?<?.05) and six items in positive affect domain (ORs 0.17–0.35; p’s?<?.05) as less important than did survivors. In contrast, parents rated seven items in positive affect domain (ORs 0.25–0.47; p’s?<?.05) as less important than did survivors.

Conclusions

Survivors, parents, and clinicians viewed importance of PRO items for survivorship care differently. These perspectives should be used to assist the development of PROs tools.

     

How do Kenyan orphan girls experience less meaningful lives and how much does it matter for ‘health’?

Background

Currently, 2.5 million orphaned children are living in Kenya and 56 million orphaned children are living across sub-Saharan Africa. No empirical research has investigated meaningfulness of life among this population, and few studies provide perspectives on the life-course consequences of losing a parent during childhood.

Methods

In this study, we assess life meaningfulness in cross section of Kenyan women (n?=?1974) in a semi-rural area of the country (Meru County) collected during June 2015. We used two sets of mediation analyses to assess (1) whether meaningfulness of life was lower among women who reported a parental death during their childhood, and how this association was mediated by social support, family functioning, school completion and HIV+?status of household, and (2) the extent to which lower subjective overall health among women who experienced orphanhood during childhood was mediated by less meaningfulness of life.

Results

Women who experienced a parental death during childhood reported significantly less meaningful lives as adults. Lower social support and family functioning explained approximately 40% of the disparity. Women who experienced a parental death during childhood also had significantly worse subjective overall health, 18% of which was explained by lower meaningfulness of life.

Conclusions

Further study on life meaningfulness and family capital in the context of the orphan crisis in sub-Saharan Africa is warranted, and required to promote equity across the lifespan. Policy efforts to support orphans and vulnerable children should target strengthening support networks and family functioning to optimize self-reported health outcomes.

     

Comparison of quality of life among long-term melanoma survivors and non-melanoma controls: a cross-sectional study

Purpose

Little is known about specific concerns facing long-term melanoma survivors. The goal of this study was to compare quality of life (QOL) and mental health between long-term melanoma survivors and population controls.

Methods

Participants from a previously conducted case-control study of risk factors for melanoma were recruited for a cross-sectional survey. Generic QOL and emotional health were measured using the SF-36 and Hospital Anxiety and Depression Scale questionnaires. A total of 724 melanoma survivors and 660 controls participated. Most melanoma survivors had stage I disease (85.6%); mean time from diagnosis was 9.6?±?1.0 years. Comparisons of QOL measures between melanoma survivors and controls were conducted using regression models, adjusting for potential confounders.

Results

Melanoma survivors, compared to controls, reported statistically significant but only slightly higher physical functioning and bodily pain QOL subscale scores than controls and otherwise similar QOL as measured by the remaining six SF-36 subscale scores. Prevalence of anxiety (18.1% vs. 19.3%, adjusted OR?=?1.00 (0.74, 1.36); p?=?1.00) and depression (7.2% vs. 9.8%, adjusted OR?=?0.74 (0.48, 1.16); p?=?1.00) were similar between melanoma survivors and controls.

Conclusion

Long-term early stage melanoma survivors report similar general QOL and mental health compared to population controls. Further research is needed to identify concerns more specific to melanoma.