Evaluation of the Fertility and Cancer Project (FCP) among young breast cancer survivors

Objective: Fertility and childbearing issues are the major quality of life concerns among young breast cancer survivors. Practical approaches are needed to convey reproductive health information. The Fertility and Cancer Project (FCP) is a dedicated research project that provides online reproductive health and fertility education. We report FCP participants' (a) changes in mood and functioning and (b) changes in knowledge of fertility and cancer from baseline to 6‐month follow‐up. Methods: Participants completed five self‐report baseline measures, accessed FCP content and participated in online discussions. At 6 months post FCP study entry, participants were asked to complete follow‐up self‐reports. Results: One hundred and six breast cancer survivors from 8 countries participated in the FCP. Mean age at diagnosis was 34.3 years; mean time since diagnosis was 22 months. Significant change was detected in improved physical functioning (p=0.019) and social functioning (p=0.02). Significant changes were also noted in improved fertility knowledge (p=0.011). Conclusion: Preliminary evidence shows that young breast cancer survivors derive improved mood and knowledge benefit from FCP participation. Internet‐based approach may be a viable format for engaging this population of cancer survivors. Copyright © 2009 John Wiley & Sons, Ltd.     

Fractures among long‐term survivors of childhood cancer

BACKGROUND:

Although reductions in bone mineral density are well documented among children during treatment for cancer and among childhood cancer survivors, little is known about the long‐term risk of fracture. The objective of this study was to ascertain the prevalence of and risk factors for fractures among individuals participating in the Childhood Cancer Survivor Study (CCSS).

METHODS:

Analyses included 7414 ≥5‐year survivors of childhood cancer diagnosed between 1970 and 1986 who completed the 2007 CCSS follow‐up questionnaire and a comparison group of 2374 siblings. Generalized linear models stratified by sex were used to compare the prevalence of reported fractures between survivors and siblings.

RESULTS:

The median ages at follow‐up among survivors and siblings were 36.2 years (range, 21.2‐58.8 years) and 38.1 years (range, 18.4‐62.6 years), respectively, with a median 22.7 years of follow‐up after cancer diagnosis for survivors. Approximately 35% of survivors and 39% of siblings reported ≥1 fracture during their lifetime. The prevalence of fractures was lower among survivors than among siblings, both in males (prevalence ratio, 0.87; 95% confidence interval, 0.81‐0.94; P < .001) and females (prevalence ratio, 0.94; 95% confidence interval, 0.86‐1.04; P = .22). In multivariable analyses, increasing age at follow‐up, white race, methotrexate treatment, and balance difficulties were associated with increased prevalence of fractures among female survivors (P = .015). Among males, only smoking history and white race were associated with an increased prevalence of fracture (P < .001).

CONCLUSIONS:

Findings from this study indicated that the prevalence of fractures among adult survivors did not increase compared with that of siblings. Additional studies of bone health among aging female cancer survivors may be warranted. Cancer 2012. © 2012 American Cancer Society.     

Randomized controlled trial of mindfulness‐based stress reduction (MBSR) for survivors of breast cancer

Objectives: Considerable morbidity persists among survivors of breast cancer (BC) including high levels of psychological stress, anxiety, depression, fear of recurrence, and physical symptoms including pain, fatigue, and sleep disturbances, and impaired quality of life. Effective interventions are needed during this difficult transitional period. Methods: We conducted a randomized controlled trial of 84 female BC survivors (Stages 0–III) recruited from the H. Lee Moffitt Cancer and Research Institute. All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and/or chemotherapy. Subjects were randomly assigned to a 6‐week Mindfulness‐Based Stress Reduction (MBSR) program designed to self‐regulate arousal to stressful circumstances or symptoms (n=41) or to usual care (n=43). Outcome measures compared at 6 weeks by random assignment included validated measures of psychological status (depression, anxiety, perceived stress, fear of recurrence, optimism, social support) and psychological and physical subscales of quality of life (SF‐36). Results: Compared with usual care, subjects assigned to MBSR(BC) had significantly lower (two‐sided p<0.05) adjusted mean levels of depression (6.3 vs 9.6), anxiety (28.3 vs 33.0), and fear of recurrence (9.3 vs 11.6) at 6 weeks, along with higher energy (53.5 vs 49.2), physical functioning (50.1 vs 47.0), and physical role functioning (49.1 vs 42.8). In stratified analyses, subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning. Conclusions: Among BC survivors within 18 months of treatment completion, a 6‐week MBSR(BC) program resulted in significant improvements in psychological status and quality of life compared with usual care. Copyright © 2009 John Wiley & Sons, Ltd     

Limitations in health care access and utilization among long‐term survivors of adolescent and young adult cancer

BACKGROUND:

Health care outcomes for long‐term survivors of adolescent and young adult (AYA) cancer were compared with young adults without a cancer history, using the 2009 Behavioral Risk Factor Surveillance System data.

METHODS:

Eligible participants were 20 to 39 years of age. There were N = 979 who self‐reported a cancer diagnosis between the ages of 15 to 34 years and were at least 5 years from diagnosis (excluding nonmelanoma skin cancer). The remaining 67,216 participants with no cancer history were used as controls. Using multivariable regressions, relative risks and 95% confidence intervals were generated to examine the relationship of survivor status on indicators of poor health care (uninsured, no personal health care provider, no routine care, and avoiding seeing a doctor due to cost). Adjusted proportions were calculated by demographic groups. Results are weighted by Behavioral Risk Factor Surveillance System survey design.

RESULTS:

Although the proportion uninsured did not differ (21% of survivors vs 23% of controls), AYA survivors reported forgoing care due to cost at higher levels than controls (relative risk = 1.67, 95% CI = 1.44‐1.94). Cost barriers were particularly high for survivors aged 20 to 29 years (44% vs 16% of controls; P < .001) and female survivors (35% vs 18% of controls; P < .001). Survivors reporting poorer health had more cost barriers. Moreover, uninsured survivors tended to report lower use of health care than did controls.

CONCLUSIONS:

AYA cancer survivors may forgo health care due to cost barriers, potentially inhibiting the early detection of late effects. Expanding health insurance coverage for young cancer survivors may be insufficient without adequate strategies to reduce their medical cost burdens. Cancer 2012. © 2012 American Cancer Society.     

Psychosexual functioning of childhood cancer survivors

Purpose: The objective of the study is to explore psychosexual functioning and its relationship with quality of life in survivors of cancer in childhood. Methods: Sixty childhood cancer survivors completed two questionnaires: psychosexual and social functioning questionnaire and MOS‐SF‐36. Results: Psychosexual problems were frequent. About 20% of the survivors felt a limitation in their sexual life due to their illness. Older survivors (?25 years) had significantly less experience with sexual intercourse than their age‐matched peers in the Dutch population (p = 0.010). Survivors treated in adolescence had a delay in achieving psychosexual milestones compared with those treated in childhood: dating (p<0.025), touching under clothes (p<0.025), masturbation (female) (p<0.05) and sexual intercourse (p<0.025). No differences were found for sexual fantasies, kissing, masturbation (male) and oral sex. The total survivor group appraised their quality of life as less positive than their Dutch peers for the subscales of general and mental health (both p<0.001), physical and social functioning (p<0.01; p<0.001), bodily pain and vitality (both p<0.001). However, quality of life was not more affected adversely in survivors with psychosexual problems compared with survivors without these problems. Conclusion: In this cohort of childhood cancer survivors, psychosexual problems were frequent. Treatment in adolescence is a risk factor for a delay in psychosexual development. Copyright © 2007 John Wiley & Sons, Ltd.     

Late morbidity leading to hospitalization among 5‐year survivors of young adult cancer: A report of the childhood,adolescent and young adult cancer survivors research program

To estimate the risk of late morbidity leading to hospitalization among young adult cancer 5‐year survivors compared to the general population and to examine the long‐term effects of demographic and disease‐related factors on late morbidity, a retrospective cohort of 902 five‐year survivors of young adult cancer diagnosed between 1981 and 1999 was identified from British Columbia (BC) Cancer Registry. A matched comparison group (N = 9020) was randomly selected from the provincial health insurance plan. All hospitalizations until the end of 2006 were determined from the BC health insurance plan hospitalization records. The Poisson regression model was used to estimate the rate ratios for late morbidity leading to hospitalization except pregnancy after adjusting for sociodemographic and clinical risk factors. Overall, 455 (50.4%) survivors and 3,419 (37.9%) individuals in the comparison group had at least one type of late morbidity leading to hospitalization. The adjusted risk of this morbidity for survivors was 1.4 times higher than for the comparison group (95% CI = 1.22–1.54). The highest risks were found for hospitalization due to blood disease (RR = 4.2; 95% CI = 1.98–8.78) and neoplasm (RR = 4.3; 95% CI = 3.41–5.33). Survivors with three treatment modalities had three‐fold higher risk of having any type of late morbidity (RR = 3.22; 95% CI = 2.09–4.94) than the comparators. These findings emphasize that young adult cancer survivors still have high risks of a wide range of late morbidities.     

Social outcomes of long‐term survivors of adolescent cancer

Objectives: The study investigates psychosexual and family outcomes among German long‐term survivors of adolescent cancer. Methods: Survivors of cancer during adolescence (n=820; age at onset of disease: M=15.8 years, SD=0.9, age at follow‐up: M=30.4, SD=6.0 years) completed questionnaires on their family life and their psychosexual and autonomy development. Outcomes were compared to an age‐matched sample (German Socio‐Economic Panel, G‐SOEP, n=820, age: M=30.4, SD=6.7 years) from the general population and to a control group of adults without cancer (n=1027, age: M=31.5, SD=7.0 years). Results: Compared to controls of the same sex, female survivors had achieved fewer developmental milestones in their psychosexual development such as having their first boyfriend, or reached these milestones later, and reported a significantly stronger desire for children. Male survivors were more likely to live with their parents when compared to same sex controls. Equivalent proportions of survivors and persons in the G‐SOEP were living in a long‐term relationship; however, survivors were less likely to have ever married or had children. At first marriage and at the birth of their first child, survivors were significantly older compared to the G‐SOEP. About 14.5% of survivors reported cancer‐related infertility. Conclusions: Survivors of adolescent cancer experience some social late effects of the disease in adulthood, such as a delayed social development as well as substantial differences in their family life and living conditions compared to healthy peers. Copyright © 2010 John Wiley & Sons, Ltd.     

Late psychiatric morbidity in survivors of cancer at a young age: A nationwide registry‐based study

Childhood cancer survivors have been shown to be prone to psychosocial adverse outcomes. Data on young adults and their psychiatric late effects are still scarce. In a nationwide, registry‐based study, we explored the risk (HR) of new psychiatric diagnoses in 5‐year survivors of childhood and young adulthood (YA) cancer (n = 13,860) compared with a sibling cohort (n = 43,392). Hazard ratios (HRs) were calculated using Cox regression models. Patients and siblings were identified from the Finnish Cancer Registry and Central Population Registry, respectively. Outcome diagnoses were retrieved from the national hospital discharge register. The risk of organic memory/brain disorders was significantly increased in both childhood (HR 4.9; 95%CI 2.7–8.9) and YA (HR 2.1; 95%CI 1.4–3.1) cancer survivors compared with siblings. Mood disorders were also more common in childhood (HR 1.3; 95%CI 1.1–1.7) and YA survivors (1.3; 95%CI 1.1–1.5) than in siblings. Radiotherapy did not explain the differences. Female childhood cancer survivors had significantly increased HRs for mood disorders, psychotic disorders, neurotic/anxiety disorders, somatization/eating disorders and personality disorders. In survivors of YA cancers, females had significantly increased HR for neurotic/anxiety disorders, and the difference between female survivors and siblings was significantly (p < 0.05) higher than that between male survivors and male siblings. The effect of treatment era was also analyzed, and the risk of organic memory and brain disorders in childhood cancer survivors did not diminish over time. Despite the trend of decreased use of cranial irradiation in children, the risk of organic memory/brain disorders was elevated, even during the most recent era. Thus, additional research on chemotherapy‐only protocols and their impact on mental health, is warranted.     

Gender differences in self‐reported late effects,quality of life and satisfaction with clinic in survivors of lymphoma

Objectives: Gender differences in perceived vulnerability to late effects and views about follow‐up among cancer survivors have received little attention. As lymphoma affects both genders similarly, we compared the consequences of cancer (late effects, perceived vulnerability and quality of life (health‐related quality of life (HRQoL)), and satisfaction with clinic visits between genders. Methods: A cohort of 115 younger adults (18–45 years, >5 years disease‐free survival), who had been treated for lymphoma participated. Questionnaires (n = 91) were completed before and after (n = 62) routine consultant‐led appointments. Survivors (n = 24) without appointments were recruited by post. Questionnaires included HRQoL, late effects, perceived vulnerability, issues survivors wanted to discuss and reported discussing in clinic, time waiting in clinic and consultation satisfaction. Results: There were no gender differences in number of self‐reported late effects or perceived vulnerability. Men with more late effects reported worse psychological HRQoL (r = 0.50, p<0.001). While men wanted to discuss more topics than they did, women were able to discuss the topics they wanted (ANOVA, p = 0.01). Multiple regression analyses showed a shorter wait in clinic (r = ?0.46, p = 0.009) and discussing more topics (r = 0.34, p = 0.06) explained 30.6% of the variance in consultation satisfaction for men. Conclusions: Issues surrounding follow‐up provision are increasingly important given the length of survival in young adults following treatment for lymphoma. Men may experience poor psychological well‐being due to distress about unanswered concerns. Consideration of their concerns should be prioritised, given that satisfaction and ultimately continued attendance at clinic and HRQoL may be dependent on the extent to which follow‐up meets survivors' expectations. Copyright © 2010 John Wiley & Sons, Ltd.     

A comparison of general,genitourinary, bowel,and sexual quality of life among long term survivors of prostate,bladder, colorectal,and lung cancer

ObjectivesStudies of local stage prostate cancer survivors suggest that treatments carry risk of persistent impotence, incontinence, and bowel dysfunction. To examine impacts of cancer type and side effects on health-related quality of life (HRQoL) in long-term cancer survivorship, we evaluated 5-year follow-up of patients with prostate cancer and compared results with a matched group of male long-term survivors of other local-stage cancers.Materials and MethodsWe examined genitourinary, bowel and sexual symptoms, and general quality of life. Matched survivors of colorectal, lung, and bladder cancers were recruited via registries in 3 different regions in the United States. Patients were surveyed 3–5 years after diagnosis with the SF-12 and EPIC to evaluate general mental and physical health-related quality of life (HRQoL) and patient function and bother.ResultsWe analyzed responses from long-term prostate (n = 77) and bladder, colorectal, and lung cancer (n = 124) patients. In multivariate analysis, long-term local stage prostate cancer survivors had significantly higher SF-12 physical component scores but did not differ from long-term survivors of other cancers in terms of their SF-12 mental summary scores. Prostate survivors had similar mental, urinary, bowel, and sexual HRQoL compared to long-term survivors of other local stage cancers.ConclusionLong-term general and prostate-specific HRQoL was similar between local stage prostate and bladder, colorectal, and lung patients with cancer. Future research focusing on factors other than initial treatment and the cancer type per se may provide more meaningful information regarding factors that predict disparities on HRQoL among longer-term survivors of early stage male cancers.     

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.     

Development of the Psycho-social Discomfort Scale (PsDS): investigation of psychometric properties among Japanese breast cancer survivors

Objective: To develop a new scale to assess psycho‐social discomfort in breast cancer (BC) survivors in Japanese society and to investigate its psychometric properties. Method: A total of 248 Japanese BC survivors completed both the Psycho‐social Discomfort Scale (PsDS) and WHO Quality of Life BREF Japanese version (WHO QoL‐Jp). A principal component factor analysis (with promax rotation) was performed, and internal consistency was examined using Cronbach's alpha. Divergent and convergent validities and criterion validity were examined using the Spearman's R. Results: The factor analysis extracted three factors: ‘internalised stigma (IS)’, ‘social disclosure of BC (SD)’, and ‘psychological resources to live with BC (PR)’. The factors were moderately correlated. The scale had good internal consistency (alpha = 0.80). All sub‐scales were inversely correlated with all the domains in the WHO QoL‐Jp (r = ?0.09 to ?0.47). BC stage was significantly correlated with the SD sub‐scale, and type of surgery was significantly correlated with the IS sub‐scale. Conclusions: The PsDS has 25 items. It measures psycho‐social discomfort that Japanese BC survivors experienced or were experiencing in their community. It has a simple factor structure, relatively good internal consistency, and a satisfactory divergent validity. Copyright © 2010 John Wiley & Sons, Ltd.     

Sexual functioning in long‐term survivors of Hodgkin's lymphoma

Objective: Studies of Hodgkin's lymphoma (HL) survivors have reported long‐term adjustment problems including sexual dysfunction, but the prevalence and persistence of sexual problems in HL survivors have not been well characterized. This study aimed to address these questions by comparing sexual health in a large cohort of long‐term HL survivors with a noncancer control group. Methods: A mailed survey including questions about current sexual problems and sexual satisfaction was completed by 465 HL survivors and 205 sibling controls. Survivors ranged from 20 to 82 years (median=44) and were treated ?7 years prior (median=18). Results: Sexual problems were commonly reported by HL survivors, with 54.2% reporting decreased sexual activity and 41.4% reporting decreased interest. When survivors' current sexual functioning was compared with the control group, however, no differences were found, and overall sexual satisfaction was positive in both groups. Among survivors, age was not associated with sexual problems but had a small significant negative association with satisfaction ( ρ =?0.12; p<0.05). No associations between time since diagnosis, disease stage, and chemotherapy treatment and sexual functioning were found. Conclusions: Consistent with previous studies, HL survivors reported high rates of current sexual problems. However, no differences in sexual problems or sexual satisfaction were found between survivors and controls. Results indicate that over the long term, survivors' sexual functioning does not differ from noncancer controls. Findings underscore the importance of including healthy control groups to determine whether difficulties reported by cancer survivors can be attributed to cancer treatment. Copyright © 2009 John Wiley & Sons, Ltd.     

Cancer-related chronic pain: examining quality of life in diverse cancer survivors

BACKGROUND:

Disparities in cancer survival and pain rates negatively impact quality of life (QOL). This study examines cancer‐related chronic pain (CP) and its impact on QOL in diverse cancer survivors.

METHODS:

This survey study focused on current and past pain, health, and QOL in black and white cancer survivors. Participants with breast, colorectal, lung, and prostate cancer and multiple myeloma were recruited through the Michigan State Cancer Registry. Analysis of variance was used to examine outcome differences by pain status, race, and sex. Hierarchical regressions explored predictors for experiencing pain.

RESULTS:

The subjects (N = 199) were 31% black, 49% female, and 57 to 79 years old; 19.5% experienced current pain, and 42.6% reported pain since diagnosis. Women experience more pain (P < .001) and greater pain severity (P = .04) than men. Blacks experienced more pain interference and disability (P < .05). Experiencing pain is related to greater depressive symptoms, poorer functioning, and more symptoms. In hierarchical regressions, female sex predicted pain since diagnosis; pain severity for pain since diagnosis was predicted by black race and female sex.

CONCLUSIONS:

The authors extend the literature by showing that 20% of diverse cancer survivors had cancer‐related CP, and 43% had experienced pain since diagnosis, revealing racial and sex disparities in cancer‐related CP's incidence and impact on QOL. Having pain was related to poorer QOL in several domains and was more frequently experienced by women. Although black race was not related to pain prevalence, it was related to greater severity. This study reveals an unaddressed cancer survivorship research, clinical, and policy issue. Cancer 2011. © 2010 American Cancer Society.     

Psychosocial issues related to sexual functioning among African‐American prostate cancer survivors and their spouses

Objective: Focus on cancer survivorship and quality of life (QOL) is a growing priority. The aim of this study was to identify and describe the most salient psychosocial concerns related to sexual functioning among African‐American (AA) prostate cancer survivors and their spouses. Methods: Twelve AA prostate cancer survivors and their spouses participated in semi‐structured individual interviews. The interviews assessed couples' experiences with psychosocial adjustment and sexual functioning posttreatment for localized prostate cancer. The data were analyzed using the constant comparison method and content analysis. Results: In this qualitative study of couples surviving prostate cancer, there were divergent views between the male prostate cancer survivors and their female partners, particularly regarding sexual functioning. For the males, QOL issues emerged as the primary area of concern, whereas survival of their husbands was considered most important among the female spouses. The male respondents expressed unease with the sexual side effects of their cancer treatment, such as erectile dysfunction and decreased sexual desire and satisfaction. Female spouses recognized decreased sexual desire in their partners following treatment, but this was not considered a primary concern. Conclusions: Patients and their spouses may have differing perceptions regarding QOL and the impact of sexual functioning on survivorship. This study points to the need for further research and intervention development to address these domains with a goal to improve QOL. Copyright © 2010 John Wiley & Sons, Ltd.     

Prospective assessment of quality of life in long‐term ovarian cancer survivors

The objective of our study was to compare prospectively the QoL in long‐term ovarian cancer survivors with short‐term survivors and to explore discriminating variables between short‐term and long‐term survival. Thirty‐three patients were included, 22 died within 5 years post diagnosis and 11 survived beyond 10 years. QoL data were collected pre‐treatment (baseline), 1‐year post diagnoses and for long‐term survivors 10 years post‐treatment using the EORTC QLQ‐C30. At baseline, there was no difference in terms of FIGO stage, residual tumor and adjuvant chemotherapy. Significantly, more short‐term survivors (96%) had intra operative ascites as compared to long‐term survivors (55%) (p=0.01). Before treatment, short‐term survivors had clinically significantly lower QoL scores on the physical functioning (mean 75.45) and role functioning scale (mean 68.94) compared to long‐term survivors (mean 68.94 and 84.85, respectively). They also reported higher levels of symptoms. One year post‐diagnosis, QoL scores were comparable in most domains. Long‐term survivors had a significantly better global QoL but more insomnia. Emotional functioning and global QoL/health status improved significantly from baseline to 1‐year post‐diagnosis and remained relatively stable at the 10‐year follow‐up. The presence of intra operative ascites and a supporting social network were identified as significant variables that discriminated between short‐term and long‐term survival. Compared to a reference sample, long‐term survivors showed similar QoL scores but more dyspnoea. Although ovarian cancer patients do not belong to the most prevalent survivor populations, we found that long‐term survivors have QoL scores similar to females without a history of cancer.     

Disparities in mental health between rural and nonrural cancer survivors: a preliminary study

Objective: While much research has sought to identify disparities in cancer incidence, survival, and treatment, little research has sought to identify disparities in mental health (MH) outcomes among cancer survivors. The present study aims to identify disparities in MH outcomes between rural and nonrural cancer survivors. Methods: Cancer survivors who met eligibility criteria were identified through the Kentucky SEER Cancer Registry. Rural status was determined by 2003 USDA Rural–Urban Continuum Codes. 116 (n=54 rural, 62 nonrural) survivors with diagnoses of breast (n=42), hematologic (n=39), or colorectal (n=35) cancer completed mail‐back questionnaires and/or a telephone interview. Results: Rural cancer survivors reported poorer MH functioning (effect size (ES)=0.45 SD), greater symptoms of anxiety (ES=0.70) and depression (ES=0.47), greater distress (ES=0.41), and more emotional problems (ES=0.47) than nonrural cancer survivors. Rural and nonrural cancer survivors did not differ consistently in regard to positive MH outcomes, such as benefit finding. The pattern of results was maintained when adjusted for education and physical functioning. Conclusions: Clinically important disparities in MH outcomes were evident between rural and nonrural cancer survivors. Interventions aimed at raising access and utilization of MH services may be indicated for cancer survivors in rural areas. Copyright © 2009 John Wiley & Sons, Ltd.     

Cancer surveillance behaviors and psychosocial factors among long‐term survivors of breast cancer

BACKGROUND:

Little is known about cancer surveillance (mammography, clinical breast examination, and pelvic examination) behaviors in long‐term (9‐16 years) breast cancer survivors. This report describes the relation of these behaviors to demographic and clinical characteristics, psychological symptoms, body satisfaction, and social support.

METHODS:

Survivors who had participated in Cancer and Leukemia Group B treatment Trial 8541 completed a survey that included questions on breast cancer surveillance and pelvic examination, psychological well being, body satisfaction, and social support.

RESULTS:

The participation rate was 78% and included 245 breast cancer survivors. Survivors (n = 107; 44%) reported completing breast cancer surveillance (mammography and clinical breast examination) and completing pelvic examination (n = 162; 68%) within recommended guidelines. There were no significant associations between breast cancer surveillance and breast cancer anxiety, depression, stressful life events, body satisfaction, social support, or demographic characteristics. Survivors within recommended guidelines for pelvic examinations were younger (P = .05), married (P = .003), had health insurance (P = .004), and had lower depression scores (P = .005) than survivors who underused or overused pelvic examination. In addition, survivors within recommended pelvic examination guidelines had significantly lower levels of breast cancer anxiety (P = .03) compared with survivors who underused pelvic examination.

CONCLUSIONS:

Many long‐term breast cancer survivors were not within recommended cancer surveillance guidelines. Private health insurance was associated with following recommendations for pelvic examinations, although such a relation did not exist for breast cancer surveillance. The results of this study have implications for the development of educational programs to improve cancer surveillance among the growing population of long‐term breast cancer survivors. Cancer 2009. © 2009 American Cancer Society.