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.     

Rural‐urban disparities in health status among US cancer survivors

BACKGROUND:

Although rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural‐urban disparities in self‐reported health among survivors.

METHODS:

The authors identified adults who had a self‐reported history of cancer from the National Health Interview Survey (2006‐2010). Rural‐urban residence was defined using US Census definitions. Logistic regression with weighting to account for complex sampling was used to assess rural‐urban differences in health status after accounting for differences in demographic characteristics.

RESULTS:

Of the 7804 identified cancer survivors, 20.8% were rural residents. This translated to a population of 2.8 million rural cancer survivors in the United States. Rural survivors were more likely than urban survivors to be non‐Hispanic white (P < .001), to have less education (P < .001), and to lack health insurance (P < .001). Rural survivors reported worse health in all domains. After adjustment for sex, race/ethnicity, age, marital status, education, insurance, time since diagnosis, and number of cancers, rural survivors were more likely to report fair/poor health (odds ratio, 1.39; 95% confidence interval, 1.20‐1.62), psychological distress (odds ratio, 1.23; 95% confidence interval, 1.00‐1.50), ≥2 noncancer comorbidities (odds ratio, 1.15; 95% confidence interval, 1.01‐1.32), and health‐related unemployment (odds ratio, 1.66; 95% confidence interval, 1.35‐2.03).

CONCLUSIONS:

The current results provide the first estimates of the proportion and number of US adult cancer survivors who reside in rural areas. Rural cancer survivors are at greater risk for a variety of poor health outcomes, even many years after their cancer diagnosis, and should be a target for interventions to improve their health and well being. Cancer 2013. © 2012 American Cancer Society.     

延续性健康管理对肝癌手术患者术后心理状态和健康行为的影响

目的 探讨延续性健康管理对肝癌手术患者术后心理状态和健康行为的影响.方法 将120例行肝癌手术的患者采用随机数字表法分为对照组(n=60)和干预组(n=60).对照组采用常规管理方法,干预组在对照组的基础上采用延续性健康管理方案.记录患者依从性情况,分别于干预前后对患者采用汉密尔顿焦虑量表(HAMA)、汉密顿抑郁量表(...     

Understanding physical activity in adolescent cancer survivors: an application of the theory of planned behavior

Notwithstanding the remarkable achievements in survival, there is a growing recognition that pediatric cancer survivors are faced with a variety of chronic health problems that may be exacerbated by maladaptive health behaviors. The purpose of the present study was to examine the utility of the theory of planned behavior (TPB) in understanding adolescent survivors' motivation to engage in physical activity. A group of adolescent cancer survivors recalled their beliefs, attitudes, norms, perceptions of control, intentions and post-treatment physical activity behaviors using a self-administered, mailed questionnaire in a retrospective design. Multiple regression analyses revealed that the TPB explained 29.1% of the variance in physical activity behavior, with the significant independent correlates being intention (beta=0.31,p=0.023) and self-efficacy (beta=0.42,p=0.04). For intention, 33.7% of the variance was explained by the TPB, with affective attitude (beta=0.32,p=0.016) and instrumental attitude (beta=0.31, p=0.037) making significant unique contributions. The present study has provided some of the first data toward understanding physical activity behavior in adolescent cancer survivors. Specifically, the results suggest that interventions designed to promote physical activity in this population should focus on the development of a positive attitude as well as fostering an enhanced sense of self-efficacy.     

Return to work in low-income Latina and non-Latina white breast cancer survivors: a 3-year longitudinal study

BACKGROUND:

Previous research has found an 80% return‐to‐work rate in mid‐income white breast cancer survivors, but little is known about the employment trajectory of low‐income minorities or whites. We set out to compare the trajectories of low‐income Latina and non‐Latina white survivors and to identify correlates of employment status.

METHODS:

Participants were low‐income women who had localized breast cancer, spoke English or Spanish, and were employed at the time of diagnosis. Interviews were conducted 6, 18, and 36 months after diagnosis. Multivariate logistic regression was used to identify independent correlates of employment status at 18 months.

RESULTS:

Of 290 participants, 62% were Latina. Latinas were less likely than non‐Latina whites to be working 6 months (27% vs 49%; P = .0002) and 18 months (45% vs 59%; P = .02) after diagnosis, but at 36 months there was no significant difference (53% vs 59%; P = .29). Latinas were more likely to be manual laborers than were non‐Latina whites (P < .0001). Baseline job type and receipt of axillary node dissection were associated with employment status among Latinas but not non‐Latina whites.

CONCLUSIONS:

Neither low‐income Latinas nor non‐Latina whites approached the 80% rate of return to work seen in wealthier white populations. Latinas followed a protracted return‐to‐work trajectory compared to non‐Latina whites, and differences in job type appear to have played an important role. Manual laborers may be disproportionately impacted by surgical procedures that limit physical activity. This can inform the development of rehabilitative interventions and may have important implications for the surgical and postsurgical management of patients. Cancer 2011;. © 2011 American Cancer Society.     

The breast cancer experience of rural women: a literature review

This report is a review of studies that focus on rural breast cancer survivorship. It includes a total of 14 studies using large databases and 27 other studies using qualitative and quantitative methods. In our review of this literature, we identified four broad themes, including access to treatment and treatment type, medical providers and health information, psychosocial adjustment and coping, and social support and psychological support services. We review the findings of the rural breast cancer survivorship studies within each of these broad themes. A few of the findings of the review include that rural and urban women receive different primary treatments for breast cancer, that rural women may have greater difficulty negotiating their traditional gender roles during and after treatment, that rural women desire greater health-related information about their breast cancer, and that rural women have less access to mental health therapy. The review discusses the implications of these findings as well as the weakness in the literature.     

Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors

Background This paper describes the ethnic and socioeconomic correlates of functioning in a cohort of long-term nonrecurring breast cancer survivors. Methods Participants (n = 804) in this study were women from the Health, Eating, Activity, and Lifestyle (HEAL) Study, a population-based, multicenter, multiethnic, prospective study of women newly diagnosed with in situ or Stages I to IIIA breast cancer. Measurements occurred at three timepoints following diagnosis. Outcomes included standardized measures of functioning (MOS SF-36). Results Overall, these long-term survivors reported values on two physical function subscales of the SF-36 slightly lower than population norms. Black women reported statistically significantly lower physical functioning (PF) scores (P = 0.01), compared with White and Hispanic women, but higher mental health (MH) scores (P < 0.01) compared with White and Hispanic women. In the final adjusted model, race was significantly related to PF, with Black participants and participants in the “Other” ethnic category reporting poorer functioning compared to the White referent group (P < 0.01, 0.05). Not working outside the home, being retired or disabled and being unemployed (on leave, looking for work) were associated with poorer PF compared to currently working (both P < 0.01). Conclusion These data indicate that race/ethnicity influences psychosocial functioning in breast cancer survivors and can be used to identify need for targeted interventions to improve functioning.     

Fear of cancer recurrence and associations with mental health status and individual characteristics among cancer survivors: Findings from a nationally representative sample

Abstract

Purpose: To describe the prevalence of fear of cancer recurrence (FCR) and test its associations with validated mental health status measures.

Design: Cross-sectional survey using the Medical Expenditure Panel Survey Experiences with Cancer Survivorship Supplement.

Sample: Post-treatment cancer survivors (n?=?1032).

Methods: Survey-weighted U.S. population-based estimates describe the prevalence of sociodemographic, health and mental health characteristics of cancer survivors by their level of FCR. Multinomial logistic regression was used to test associations of validated measures of mental health status and individual characteristics on levels of FCR in unadjusted models and those controlling for sociodemographic and health characteristics.

Findings: Overall, 34.3% of cancer survivors reported no FCR, 54.4% reported low FCR, and 11.3% reported high FCR. Cancer survivors were at increased risk of reporting high FCR relative to no FCR if they had a low 12-item Short Form Health Survey Mental Component Summary score (≤48) compared to high scores (odds ratio = 2.88; 95% confidence interval = 1.57, 5.29). Reporting depressive symptoms or psychological distress did not significantly increase the risk of reporting high or low FCR relative to no FCR.

Conclusions: To our knowledge, this study is the first to provide U.S. population-based estimates of associations between FCR and individual and health characteristics.

Implications for Psychosocial Providers or Policy: Our results provide valuable information about which survivors are most at-risk for FCR. Future research is needed to more clearly differentiate FCR from other constructs.     

Using the theory of planned behavior to understand health professionals' attitudes and intentions to refer cancer patients for psychosocial support

Objective: To describe oncology professionals' patterns of referral to existing community and psychosocial support services, including complementary therapies utilizing the theory of planned behavior (TPB). Methods: An exploratory cross‐sectional survey of 72 oncology professionals including nurses (73.6%), medical practitioners (19.4%) and allied health professionals (6.9%) from health institutions in South Australia assessed past referral patterns, perceived attitudes of peers, control over and attitudes toward, referral, past referral practices and how these impact on intention to refer. Results: Referral to support services such as a cancer helpline, allied health or complementary services was infrequent. A hierarchical regression entering awareness, past referral and the TPB variables (attitude, subjective norm and perceived control) explained 51% of the variance on the outcome ‘intention to refer’. Barriers to referral for support included lack of local services for remote patients, and financial considerations. Conclusion: Interventions with health professionals should focus on the development of a culture, which recognizes the importance of addressing a breadth of patient needs across the cancer trajectory. Education and support for health professionals is required to ensure that they feel comfortable discussing support needs and referring to appropriate support services. Copyright © 2010 John Wiley & Sons, Ltd.     

Healthy Sisters: A Feasibility study of a health behavior intervention for women of color breast cancer survivors

ABSTRACT

There is strong evidence for the need to educate and empower women of color breast cancer survivors (WCBCS) to adopt healthy lifestyle behaviors. The purpose of this study was to explore feasibility and preliminary efficacy of a culturally grounded lifestyle intervention on functional ability, quality of life, and health behaviors. A community-based sample of WCBCS was recruited from two inner cities, with encouragement to invite a partner. There were 30 WCBCS and 10 partners who participated in the 6-week interactive intervention. Data were collected at baseline, end of intervention and 3 and 6 months. There was significant improvement in healthy lifestyle behaviors (p = 0.041), physical activity (p = 0.003), nutrition (p = 0.007), and stress management (p = 0.010) for WCBCS and, for partners, improvements in healthy lifestyle behaviors (p = 0.041), nutrition (p = 0.007), and health responsibility (p = 0.034).