Spiritual well-being and depressive symptoms among cancer survivors

Purpose

Depression is common among patients diagnosed with cancer and may be inversely associated with spiritual well-being. While numerous strategies are employed to manage and cope with illness, spiritual well-being has become increasingly important in cancer survivorship research. This study examined the association between spiritual well-being and depressive symptoms.

Methods

This cross-sectional study utilized self-report data from 102 diverse cancer survivors recruited from peer-based cancer support groups in San Diego County. Depression was measured with the Patient Health Questionnaire-8 (PHQ-8) and spiritual well-being was measured with the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being (FACIT-Sp) comprised of two subscales (Meaning/Peace and Faith).

Results

Hierarchal regression analysis indicated that Meaning/Peace significantly predicted depressive symptoms after adjusting for socio-demographics, cancer stage, time since diagnosis, and Faith (p?<?.001).

Conclusions

Findings suggest that Spiritual Well-Being is a valuable coping mechanism and that Meaning/Peace has a unique advantage over Faith in protecting cancer survivors from the effects of depression symptoms; therefore, turning to Faith as source of strength may improve psychological well-being during survivorship.

Implications

Future programs and healthcare providers should be cognizant of the influential role of spiritual well-being in depression symptoms in an effort to improve psychological well-being among cancer survivors.     

Daytime sleepiness and sleep duration in long-term cancer survivors and non-cancer controls: results from a registry-based survey study

Purpose

Sleep-related complaints are common in cancer survivors. Although daytime sleepiness and sleep duration are associated with poor functional status, quality of life, and mortality in the general population, little is known about these issues in long-term cancer survivors. This study examined differences in daytime sleepiness and sleep duration between long-term cancer survivors and non-cancer controls.

Methods

Survey data were analyzed from individuals diagnosed with cancer ≥2?years in the past (n?=?1,171, mean age?=?64.30, 80.8% white, 22.8% male) and spouse/friends controls (n?=?250, mean age?=?60.78, 88.0% white, 64.8% male). Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Associations between sleep-related variables and history of cancer were estimated with multivariable logistic regression, adjusting for potential confounders. Stratified analyses were conducted to identify subgroups of survivors most at risk for sleep problems.

Results

Cancer survivors were more likely than controls to report excessive daytime sleepiness (OR?=?1.64, 95% CI: 1.07, 2.50). A cancer diagnosis was associated with longer sleep duration among males (OR?=?1.25, 95% CI: 1.02, 1.53), but not in females (OR?=?0.87, 95% CI: 0.37, 1.05). All other associations were similar regardless of cancer site, histology, time since diagnosis, treatment history, and history of multiple cancers.

Conclusions

Disturbances in daytime sleepiness and sleep duration persist among long-term cancer survivors and should be monitored in routine survivorship care. More research is needed to identify cancer survivors who are at increased risk for daytime sleepiness and disturbed sleep duration, as well as to identify causal mechanisms for, and interventions to mitigate, persistent differences.     

A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer

Purpose

This study aims to provide recommendations on the optimal strategies and interventions for the prevention, screening, assessment, and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) in adult cancer populations.

Methods

A systematic search of the published health literature was conducted to identify randomized controlled trials, clinical practice guidelines, systematic reviews, and other guidance documents. The Sleep Disturbance Expert Panel [comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers, and guideline methodologists] reviewed, discussed, and approved the final version of the guideline. Health care professionals across Canada were asked to provide feedback through an external review process.

Results

Three clinical practice guidelines and 12 randomized controlled trials were identified as the evidence base. Overall, despite the paucity of evidence, the evidence and expert consensus suggest that it is important to screen and assess adult cancer patients for sleep disturbances using standardized screening tools on a routine basis. While prevention of sleep disturbance is the desired objective, cognitive behavioral therapies are effective in improving sleep outcomes. As part of the external review with 16 health care providers, 81 % indicated that they agreed with the recommendations as written.

Conclusions

Sleep difficulty is a prevalent problem in cancer populations that needs greater recognition by health professionals. Prevention, screening, assessment, and treatment strategies supported by the best available evidence are critical. Recommendations and care path algorithms for practice are offered.     

Living with cancer-related uncertainty: associations with fatigue,insomnia, and affect in younger breast cancer survivors

Purpose

Uncertainty in cancer patients and survivors about cancer-related symptoms, treatment, and disease course has been related to poorer mental and physical health. However, little is known about whether cancer-related uncertainty relates with specific disease and treatment-related outcomes such as fatigue, insomnia, and affect disruptions. In this paper, we report these associations in younger survivors aged 50 years or less, a population increasing in prevalence.

Methods

Participants included 313 breast cancer survivors (117 African-Americans and 196 Caucasians) who were aged 24 to 50 years and were 2 to 4 years posttreatment. Self-reported cancer-related uncertainty (Mishel Uncertainty in Illness Scale–Survivor Version), fatigue (Piper Fatigue Scale–Revised), insomnia (Insomnia Severity Index), and negative and positive affect (Positive and Negative Affect Schedule (PANAS)) measures were collected upon study entry.

Results

Hierarchical regression analyses controlled for relevant sociodemographic variables include the following: race, age, years of education, number of children, employment status, marital status, monthly income, smoking status, family history of cancer, endorsement of treatment-induced menopause, and religiosity. Over and above these factors, higher cancer-related uncertainty was significantly associated with more self-reported fatigue (β?=?.43), insomnia (β?=?.34), negative affect (β?=?.43), as well as less positive affect (β?=??.33), all ps?<?.01.

Conclusions

Younger breast cancer survivors who are 2–4 years posttreatment experience cancer-related uncertainty, with higher levels associated with more self-reported psychophysiological disruptions. Cancer survivors who present in clinical settings with high uncertainty about recurrence or management of long-term effects of treatment may thus benefit from assessment of fatigue, insomnia, and affect.     

Exploring the use of the survivorship consult in providing survivorship care

Purpose

Advances in breast cancer treatment have increased survival and contributed to longer periods of survivorship as reported by the Committee CCSsS (Canadian Cancer Statistics) (2011) and Hewitt et al. (2005), increasing the relevance of survivorship care. Survivorship care includes encouraging survivors to acquire the knowledge, skills and confidence to manage their life, as well as engaging survivors through post-diagnosis disease self-management and self-care strategies. The Survivorship Consult (SC) was designed to help survivors reflect on their needs, establish goals and create an action plan.

Methods

Twenty-six breast cancer survivors who participated in the SC at Princess Margaret Cancer Centre took part in semi-structured interviews to assess the survivor experience and effectiveness of the SC. Data from these interviews were coded, and themes were identified using a modified grounded theory approach.

Results

Themes that emerged regarding the experience and effectiveness of the SC included (1) the supportive experience of collaborative dialogue with supportive care clinicians (i.e. nurses, social workers, occupational therapists, etc.), (2) the development of personalized goals that motivated individuals to implement recommendations, (3) an enhanced understanding of their health condition, team and options, (4) an improved ability to identify needs and (5) an increased sense of confidence to manage issues related to care.

Conclusions

The assessment of the SC improved the experience of breast cancer patients by providing a supportive environment where they could feel cared about, by increasing understanding of their condition and its treatment, by improving communication with the care team and by motivating patients to manage care issues. Further research is needed on survivors who conduct the SC before the treatment phase of their cancer trajectory.     

Perceptions of risk among childhood and young adult cancer survivors who smoke

Purpose

Despite the fact that childhood and young adult cancer survivors are at increased risk for chronic health problems as a result of their cancer treatment, many use tobacco, thereby increasing their risks. Perceptions of risk related to tobacco use can be targeted for interventions aimed at improving health behaviors for childhood, adolescent, and young adult cancer survivors. Understanding the covariates of perceptions of health risks among young adult survivors who smoke will help to determine targets for intervention.

Method

Three hundred seventy-four participants who were diagnosed with cancer prior to age 35, currently between 18 and 55 years of age, and current smokers were recruited as part of a larger smoking cessation study, Partnership for Health-2 (PFH-2). Data were collected by telephone survey.

Results

Overall, women had the highest perception of risk for serious health problems, a second cancer, and heart problems. Additionally, those participants who were dependent on nicotine endorsed that they were at higher risk of serious health problems and second cancers, but not heart problems. Finally, Hodgkin lymphoma survivors reported that they were at increased risk for second cancers and heart problems compared to their “healthy” peers.

Conclusion

Young adult cancer survivors who smoke correctly perceived some of their increased health risks. Additional motivation and education is needed for those young adult cancer survivors who perceive their increased health risks yet continue to smoke. Further education is needed for young survivors so they have a fully appropriate sense of risk, especially as it relates to their tobacco use.     

Physical activity preferences of early-stage lung cancer survivors

Purpose

Engagement in physical activity can provide important benefits for cancer patients and survivors, including those diagnosed with lung cancer. Despite this, many survivors do not engage in recommended levels of physical activity and little is known about the obstacles encountered by lung cancer survivors. The current study examines the physical activity preferences of early-stage lung cancer survivors.

Method

As part of a larger survey study, 175 non-small cell lung cancer survivors who were on average 3.6 years from surgical treatment responded to questions regarding their preferences for physical activity and physical activity advice. Demographic and medical characteristics were also collected.

Results

The majority of respondents (62 %) reported a desire to receive advice regarding physical activity, predominantly before treatment (68 %), in face-to-face interactions (95 %) with a physician (80 %), and within the context of a cancer care center (92 %). Approximately half of participants indicated they would be interested in an exercise program tailored to lung cancer survivors and most individuals (73 %) reported feeling capable of engaging in an exercise program. Differences in physical activity preferences emerged based on demographic and disease characteristics.

Conclusions

The majority of participants reported a desire for physical activity advice and a willingness to engage in physical activity. Important differences were found based on demographic and medical characteristics, which may warrant consideration in the development and dissemination of physical activity interventions for this cancer survivor population.     

Oral and dental late effects in survivors of childhood cancer: a Children’s Oncology Group report

Purpose

Multi-modality therapy has resulted in improved survival for childhood malignancies. The Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers provide practitioners with exposure- and risk-based recommendations for the surveillance and management of asymptomatic survivors who are at least 2 years from completion of therapy. This review outlines the pathophysiology and risks for oral and dental late effects in pediatric cancer survivors and the rationale for oral and dental screening recommended by the Children’s Oncology Group.

Methods

An English literature search for oral and dental complications of childhood cancer treatment was undertaken via MEDLINE and encompassed January 1975 to January 2013. Proposed guideline content based on the literature review was approved by a multi-disciplinary panel of survivorship experts and scored according to a modified version of the National Comprehensive Cancer Network “Categories of Consensus” system.

Results

The Children’s Oncology Group oral-dental panel selected 85 relevant citations. Childhood cancer therapy may impact tooth development, salivary function, craniofacial development, and temporomandibular joint function placing some childhood cancer survivors at an increased risk for poor oral and dental health. Additionally, head and neck radiation and hematopoietic stem cell transplantation increase the risk of subsequent malignant neoplasms in the oral cavity. Survivors require routine dental care to evaluate for potential side effects and initiate early treatment.

Conclusions

Certain childhood cancer survivors are at an increased risk for poor oral and dental health. Early identification of oral and dental morbidity and early interventions can optimize health and quality of life.     

Dealing with the financial burden of cancer: perspectives of older breast cancer survivors

Purpose

Financial burden among cancer survivors is often overlooked in survivorship care planning. Cancer survivors with limited incomes may be particularly affected. Yet, little data are available to address financial issues among them. Eliciting the survivors’ perspectives on how to deal with this financial burden is a first crucial step to identifying the means to provide this supportive care.

Methods

In this pilot study, three nominal group technique (NGT) sessions were conducted with a convenience sample of 23 older breast cancer survivors (age 52 to 83) recruited from a county safety net hospital and a Comprehensive Cancer Center. One single NGT question was posed in these sessions, namely “What could help women deal with the financial burden that cancer brings to them and their families?” Survivors responded in an iterative fashion and then ranked the most relevant responses.

Results

The most relevant responses addressed the (1) need for affordable insurance; (2) need to have prompt information on treatment costs patients will face, insurance coverage, and agencies or programs that provide needed products and services; and (3) need to access social workers, navigators, support groups, or others knowledgeable about available resources. Survivors also suggested that physicians become aware of cancer costs and financial issues faced by patients and consider costs in their treatment plans.

Conclusions

Older survivors face financial challenges for which there are few available resources. They suggested several avenues to address cancer-related financial issues that may be considered in developing supportive interventions.     

‘They’re survivors physically but we want them to survive mentally as well’: health care professionals’ views on providing potential late effect information

Purpose

The concept of providing personalised care plans for cancer survivors is receiving increasing attention; a recognised element of a care plan is to provide an indication of the risks and consequences of treatment. This paper reports health care professional (HCP) response to providing cancer survivors with information on potential late effects of their cancer treatment.

Methods

Eighteen HCPs from five cancer centres and three general practices in the UK completed semi-structured interviews which were digitally recorded, transcribed and qualitatively analysed using framework analysis.

Results

HCPs’ view of health care was that it is currently focused on acute care and needs are responded to as they may arise, including those which are late effects of cancer treatments. The concept of pre-empting a discussion of potential late effects during the survivorship phase was felt to be discordant with this approach and could impact on adjustment to life after cancer treatment.

Conclusion

Providing cancer survivors with information on potential late effects requires further consideration. Evidence for survivor preference for late effect information and the benefit afforded to survivors who receive it could inform the practice of HCPs. If a culture of proactivity is to be encouraged regarding discussions of future potential risk, HCPs may need support in considering ways of presenting survivors with reality whilst being mindful of their need to retain hope during the survivorship phase.     

Lower limb lymphedema in gynecological cancer survivors—effect on daily life functioning

Purpose

Lower limb lymphedema (LLL) is a common condition after pelvic cancer treatment but few studies have evaluated its effect on the quality of life and its consequences on daily life activities among gynecological cancer survivors.

Methods

We identified a cohort of 789 eligible women, treated with pelvic radiotherapy alone or as part of combined treatment of gynecological cancer, from 1991 to 2003 at two departments of gynecological oncology in Sweden. As a preparatory study, we conducted in-depth interviews with gynecological cancer survivors and constructed a study-specific questionnaire which we validated face-to-face. The questionnaire covered physical symptoms originating in the pelvis, demographic, psychological, and quality of life factors. In relation to the lymph system, 19 questions were asked.

Results

Six hundred sixteen (78 %) gynecological cancer survivors answered the questionnaire and participated in the study. Thirty-six percent (218/606) of the cancer survivors reported LLL. Overall quality of life was significantly lower among cancer survivors with LLL. They were also less satisfied with their sleep, more worried about recurrence of cancer, and more likely to interpret symptoms from the body as recurrence. Cancer survivors reported that LLL kept them from physical activity (45 %) and house work (29 %) and affected their ability to partake in social activities (27 %) or to meet friends (20 %).

Conclusion

Lower limb lymphedema has a negative impact on quality of life among gynecological cancer survivors, affecting sleep and daily life activities, yet only a few seek professional help.     

Childhood cancer survivors’ primary care and follow-up experiences

Purpose

Although most childhood cancer survivors see a primary care provider (PCP), little is known about these encounters. We explored themes related to survivors’ (1) experiences with primary care, (2) communication with their PCPs about their cancer, and (3) their knowledge and impressions about follow-up care, including their interest in a survivor care plan (SCP).

Methods

From April to July 2012, we conducted in-depth, semi-structured telephone interviews with 53 adult survivors recruited from the Utah Cancer Surveillance, Epidemiology, and End Results (SEER) Registry. Participants were randomly selected from sex, age, and rural/urban strata and were younger than 21 years at the time of diagnosis. Participants were asked if they had a PCP and whether they discussed their cancer history with their provider and their interest in a SCP. Interviews were recorded, transcribed, and content-analyzed.

Results

The average age at interview was 39.1 years (SD?=?11.2). Most survivors had a current PCP (83.0 %). Almost half were not worried about their health despite having had cancer. Detailed discussions about cancer history with PCPs were generally rare. Few survivors had a follow-up care plan, but over half thought a SCP could empower their medical decision making. However, one-third of the survivors were skeptical about the usefulness of a SCP and some were worried about health-care costs.

Conclusions

Childhood cancer survivors need better care coordination. Of concern is that many do not discuss their cancer history with their current PCPs and most have no SCP.     

The use of cancer treatment summaries and care plans among Massachusetts physicians

Purpose

Cancer survivorship presents many challenges for affected individuals and their health care providers. Reports from The Institute of Medicine document these challenges and recommend the use of survivorship treatment summaries and care plans to improve communication and coordination of care for cancer survivors. The purpose of our study was to assess current use of treatment summaries and care plans in Massachusetts and identify obstacles to greater use.

Methods

A survey was mailed to cancer specialist physicians (CSPs) and primary care physicians (PCPs) in Massachusetts. The survey asked CSPs about their preparation of treatment summaries and care plans for their cancer survivor patients and perceived barriers to the provision of these documents. PCPs were asked about receipt and utility of treatment summaries and care plans and information they would like to see in these reports.

Results

One hundred eight CSPs and 400 PCPs answered the survey. Fifty-six percent of CSPs reported that they, or their staff, prepared treatment summaries for their cancer survivor patients; however, only 14% reported preparing care plans. Fifty-four percent of PCPs reported ever receiving a treatment summary, but only 16% ever received a care plan. CSPs cited lack of training, reimbursement, and templates as barriers to preparing care plans.

Conclusions

Interventions are needed to make treatment summaries and care plans a part of standard care for all cancer survivors. Increasing the use of treatment summaries and care plans will require specific training and reimbursement and may be facilitated by templates that capture automated data.     

From diagnosis through survivorship: health-care experiences of colorectal cancer survivors with ostomies

Purpose

The journey from diagnosis through treatment to survivorship can be challenging for colorectal cancer (CRC) survivors with permanent ostomies. Memories of both the positive and negative health-care interactions can persist years after the initial diagnosis and treatment. The purpose of this paper is to describe the health-care experiences of long-term (>5 years) CRC survivors with ostomies.

Methods

Thirty-three CRC survivors with ostomies who were members of Kaiser Permanente, an integrated care organization, in Oregon, southwestern Washington and northern California participated in eight focus groups. Discussions from the focus groups were recorded, transcribed, and analyzed for potential categories and themes.

Results

Health-care-related themes described CRC survivors’ experiences with diagnosis, treatment decision-making, initial experiences with ostomy, and survivorship. Participants discussed both positive and negative health-care-related experiences, including the need for continued access to trained nurses for ostomy self-care, access to peer support, and resources related to managing persistent, debilitating symptoms.

Conclusions

Long-term CRC survivors with ostomies have both positive and negative health-care experiences, regardless of health-related quality of life (HRQOL) and gender. Long-term support mechanisms and quality survivorship care that CRC survivors with ostomies can access are needed to promote positive adjustments and improved HRQOL.

Structured abstract

The current literature in CRC survivorship suggests that HRQOL concerns can persist years after treatment completion. The coordination of care to manage persistent late- and long-term effects are still lacking for CRC survivors living with an ostomy. Findings from this qualitative analysis will aid in the development of support strategies that foster more positive adjustments for CRC survivors living with an ostomy and support their ongoing ostomy-related needs.     

Appropriate and necessary oral care for people with cancer: guidance to obtain the right oral and dental care at the right time

Purpose

The identification of experienced and knowledgeable dental specialists to provide appropriate oral care for cancer patients, as well as the integration of this care within general oncology management, may be a challenge. This paper discusses the general and additional requirements for dental care providers to support the cancer patient and provide prevention and/or treatment for oral complications of cancer therapy.

Methods

We performed a literature review of specific issues regarding the oral cavity and adjacent structures in the cancer patient, including detection and early diagnosis of oral malignancy. We incorporated the systemic effects of cancer and its therapy that affect oral disease and treatment. We present a summary of how to seek expert dental care for cancer patients and for referral from the dental and medical community.

Results

Due to the complexity conferred by the disease and its treatment, cancer patients require educated, experienced dentists for treatment and/or prevention of oral-related morbidity. Correct diagnosis and evidence-based prophylactic and therapeutic oral care can significantly improve patient quality of life and reduce morbidity and healthcare costs.

Conclusions

The knowledge and expertise of dental professionals regarding prevention/treatment of complications and secondary malignant lesions in cancer patients are critical. Integration of oral care with the oncology care and in survivors requires effective communication between dental and medical providers beginning ideally at diagnosis. These clinicians may be identified at the cancer center, nearby hospital dental programs, and, less commonly, in the community.     

Evaluation of a screening programme for psychological distress in cancer survivors

Purpose

This study is aimed at evaluating the feasibility of a screening procedure for psychological distress in cancer survivors.

Methods

Consecutive series of 339 cancer patients from three centres were requested to fill in two questionnaires measuring psychological distress (PDI) and social support (MOSS). Psychological intervention was offered to patients with significant degree of distress.

Results

Most patients accepted to be screened (72.0%; n?=?244), and a subgroup (16.0%) showed high psychological distress. A higher ratio of distressed patients was observed among those with lower social support (P?=?0.017). A significant (P?<?0.01) negative correlation between psychological distress and social support was observed. A psychological intervention was offered to patients with high psychological distress, but only 15.6% completed it.

Conclusions

Results from this study provide both some insights into the characteristics of psychological distress and some input on issues that may arise when implementing a screening procedure for psychological distress in cancer survivors. Further research is needed to assess both the clinical significance of distress and the most appropriate tools to carry out screening procedures within the target population.     

How does the Distress Thermometer compare to the Hospital Anxiety and Depression Scale for detecting possible cases of psychological morbidity among cancer survivors?

Purpose

Use of the Distress Thermometer (DT) as a screening tool is increasing across the cancer trajectory. This study examined the accuracy and optimal cut-off score of the DT compared to the Hospital Anxiety and Depression Scale (HADS) for detecting possible cases of psychological morbidity among adults in early survivorship.

Methods

This study is a cross-sectional survey of 1,323 adult cancer survivors recruited from two state-based cancer registries in Australia. Participants completed the DT and the HADS at 6?months post-diagnosis.

Results

Compared to the HADS subscale threshold ??8, the DT performed well in discriminating between cases and non-cases of anxiety, depression and comorbid anxiety?Cdepression with an area under the curve of 0.85, 0.84 and 0.87, respectively. A DT cut-off score of ??2 was best for clinical use (sensitivity, 87?C95?%; specificity, 60?C68?%), ??4 was best for research use (sensitivity, 67?C82?%; specificity, 81?C88?%) and ??3 was the best balance between sensitivity (77?C88?%) and specificity (72?C79?%) for detecting cases of anxiety, depression and comorbid anxiety?Cdepression. The DT demonstrated a high level of precision in identifying non-cases of psychological morbidity at all possible thresholds (negative predictive value, 77?C99?%).

Conclusions

The recommended DT cut-off score of ??4 was not supported for universal use among recent cancer survivors. The optimal DT threshold depends upon whether the tool is being used in the clinical or research setting. The DT may best serve to initially identify non-cases as part of a two-stage screening process. The performance of the DT against ??gold standard?? clinical interview should be evaluated with cancer survivors.     

Smoking status,service use and associated factors among Japanese cancer survivors—a web-based survey

Purpose

This study aims to investigate smoking status and its associated factors among Japanese cancer survivors. We stretched our focus on association with health-related behaviors other than smoking (alcohol intake, physical exercise, and social activity) and the smoking cessation strategies used by cancer survivors.

Methods

An anonymous cross-sectional web-based survey was conducted, enrolling survivors of various types of cancer up to 10 years after diagnosis. Smoking status, socioeconomic status, health-related behaviors other than smoking, and smoking cessation resource that the participants used were evaluated. Factors associated with continuous smoking after cancer diagnosis were explored using multivariate analysis.

Results

Among 168 participants who were smoking at the time of cancer diagnosis, 96 participants (57.1 %) continued smoking. Sixty-seven survivors (69.8 %) were willing to reduce or quit smoking, however, only 39 survivors (40.6 %) were provided with counseling or intervention on smoking cessation. Male gender, shorter time after cancer diagnosis, and lack of regular physical exercise associated with continuous smoking. Higher level of fear of cancer recurrence had trend-level significance of association with smoking cessation.

Conclusions

Substantial proportions of Japanese cancer survivors continue smoking after diagnosis of cancer. The majority of them are not provided with relevant information or support, despite their willingness of reducing or quitting smoking. Smoking cessation is associated with other health behaviors (i.e., physical exercise). This suggests considerable missed opportunities for health-care providers to provide cancer survivors with counseling and evidence-based interventions. Promotion of professional support on smoking cessation and education to encourage healthy behaviors are needed.     

Employer-sponsored health insurance coverage limitations: results from the Childhood Cancer Survivor Study

Purpose

The Affordable Care Act (ACA) will expand health insurance options for cancer survivors in the USA. It is unclear how this legislation will affect their access to employer-sponsored health insurance (ESI). We describe the health insurance experiences for survivors of childhood cancer with and without ESI.

Methods

We conducted a series of qualitative interviews with 32 adult survivors from the Childhood Cancer Survivor Study to assess their employment-related concerns and decisions regarding health insurance coverage. Interviews were performed from August to December 2009 and were recorded, transcribed, and content analyzed using NVivo 8.

Results

Uninsured survivors described ongoing employment limitations, such as being employed at part-time capacity, which affected their access to ESI coverage. These survivors acknowledged they could not afford insurance without employer support. Survivors on ESI had previously been denied health insurance due to their preexisting health conditions until they obtained coverage through an employer. Survivors feared losing their ESI coverage, which created a disincentive to making career transitions. Others reported worries about insurance rescission if their cancer history was discovered. Survivors on ESI reported financial barriers in their ability to pay for health care.

Conclusions

Childhood cancer survivors face barriers to obtaining ESI. While ACA provisions may mitigate insurance barriers for cancer survivors, many will still face cost barriers to affording health care without employer support.     

Investigating physical symptom burden and personal goal interference in early-stage breast cancer patients

Purpose

Physical symptoms associated with breast cancer and its treatment can substantially interfere with functional outcomes and quality of life. The present study seeks to delineate the relationship between physical symptom burden and cancer-related goal interference in early-stage breast cancer patients.

Methods

Self-report questionnaires were administered to 43 eligible female patients at four time-points in the 6 months following surgery for early-stage breast cancer. Physical symptoms, cancer-related goal interference, and psychological distress were assessed at each time-point. K-means cluster analysis and independent sample t tests evaluated the relationships of interest.

Results

Women with a higher physical symptom burden experienced significantly higher goal interference and psychological distress than those with a lower burden at multiple time-points following surgery.

Conclusions

This study provides preliminary evidence that physical symptom burden can interfere with important goal pursuit in early-stage breast cancer patients. Breast cancer survivors with ongoing challenging symptoms may require targeted psychosocial support to cope with possible goal interference and associated distress.