Barriers to follow-up care among survivors of adolescent and young adult cancer

Purpose

Though the need for risk-based follow-up care for survivors of adolescent and young adult (AYA) cancer has been documented, survivors often report forgoing recommended care due to cost. We sought to understand whether additional barriers to follow-up care exist for AYA survivors.

Methods

We recruited survivors who were diagnosed with cancer between the ages of 15 and 39 using the Utah Cancer Registry (UCR). Overall, 28 survivors participated in 6 focus groups held between March and May 2015 in Salt Lake City and St. George, UT. Focus group discussions focused on the reasons survivors may or may not attend recommended medical visits after completing therapy.

Results

Survivors reported myriad barriers to follow-up medical visits, including lack of clear provider recommendation, fear of recurrent cancer diagnosis, wishing to move on with life, competing life responsibilities due to work and children, and not perceiving the need for a visit due to lack of symptoms.

Conclusions

Though cost likely plays a major part in follow-up care adherence for survivors of AYA cancer, in our focus groups, participants indicated there were many other psychosocial and logistic barriers to care. Such factors play an important role in the day-to-day lives of survivors and are critical in medical decision-making.

Implications for cancer survivors

Several factors impede follow-up care adherence for survivors of AYA cancer that are amenable to interventions, including clearer provider recommendations, flexible appointment times, and childcare availability in clinics.

     

Barriers to physical activity and healthy diet among breast cancer survivors: A multilevel perspective

Cancer survivors engage in suboptimal levels of health behaviours and report many barriers to health behaviours, but we lack a solid understanding of the different levels of barriers and how they relate to enacted health behaviours. To address these issues, we conducted mixed‐method research in 97 breast cancer survivors. Participants' barriers to physical activity (PA) and healthy diet, asked as an open‐ended question, were coded as individual‐level, social‐level, and organisational/environmental‐level for each health behaviour. Moderate‐to‐vigorous PA and fruit and vegetable (F&V) intake were assessed. Most participants perceived at least one PA (72.7%) and diet (64.9%) individual‐level barrier (e.g. physical symptoms/injury); only 15.2% (PA) and 15.6% (diet) reported at least one social‐level barrier (e.g. family obligations). About 28.8% (PA) and 29.9% (diet) perceived at least one organisational/environmental‐level barrier (e.g. job demand, cost of F&V). Survivors perceiving individual‐level dietary barriers consumed less F&V (?.65 servings/day) than those not perceiving dietary barriers at this level. Survivors perceiving social‐level dietary barriers reported marginally lower F&V intake (?.65 servings/day) than their counterparts. Those perceiving organisational/environmental‐level PA barriers reported marginally fewer minutes (?44.30/week) of moderate‐to‐vigorous PA than their counterparts. Barriers at multiple levels should be addressed to improve health behaviours among breast cancer survivors.     

Cancer information seeking among African Americans

Background. Relatively little is known about the factors that impact African Americans’ health information seeking, a behavior relevant to cancer disparity. Methods. In this article, we examine African American cancer information seeking using data from Cancer Information Service (CIS) call data (N=32,834 African American callers). Results. Compared to members of other racial groups, fewer African American callers sought information on prevention and psychosocial support. African American calls were likely to result in information on medical referrals and support services. Conclusions. Increased knowledge of CIS resources relevant to treatment and support may increase African American use of CIS.     

Factors related to cancer information scanning and seeking behavior among high school students in Korea

Objective: This paper aimed to determine the relationship between cancer information scanning andseeking experience of adolescents and cancer preventive behavior, perceived cancer risk, and levels of cancerrelatedknowledge. Methods: The study sample comprised 1,000 second-year students from 6 high schools:the general and vocational school systems were each represented by 1 boys’, 1 girls’, and 1 coeducationalhigh school. In July 2011, trained researchers visited each classroom, explained the purpose of the study,distributed questionnaires to the students who agreed to participate, instructed them to complete the surveyby self-reporting, and collected the completed questionnaires. Results: The students who attended generalhigh schools (as compared with vocational high schools), earned higher grades, consumed more vegetables,had a higher perceived cancer risk, and answered the cancer-related questions more correctly had morecancer information scanning and seeking experience. Conclusion: These results reinforce the importance ofcancer prevention health education. Furthermore, the results may help in preparing a strategy that enablespeople to acquire accurate cancer-related information easily and quickly.     

Return to work among self-employed cancer survivors

Purpose

The aim of this study is to investigate whether salaried and self-employed workers differ regarding factors relevant for return to work after being diagnosed with cancer. The possible mediators of an effect of self-employment on work ability were also investigated.

Methods

A total of 1115 cancer survivors (1027 salaried and 88 self-employed) of common invasive cancer types who were in work at the time of diagnosis completed a mailed questionnaire 15–39 months after diagnosis.

Results

Twenty-four percent of self-employed cancer survivors reported that they had not returned to work at the time of the survey, and 18 % of those who were salaried had not. While 9 % of the self-employed had received disability or early retirement pension, only 5 % had received such a pension among salaried employees. Compared with the salaried workers, the self-employed people reported significantly more often reduced work hours (P < 0.001), negative cancer-related financial (P < 0.001), and occupational changes (P = 0.005) and low overall health (P = 0.02), quality of life (P = 0.04), and total work ability (P = 0.02). The negative effect of self-employment on total work ability seems to be mediated by reduced work hours and a negative cancer-related financial change.

Conclusions

Compared with salaried, self-employed workers in Norway, they seem to struggle with work after cancer. This may be because the two groups have different work tasks and because self-employed people have lower social support at work and less legal support from the Working Environment Act and public health insurance.

Implications for cancer survivors

Self-employed people with cancer should be informed about the work-related challenges they may encounter and be advised to seek practical help from social workers who know about the legal rights of self-employed people.

     

Dietary changes among cancer survivors

Given the limited scientific knowledge about dietary factors that affect cancer recurrence, dietary guidelines for cancer survivors are similar to general recommendations on healthy eating. This study explored the patterns of and motivation for, dietary changes among cancer patients. We conducted in-person interviews with 143 cancer survivors who were chosen from a mail survey on complementary and alternative medicine among cancer patients. We applied qualitative analysis using the software package NUD*IST to sort and code the transcribed interviews. The majority of dietary changes reported by 69 cancer patients agreed with current nutritional recommendations, such as decreasing meat and fat intake and increasing the consumption of vegetables and fruits. However, many diet changers also reported the intake of herbal and vitamin supplements, many with unproven effects. The major themes for changing diet were hopes that nutrition would increase well-being, maintain health and prevent cancer recurrence and beliefs that foods that cause or prevent cancer should be avoided and increased, respectively. Many cancer patients use non-scientific reasons when deciding on dietary changes and supplement use. Increasing communication with health care providers may prevent the use of extreme diets, unproven and possibly harmful supplements and reduce exaggerated hopes related to the benefits of a particular dietary regimen.     

Barriers to procreational intentions among cancer survivors 2 years after diagnosis: a French national cross‐sectional survey

Objectives: To determine the procreational intention rates among cancer survivors whose fertility was unimpaired and to identify the factors associated with their procreational intentions. Methods: Six thousand nine hundred and fifty‐seven adult cancer patients treated between September and October 2002 were randomly selected from the French National Health Insurance Fund's Chronic Disease File. Of the 6957, 4270 responded to a cross‐sectional questionnaire 2 years after diagnosis, of whom 959 reported being fertile and responded to a question about their procreational intentions. Results: Among the 257 male and female survivors aged 20–44, 86 (33.5%) had procreational intentions. After adjusting for age, gender, and already having children, only a high educational level (adjusted odds ratio: 3.1, 95% confidence interval 1.3–7.8) and stable or increasing financial resources (2.4, 1.0–5.7) were independently associated with the respondents' procreational intentions. Neither cancer stage at diagnosis nor the present stage significantly affected their plans in this respect. Conclusions: Two years after cancer diagnosis, the reasons why some survivors who are still fertile have no parenthood projects were similar to those earlier given by members of the general population. Copyright © 2010 John Wiley & Sons, Ltd.     

Lifestyle behaviors among US cancer survivors

Purpose

We describe and compare lifestyle behaviors, including smoking, physical activity, alcohol consumption, and nutrition, among cancer survivors to individuals with no cancer.

Methods

Data from the 2013 Behavior Risk Factor Surveillance System were used for this cross-sectional study. Weighted analysis was performed, and associations were examined by adjusted prevalence ratios (APRs) and 95 % confidence intervals (CIs).

Results

Comparing survivors to individuals with no cancer history, differences were found for a smoking quit attempt (APR 1.08; CI 1.04, 1.12), physical inactivity (APR 1.11; CI 1.07, 1.15), and binge drinking (APR 0.89; CI 0.83, 0.95). An interaction with gender was observed when examining smoking and heavy drinking. Smoking was lower (APR 0.85; CI 0.79, 0.92) among male survivors than males with no cancer history, while higher (APR 1.25; CI 1.18, 1.32) among female survivors compared to females with no cancer history. Heavy drinking (APR 0.85; CI 0.73, 0.98) was lower among male survivors than males with no cancer history, while cancer survivorship was not associated with heavy drinking among females. No differences existed for fruit and vegetable consumption or body mass index.

Conclusions

US cancer survivors are not more likely than the general population to engage in all healthy lifestyle behaviors. Interventions, including improved physician communication, to reduce physical inactivity among all cancer survivors and cigarette smoking among female survivors are needed.

Implications for Cancer Survivors

Cancer survivors are at increased risk for comorbid conditions, and acceptance of healthy behaviors may reduce dysfunction and improve long-term health. Ultimately, opportunities exist for clinicians to promote lifestyle changes that may improve the length and quality of life of their patients.

     

Birth rates among female cancer survivors

BACKGROUND:

More women of fertile age are long‐term survivors of cancer. However, population‐based data on birth rates of female cancer survivors are rare.

METHODS:

A total of 42,691 women ≤ 45 years with a history of cancer were identified from the Swedish Multi‐Generation Register and the Swedish Cancer Register, for whom relative birth rates were calculated as compared to the background population, ie, standardized birth ratios (SBRs). Independent factors associated with reduced birth rates among cancer survivors were estimated using Poisson modeling.

RESULTS:

Compared to the background population, cancer survivors were 27% less likely to give birth (SBR = 0.73, 95% confidence interval [CI] = 0.72‐0.75). Large difference in SBRs existed by cancer site, with high SBRs for survivors of melanoma skin, thoracic, head and neck, and thyroid cancers, and low SBRs for reproductive, breast, brain and eye, and hematopoietic cancer survivors. Parity status at diagnosis affected fertility: women who already had a child at the time of diagnosis were less likely to give birth (SBR = 0.50, 95% CI = 0.48‐0.53) than were nulliparous women (SBR = 0.87, 95% CI = 0.85‐0.90). Multivariate analysis showed that cancer site (reproductive organs), age at onset of cancer (< 12 years), and parity status were all significant and independent predictors of a reduced probability of giving birth after diagnosis.

CONCLUSIONS:

Cancer survivors are less likely to give birth compared with the background population. Large variations in the likelihood to give birth after diagnosis were seen according to age at onset, cancer site, and parity status at diagnosis. Cancer 2013. © 2013 American Cancer Society.