Emotional distress among adult survivors of childhood cancer

Purpose

The purposes of this study were to estimate the prevalence of emotional distress in a large cohort of adult survivors of childhood cancer and to evaluate the interrelationship of risk factors including cancer-related late effects.

Methods

Adult survivors of childhood cancer (N?=?1,863), median age of 32 years at follow-up, completed comprehensive medical evaluations. Clinically relevant emotional distress was assessed using the Brief Symptom Inventory 18 and was defined as T-scores ≥63. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated using multivariable logistic regression models to identify risk factors for distress. Path analysis was used to examine associations among identified risk factors.

Results

Elevated global distress was reported by 15.1 % of survivors. Cancer-related pain was associated with elevated distress (OR 8.72; 95 % CI, 5.32–14.31). Survivors who reported moderate learning or memory problems were more likely to have elevated distress than survivors who reported no learning or memory problems (OR 3.27; 95 % CI, 2.17–4.93). Path analysis implied that cancer-related pain has a direct effect on distress symptoms and an indirect effect through socioeconomic status and learning or memory problems. Similar results were observed for learning or memory problems.

Conclusions

Childhood cancer-related morbidities including pain and learning or memory problems appear to be directly and indirectly associated with elevated distress symptoms decades after treatment. Understanding these associations may help inform intervention targets for survivors of childhood cancer experiencing symptoms of distress.

Implications for Cancer Survivors

A subset of long-term childhood cancer survivors experience significant emotional distress. Physical and cognitive late effects may contribute to these symptoms.     

Racial and ethnic differences in health status and health behavior among breast cancer survivors—Behavioral Risk Factor Surveillance System, 2009

Purpose

Differences in health status and behavioral risk factors may explain racial/ethnic breast cancer disparities. We examined racial/ethnic differences in health status and behaviors among female breast cancer survivors compared to females without breast cancer.

Methods

Using cross-sectional data from the 2009 Behavioral Risk Factor Surveillance System, a national state-based, random sample telephone survey, we explored differences in self-rated health, obesity and selected behaviors (physical activity, smoking, alcohol use, fruit, and vegetable consumption) among females aged 18 years and older, who reported a previous breast cancer diagnosis (survivors, n?=?10,035) and those who reported no breast cancer history (n?=?234,375) by race/ethnicity. Adjusted prevalences of health status and behaviors, accounting for sociodemographics, comorbidities and health care access, were estimated by race/ethnicity.

Results

Compared to all other racial/ethnic groups, more white females reported heavy alcohol consumption and more black females reported obesity regardless of their breast cancer status. Among breast cancer survivors, more whites (33.7 %) were former smokers compared to blacks (24.5 %), “others” (20.5 %), and Hispanics (16.2 %) (p?=?0.001). Racial/ethnic differences in obesity also varied by reported time since diagnosis (p value?=?0.018). Among long-term survivors (diagnosed >5 years before interview), more black survivors (34.8 %) reported obesity compared to white survivors (23.0 %). Also, among “other” race survivors, long-term survivors (22.0 %) reported more obesity than survivors diagnosed less than 5 years before interview (7.8 %).

Conclusions

These findings suggest opportunities to increase health behaviors and reduce racial disparities among breast cancer survivors.

Implications for Cancer Survivors

Engaging in healthy behaviors can play a significant role in enhancing health outcomes and quality of life of breast cancer survivors. More research is needed to better understand racial differences in obesity, smoking and alcohol consumption in order to develop effective, culturally appropriate interventions to promote a healthy lifestyle after a breast cancer diagnosis.     

Prevalence and predictors of prescription psychoactive medication use in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study

Purpose

Childhood cancer survivors are at risk for late effects which may be managed pharmacologically. The purposes of this study were to estimate and compare the prevalence of psychoactive medication use of adult survivors of childhood cancer and sibling controls, identify predictors of medication use in survivors, and investigate associations between psychoactive medications and health-related quality of life (HRQOL).

Methods

Psychoactive medication use from 1994 to 2010 was evaluated in 10,378 adult survivors from the Childhood Cancer Survivor Study. A randomly selected subset of 3,206 siblings served as a comparison group. Multivariable logistic regression models were used to calculate odds ratios (OR) for baseline and new onset of self-reported psychoactive medication use and HRQOL.

Results

Survivors were significantly more likely to report baseline (22 vs. 15 %, p?<?0.001) and new onset (31 vs. 25 %, p?<?0.001) psychoactive medication use compared to siblings, as well as use of multiple medications (p?<?0.001). In multivariable models, controlling for pain and psychological distress, female survivors were significantly more likely to report baseline and new onset use of antidepressants (OR?=?2.66, 95 % CI?=?2.01–3.52; OR?=?2.02, 95 % CI?=?1.72–2.38, respectively) and multiple medications (OR?=?1.80, 95 % CI?=?1.48–2.19; OR?=?1.77, 95 % CI?=?1.48–2.13, respectively). Non-cranial radiation and amputation predicted incident use of analgesics >15 years following diagnosis. Antidepressants were associated with impairment across all domains of HRQOL, with the exception of physical function.

Conclusions

Prevalence of psychoactive medication use was higher among survivors for most medication classes, as was the use of multiple medications. Clinicians should be aware of the possible contribution of psychoactive medications to HRQOL.

Implications for Cancer Survivors

Survivors of childhood cancer are more likely to be prescribed psychoactive medication than their sibling counterparts, though use of such medication does not appear to normalize quality of life. Survivors are encouraged to consider additional interventions, including psychosocial support and physical exercise.     

Health behaviors,quality of life,and psychosocial health among survivors of adolescent and young adult cancers

Purpose

Survivors of adolescent and young adult (AYA) cancer may engage in unhealthy lifestyles (e.g., smoking), potentially heightening their risk for long-term health problems. We assessed health behaviors and constructs including quality of life (QOL) and psychosocial well-being among survivors of AYA cancer compared to the general population.

Methods

We used 2009 Behavioral Risk Factor Surveillance System data to evaluate health behaviors for survivors of AYA cancer compared to AYAs without cancer. Multivariable regressions assessed health behaviors (smoking, binge drinking, physical inactivity, and low fruit/vegetable intake) by sex and age between AYA survivors and controls, and among survivors to determine the effects of demographic, QOL, psychosocial, and cancer factors on behaviors.

Results

A greater proportion of female survivors of AYA cancer smoked than controls (currently aged 20–39: 27 vs. 14.3%, respectively; currently aged 40–64: 29.3 vs. 18.4%, respectively). Generally, survivors and controls were non-adherent to national health behavior guidelines. Uninsured survivors were at greater risk of smoking vs. insured (females, Relative Risk (RR)?=?1.64, 95 % confidence interval (CI) 1.43–1.90; males, RR?=?2.62, 95 % CI 1.71–4.02). Poor social/emotional support was associated with smoking (RR?=?1.26, 95 % CI 1.07–1.48) among female survivors and was associated with low fruit/vegetable intake among male (RR?=?1.12, 95 % CI 1.01–1.23) and female (RR?=?1.12, 95 % CI 1.05–1.19) survivors. Female survivors >10 years from diagnosis had higher risk of smoking (RR?=?1.26–1.91, all p?<?0.01) than survivors 5–10 years from diagnosis.

Conclusions

Unhealthy lifestyle behaviors are common in survivors of AYA cancer.

Implications for Cancer Survivors

AYA survivors require health behavior support.

     

Noncancer-related mortality risks in adult survivors of pediatric malignancies: the childhood cancer survivor study

Purpose

We sought to identify factors, other than cancer-related treatment and presence/severity of chronic health conditions, which may be associated with late mortality risk among adult survivors of pediatric malignancies.

Methods

Using the Childhood Cancer Survivor Study cohort and a case–control design, 445 participants who died from causes other than cancer recurrence/progression or non-health-related events were compared with 7,162 surviving participants matched for primary diagnosis, age at baseline questionnaire, time from diagnosis to baseline questionnaire, and time at-risk. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for overall/cause-specific mortality. Independent measures included number/severity of chronic conditions, medical care, health-related behaviors, and health perceptions/concerns.

Results

Adjusting for education, income, chemotherapy/radiation exposures, and number/severity of chronic health conditions, an increased risk for all-cause mortality was associated with exercising fewer than 3 days/week (OR?=?1.72, CI 1.27–2.34), being underweight (OR?=?2.58, CI 1.55–4.28), increased medical care utilization (P?<?0.001), and self-reported fair to poor health (P?<?0.001). Physical activity was associated with a higher risk of death among males (OR?=?3.26, CI 1.90–5.61) reporting no exercise compared to those who exercised ≥3 times per week. Ever consuming alcohol was associated with a reduced risk of all-cause (OR?=?0.61, CI 0.41–0.89) and other nonexternal causes of death (OR?=?0.40, CI 0.20–0.79). Concerns/worries about future health (OR?=?1.54, CI 1.10–2.71) were associated with increased all-cause mortality.

Conclusions

Factors independent of cancer treatment and chronic health conditions modify the risk of death among adult survivors of pediatric cancer.

Implications for Cancer Survivors

Continued cohort observation may inform interventions to reduce mortality.     

Rural–urban differences in health behaviors and implications for health status among US cancer survivors

Purpose

Rural US adults have increased risk of poor outcomes after cancer, including increased cancer mortality. Rural–urban differences in health behaviors have been identified in the general population and may contribute to cancer health disparities, but have not yet been examined among US survivors. We examined rural–urban differences in health behaviors among cancer survivors and associations with self-reported health and health-related unemployment.

Methods

We identified rural (n = 1,642) and urban (n = 6,162) survivors from the cross-sectional National Health Interview Survey (2006–2010) and calculated the prevalence of smoking, physical activity, overweight/obesity, and alcohol consumption. Multivariable models were used to examine the associations of fair/poor health and health-related unemployment with health behaviors and rural–urban residence.

Results

The prevalence of fair/poor health (rural 36.7 %, urban 26.6 %), health-related unemployment (rural 18.5 %, urban 10.6 %), smoking (rural 25.3 %, urban 15.8 %), and physical inactivity (rural 50.7 %, urban 38.7 %) was significantly higher in rural survivors (all p < .05); alcohol consumption was lower (rural 46.3 %, urban 58.6 %), and there were no significant differences in overweight/obesity (rural 65.4 %, urban 62.6 %). All health behaviors were significantly associated with fair/poor health and health-related unemployment in both univariate and multivariable models. After adjustment for behaviors, rural survivors remained more likely than urban survivors to report fair/poor health (OR = 1.21, 95 % CI 1.03–1.43) and health-related unemployment (OR = 1.49, 95 % CI 1.18–1.88).

Conclusions

Rural survivors may need tailored, accessible health promotion interventions to address health-compromising behaviors and improve outcomes after cancer.     

Factors associated with childhood cancer survivors’ knowledge about their diagnosis,treatment, and risk for late effects

Background

While most children with cancer survive their initial disease, cancer therapy places them at risk for late effects (LE). Knowledge of their diagnosis, treatment, and LE risk may motivate survivors to attend long-term follow-up care. The aims of this study were to examine knowledge of cancer history and future risks, and to identify factors associated with such knowledge, in a cohort of childhood cancer survivors.

Methods

Survivors (i.e., patients finished cancer treatment, regardless of time since completion) aged 15 to 26 years from three Canadian cancer centers were invited to complete a questionnaire that assessed knowledge of cancer history and potential LE of treatments, including five specific LE known to have considerable long-term health impact. Clinical data were extracted from hospital records and used to validate participants’ answers.

Results

Of 250 participants, 16 (6 %) were unable to name their cancer, 79 (32 %) had partial or no knowledge of their therapy, and 83 (33 %) were unaware of at least some of their risks for LE. Decreasing age (OR for increase in age?=?1.2 (1.1–1.4)), having had a renal tumor compared to leukemia (OR?=?0.3 (0.1–0.9)), and lacking knowledge about treatment (OR?=?0.4 (0.2–0.9)) were associated with lack of knowledge of LE. Of the five, the most and least familiar LE was LE associated with impaired pulmonary function and risk of second malignancy, respectively.

Conclusion

This study highlights knowledge deficits in survivors, specifically regarding their risk for LE.

Implications for Cancer Survivors

Findings can be utilized to target survivors at risk for knowledge deficits.

     

Physical activity among adult survivors of childhood lower-extremity sarcoma

Introduction

Adult survivors of childhood lower-extremity sarcoma are largely physically inactive, a behavior which potentially compounds their health burden. Altering this behavior requires understanding those factors that contribute to their physical inactivity. Therefore, this investigation sought to identify factors associated with inactivity in this subpopulation of cancer survivors.

Methods

Demographic, personal, treatment, and physical activity information from adult survivors of childhood lower-extremity sarcomas was obtained from the Childhood Cancer Survivor Study (CCSS) cohort. Generalized linear models were used to identify variables that best identified those individuals who were physically inactive.

Results

Only 41% of survivors met Center for Disease Control (CDC) activity guidelines. Survivors were 1.20 (95% confidence intervals (CI) 1.11?C1.30) more likely compared to CCSS sibling cohort and 1.12 (95% CI 1.10?C1.15) times more likely than the general population to fail to meet CDC guidelines. Significant predictors of physical inactivity included female sex, hemipelvectomy surgery, and platinum and vinca alkaloid chemotherapy.

Conclusions

The primary findings of this study are that survivors of childhood onset lower-extremity sarcoma are (1) highly likely to be physically inactive and (2) less likely than their siblings or the general population to regularly exercise. This study has identified treatment-related risk factors associated with inactivity that will help health and wellness practitioners develop successful exercise interventions to help these survivors achieve recommended levels of physical activity for health.

Implications for cancer survivors

These results suggest that physical activity interventions for adult survivors of childhood lower-extremity sarcomas should be sex specific and responsive to unique physical late effects experienced by these survivors.     

Insurance,chronic health conditions,and utilization of primary and specialty outpatient services: a Childhood Cancer Survivor Study report

Purpose

Survivors of childhood cancer require life-long outpatient healthcare, which may be impacted by health insurance. This study sought to understand survivors’ utilization of outpatient healthcare provider services.

Methods

The study examined cross-sectional survey data using an age-stratified sample from the Childhood Cancer Survivor Study of self-reported annual use of outpatient services. Multivariable logistic regression analyses were used to identify risk factors associated with utilization of services.

Results

Six hundred ninety-eight survivors were surveyed, median age 36.3 years (range 22.2–62.6), median time from diagnosis 28.8 years (range 23.1–41.7). Almost all (93%) of survivors had at least one outpatient visit during the previous year; 81.3% of these visits were with a primary care providers (PCP), 54.5% were with specialty care physicians, 30.3% were with nurse practitioner/physician’s assistants (NP/PA), and 14.2% were with survivorship clinic providers. Survivors with severe to life-threatening chronic health conditions had greater odds of utilizing a specialty care physician (OR?=?5.15, 95% CI 2.89–9.17) or a survivorship clinic (OR?=?2.93, 95% CI 1.18–7.26) than those with no chronic health conditions. Having health insurance increased the likelihood of seeking care from NP/PA (private, OR?=?2.76, 95% CI 1.37–5.58; public, OR?=?2.09, 95% CI 0.85–5.11), PCP (private, OR?=?7.82, 95% CI 3.80–13.10; public, OR?=?7.24, 95% CI 2.75–19.05), and specialty care (private, OR?=?2.96, 95% CI 1.48–5.94; public, OR?=?2.93, 95% CI 1.26–6.84) compared to without insurance.

Conclusion

Most childhood cancer survivors received outpatient care from a PCP, but a minority received care from a survivorship clinic provider. Having health insurance increased the likelihood of outpatient care.

Implications for Cancer Survivors

Targeted interventions in the primary care setting may improve risk-based, survivor-focused care for this vulnerable population.

     

Health behaviors of cancer survivors of different sexual orientations

Objective

This study identifies differences by sexual orientation in health behaviors of cancer survivors.

Methods

We pooled data from the 2001, 2003, and 2005 California health interview survey to compare cancer survivors’ alcohol use, smoking, exercise, fruit and vegetable consumption, weight, and physician visits by sexual orientation.

Results

Female bisexual cancer survivors were 2.2 times more likely to report being a current smoker and were 0.39 times less likely to report physical inactivity compared with female heterosexual cancer survivors. Lesbian cancer survivors were 7.4 times more likely to have visited a physician during the past year than female heterosexual cancer survivors. Among male cancer survivors, both gay and bisexual men had significantly lower odds (OR?=?0.4) of being overweight or obese, and bisexual men were 3.0 times more likely to engage in vigorous activity and 7.8 times more likely to visit physicians compared with heterosexual men.

Conclusions

This study’s prevalence estimates of behavioral risk factors of gay, lesbian, and bisexual cancer survivors suggest considerable need for promotion of healthy lifestyle behaviors. We discuss the need for future studies with lesbian, gay, and bisexual cancer survivors.     

Trajectories of social isolation in adult survivors of childhood cancer

Purpose

Long-term childhood cancer survivors may be at increased risk for poor social outcomes as a result of their cancer treatment, as well as physical and psychological health problems. Yet, important challenges, namely social isolation, are not well understood. Moreover, survivors' perspectives of social isolation as well as the ways in which this might evolve through young adulthood have yet to be investigated. The purpose of this research was to describe the trajectories of social isolation experienced by adult survivors of a childhood cancer.

Methods

Data from 30 in-depth interviews with survivors (9 to 38 years after diagnosis, currently 22 to 43 years of age, 60 % women) were analyzed using qualitative, constant comparative methods.

Results

Experiences of social isolation evolved over time as survivors grew through childhood, adolescence and young adulthood. Eleven survivors never experienced social isolation after their cancer treatment, nor to the present day. Social isolation among 19 survivors followed one of three trajectories; (1) diminishing social isolation: it got somewhat better, (2) persistent social isolation: it never got better or (3) delayed social isolation: it hit me later on.

Conclusions

Knowledge of when social isolation begins and how it evolves over time for different survivors is an important consideration for the development of interventions that prevent or mitigate this challenge.

Implications for Cancer Survivors

Assessing and addressing social outcomes, including isolation, might promote comprehensive long-term follow-up care for childhood cancer survivors.     

Prevalence and predictors of human papillomavirus (HPV) vaccination among young women surviving childhood cancer

Purpose

Human papillomavirus (HPV) is a sexually transmitted infection and the cause of cervical and other cancers. Vaccination is available to protect against genital HPV and is recommended for individuals aged 9–26 years. This study aimed to estimate the prevalence of HPV vaccination among childhood cancer survivors and to identify factors associated with vaccine outcomes.

Methods

Young adult females with (n?=?114; M age?=?21.18 years, SD?=?2.48) and without (n?=?98; M age?=?20.65 years, SD?=?2.29) a childhood cancer history completed surveys querying HPV vaccination initiation/completion, as well as sociodemographic, medical, and health belief factors. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs) for vaccine outcomes.

Results

Among survivors, 38.6 % (44/114) and 26.3 % (30/114) initiated or completed vaccination compared to 44.9 % (44/98) and 28.6 % (28/98) among controls, respectively. In the combined survivor/control group, physician recommendation (OR?=?11.24, 95 % CI 3.15–40.14) and familial HPV communication (OR?=?7.28, 95 % CI 1.89–28.05) associated with vaccine initiation. Perceptions of vaccine benefit associated with vaccine completion (OR?=?10.55, 95 % CI 1.59–69.92), whereas perceptions of HPV-related severity associated with non-completion (OR?=?0.14, 95 % CI 0.03–0.71).

Conclusion

Despite their increased risk for HPV-related complication, a minority of childhood cancer survivors have initiated or completed HPV vaccination. Modifiable factors associated with vaccine outcomes were identified.

Implications for Cancer Survivors

HPV vaccination is a useful tool for cancer prevention in survivorship, and interventions to increase vaccine uptake are warranted.

     

Predictors of risk-based medical follow-up: a report from the childhood cancer survivor study

Purpose

The purpose of this study is to conduct an intervention study designed to assess the effectiveness of using a newsletter to increase medical follow-up in pediatric cancer survivors at risk of selected treatment complications.

Methods

Survivors participating in the Childhood Cancer Survivor Study who were at least 25 years of age and at risk of cardiovascular disease, breast cancer, or osteoporosis related to previous cancer treatment were randomly assigned to receive a newsletter featuring brief health risk information or a newsletter including an insert providing more comprehensive health risk information. A follow-up survey distributed 24 months after the newsletter intervention assessed predictors of medical follow-up.

Results

Overall, there were no differences found among the groups in terms of access to a treatment summary, medical follow-up, discussion of childhood cancer health risks, and medical screening for the targeted health behaviors. One exception, indicating borderline significance was that women at risk for osteoporosis who received the newsletter insert were more likely to have discussed their risk with a doctor than those who only received the brief information (10.1 % vs. 4.0 % p?=?0.05). Discussion of breast cancer (OR?=?2.15; 95 % CI?=?1.74-2.66), heart disease (OR?=?5.54; 95 % CI?=?4.67–6.57) and osteoporosis (OR?=?10.6; 95 % CI?=?8.34–13.47) risk with physician significantly predicted report of undergoing screening for targeted behavior in previous 2 years as did physician access to treatment summary.

Conclusions

More detailed content in a newsletter had minimal effect on recommended screening. However, survivor’s discussion of cancer-related risks with one’s doctor significantly influenced participation in health screening. These results highlight the integral role of communication in health behavior.

Implications for Cancer Survivors

This study is designed to assess communication strategies that increase medical follow-up in pediatric cancer survivors at risk of selected treatment complications. The results are of great importance not only to the pediatric oncology community but also the broad range of adult oncology medical specialties who are directly involved in the long-term medical care of this ever increasing population of cancer survivors.     

Objectively measured physical activity among US cancer survivors: considerations by weight status

Purpose

We have a limited understanding of the objectively determined physical activity levels of cancer survivors at the population level. Further, we have even less of an understanding of this behavior by weight status (i.e., normal weight, overweight, and obese). Therefore, the purpose of this study was to describe accelerometer-assessed physical activity levels among US cancer survivors and to do so across weight status.

Methods

Data from the 2003–2006 NHANES was used. One hundred twenty-six adult cancer survivors wore an accelerometer for ≥4 days, with weight status determined from measured body mass index.

Results

Approximately 13 % of cancer survivors were sufficiently active (i.e., met current physical activity guidelines). Results were not significant for light-intensity physical activity; however, results showed that obese cancer survivors engaged in 47 % less MVPA than normal weight cancer survivors (rate ratio?=?0.53; 95 % CI, 0.29–0.93).

Conclusion

Most adult cancer survivors are insufficiently active and obese cancer survivors engage in less MVPA than their counterparts.

Implications for Cancer Survivors

Health care professionals are encouraged to increase cancer survivors’ awareness of the minimum levels of MVPA needed for optimal health, particularly among obese cancer survivors. Additionally, cancer survivors should also be informed of the positive health outcomes associated with light-intensity physical activity.     

Health-related quality of life in survivors of childhood cancer: the role of chronic health problems

Introduction

The influence of specific health problems on health-related quality of life (HRQoL) in childhood cancer survivors is unknown. We compared HRQoL between survivors of childhood cancer and their siblings, determined factors associated with HRQoL, and investigated the influence of chronic health problems on HRQoL.

Methods

Within the Swiss Childhood Cancer Survivor Study, we sent a questionnaire to all survivors (≥16 years) registered in the Swiss Childhood Cancer Registry, who survived >5 years and were diagnosed 1976–2005 aged <16 years. Siblings received similar questionnaires. We assessed HRQoL using Short Form-36 (SF-36). Health problems from a standard questionnaire were classified into overweight, vision impairment, hearing, memory, digestive, musculoskeletal or neurological, and thyroid problems.

Results

The sample included 1,593 survivors and 695 siblings. Survivors scored significantly lower than siblings in physical function, role limitation, general health, and the Physical Component Summary (PCS). Lower score in PCS was associated with a diagnosis of central nervous system tumor, retinoblastoma or bone tumor, having had surgery, cranio-spinal irradiation, or bone marrow transplantation. Lower score in Mental Component Summary was associated with older age. All health problems decreased HRQoL in all scales. Most affected were survivors reporting memory problems and musculoskeletal or neurological problems. Health problems had the biggest impact on physical functioning, general health, and energy and vitality.

Conclusions

In this study, we showed the negative impact of specific chronic health problems on survivors’ HRQoL.

Implications for Cancer Survivors

Therapeutic preventive measures, risk-targeted follow-up, and interventions might help decrease health problems and, consequently, improve survivors’ quality of life.     

Health status of older cancer survivors—results of the PolSenior study

Purpose

The purpose of this study is to characterize health status of older cancer survivors using data from the population-based PolSenior study.

Methods

We compared cancer survivors and non-cancer subjects according to comorbidities, functional status, mental health, and sociodemographic factors.

Results

There were 286 (5.8%) cancer survivors in a population of 4943 adults aged 65 years and older. The mean age of cancer survivors was 79.4?±?8.2 years and the median time since cancer diagnosis was 8.5 years (Q1–Q3: 4–16 years). After adjustment for age, sex, education, marital status, and number of comorbidities, compared with a non-cancer population, cancer survivors were more likely to experience falls (OR?=?1.38; 95% CI: 1.04–1.83), and to report poor health (OR?=?1.49; 95%CI: 1.83–2.06), but cancer survivorship was not associated with impairments in instrumental activities of daily living (IADLs). Age and university education, but neither the time from cancer diagnosis nor the number of comorbidities, were associated with impairments in cancer survivors. Three or more chronic diseases were found in over 50% of cancer survivors and in 38% of the non-cancer population (p?<?0.001).

Conclusions

Cancer survivors over the age of 65 years have a higher prevalence of falls, are more likely to report poor health status, and have a higher number of chronic conditions than the non-cancer population, but they maintain independence in IADLs. Advanced age and elementary education are associated with increased occurrence of functional impairments in older cancer survivors

Implications for cancer survivors

Older cancer survivors may require preventive services to reduce the risk of functional decline.

     

Mental health insurance access and utilization among childhood cancer survivors: a report from the childhood cancer survivor study

Purpose

To describe and compare the prevalence of mental health access, preference, and use among pediatric cancer survivors and their siblings. To identify factors associated with mental health access and use among survivors.

Methods

Six hundred ninety-eight survivors in the Childhood Cancer Survivor Study (median age?=?39.4; median years from diagnosis?=?30.8) and 210 siblings (median age?=?40.4) were surveyed. Outcomes included having mental health insurance coverage, delaying care due to cost, perceived value of mental health benefits, and visiting a mental health provider in the past year.

Results

There were no differences in mental health access, preferences, and use between survivors and siblings (p?>?0.05). Among respondents with a history of distress, most reported not having seen a mental health provider in the past year (80.9% survivors vs. 77.1% siblings; p?=?0.60). Uninsured survivors were more likely to defer mental health services due to cost (24.6 vs. 8.4%; p?<?0.001). In multivariable models, males (OR?=?2.96) and survivors with public (OR?=?6.61) or employer-sponsored insurance (ESI; OR?=?14.37) were more likely to have mental health coverage.

Conclusions

Most childhood cancer survivors value having mental healthcare benefits; however, coverage and use of mental health services remain suboptimal. The most vulnerable of survivors, specifically the uninsured and those with a history of distress, are at risk of experiencing challenges accessing mental health care.

Implications for Cancer Survivors

Childhood cancer survivors are at risk for experiencing high levels of daily life stress that is compounded by treatment-related sequelae. Integrative, system-based approaches that incorporate financial programs with patient education about insurance benefits can help reduce some of the financial barriers survivors face.

     

Employment outcomes among survivors of common cancers: the Symptom Outcomes and Practice Patterns (SOAPP) study

Introduction

Risk factors for employment difficulties after cancer diagnosis are incompletely understood, and interventions to improve post-cancer employment remain few. New targets for intervention are needed.

Methods

We assessed a cohort of 530 nonmetastatic cancer patients (aged?≤?65 years, >6 months from diagnosis, off chemo- or radiotherapy) from the observational multi-site Symptom Outcomes and Practice Patterns study. Participants reported employment change, current employment, and symptoms. Groups were based on employment at survey (working full- or part-time versus not working) and whether there had been a change due to illness (yes versus no). The predictive power of symptom interference with work was evaluated for employment group (working stably versus no longer working). Race/ethnicity, gender, cancer type, therapy, and time since diagnosis were also assessed. Association between employment group and specific symptoms was examined.

Results

The cohort was largely non-Hispanic white (76 %), female (85 %), and diagnosed with breast cancer (75 %); 24 % reported a change in employment. On multivariable analysis, participants with at least moderate symptom interference were more likely to report no longer working than their less effected counterparts (odds ratio (OR)?=?8.0, 95 % CI, 4.2–15.4), as were minority participants compared with their non-Hispanic white counterparts (OR?=?3.2, 95 % CI, 1.8–5.6). Results from the multiple regression model indicated the combination of fatigue (OR?=?2.3, 95 % CI, 1.1–4.7), distress (OR?=?3.9, 95 % CI, 1.7–9.0), and dry mouth (OR?=?2.6, 95 % CI, 1.1–6.2) together with race/ethnicity and time since diagnosis adequately accounted for employment group.

Conclusions

Our findings support the hypothesis that residual symptom burden is related to post-cancer employment: Residual symptoms may be targets for intervention to improve work outcomes among cancer survivors.

Implications for Cancer Survivors

This analysis examines whether increased symptom burden is associated with a change to not working following a cancer diagnosis. We also examined individual symptoms to assess which symptoms were most strongly associated with not working after a cancer diagnosis. Our hope is that we will be able to use this information to both screen survivors post-active treatment as well as target high-risk symptoms for further and more aggressive intervention, in an attempt to improve post-cancer work outcomes.     

Predictors of financial difficulties and work modifications among cancer survivors in the United States

Purpose

The aim of this study is to examine predictors of cancer-related financial difficulties and work modifications in a national sample of cancer survivors.

Methods

Using the 2011 Medical Expenditure Panel Survey and Experiences with Cancer Survivorship Supplement, the prevalence of financial difficulties and work modifications was examined. Logistic regression and survey weights were used to model these outcomes as functions of sociodemographic and health covariates separately among survivors in active treatment and survivors under age 65 years.

Results

Among all survivors, 33.2 % reported any financial concern, with 17.9 % reporting financial difficulties such as debt or bankruptcy. Among working survivors, 44.0 % made any work modification and 15.3 % made long-term work modifications (e.g., delayed or early retirement). Among those in active treatment, predictors of financial difficulty included: race/ethnicity other than white, non-Hispanic [OR?=?8.0; 95 % CI 2.2–28.4]; income <200 % of federal poverty level (FPL) [OR?=?15.7; 95 % CI 2.6–95.2] or between 200 and 400 % of FPL [OR?=?8.2; 95 % CI 1.3–51.4]; residence in a non-metropolitan service area [OR?=?6.4; 95 % CI 1.6–25.0]; and good/fair/poor self-rated health [OR?=?3.8; 95 % CI 1.0–14.2]. Among survivors under age 65 years, predictors of long-term work modifications included good/fair/poor self-rated health [OR?=?4.1; 95 % CI 1.6–10.2], being married [OR?=?2.2; 95 % CI 1.0–4.7], uninsured [OR?=?3.5; 95 % CI 1.3–9.3], or publicly insured [OR?=?9.0; 95 % CI 3.3–24.4].

Conclusions

A substantial proportion of cancer survivors experience cancer-related financial difficulties and work modifications, particularly those who report race/ethnicity other than white, non-Hispanic, residence in non-metropolitan areas, worse health status, lower income, and public or no health insurance.

Implications for cancer survivors

Attention to the economic impact of cancer treatment is warranted across the survivorship trajectory, with particular attention to subgroups at higher risk.