Time Since Diagnosis as a Predictor of Symptoms, Depression, Cognition, Social Concerns, Perceived Benefits, and Overall Health in Cancer Survivors

Purpose/Objectives: To assess whether health and other factors are different in short-term cancer survivors (less than five years since diagnosis), long-term survivors (5-10 years), and very long-term survivors (more than 10 years).

Design: A cross-sectional survey.

Setting: New Zealand.

Sample: 836 survivors of adult-onset cancers (6 months to 43 years since diagnosis).

Methods: Survivors were recruited using community-based methods and answered a mailed questionnaire.

Main Research Variables: Physical and emotional health, depression, symptoms, cognitive difficulty, social concerns, and perceived benefits of cancer.

Findings: Physical and emotional health, depression, physical symptoms, and perceived benefits of cancer were not associated with time since diagnosis, but longer time since diagnosis was associated with decreases in cognitive difficulties and social concerns. The survivors in this study reported a mean of 8.4 physical symptoms, regardless of time since diagnosis, with the most frequent being fatigue (76%), aches and pain (75%), and trouble sleeping (68%).

Conclusions: Most survivors enjoyed a moderately good level of health. However, some adverse effects, such as symptoms, were similar in short-, long-, and very long-term survivors, suggesting that interventions may be needed to prevent persistent issues as time progresses.

Implications for Nursing: The findings suggest a need to reconsider the common attitude that survivors who finish treatment should be able to return to normal life. Assessment of symptoms, particularly fatigue, pain, and sleep issues, is important even in very long-term survivors.

References

Antoni, M. H., Lehman, J. M., Kilbourn, K. M., Boyers, A. E., Culver, J. L., Alferi, S. M., … Carver, C. S. (2001). Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychology, 20, 20-32. doi: 10.1037/0278-6133.20.1.20

Aziz, N. M., & Rowland, J. H. (2003). Trends and advances in cancer survivorship research: Challenge and opportunity. Seminars in Radiation Oncology, 13, 248-266. doi: 10.1016/S1053-4296(03)00024-9

Barsevick, A., Dudley, W., Beck, S., Sweeney, C., Whitmer, K., & Nail, L. (2004). A randomized clinical trial of energy conservation for patients with cancer-related fatigue. Cancer, 100, 1302-1310.

Bennett, J. A., Lyons, K. S., Winters-Stone, K., Nail, L. M., & Scherer, J. (2007). Motivational interviewing to increase physical activity in long-term cancer survivors: A randomized controlled trial. Nursing Research, 56, 18-27. doi: 10.1097/00006199-200701000-00003

Bush, N. E., Haberman, M., Donaldson, G., & Sullivan, K. M. (1995). Quality of life of 125 adults surviving 6-18 years after bone marrow transplantation. Social Science and Medicine, 40, 479-490. doi: 10.1016/0277-9536(94)00153-K

Cancer Research UK. (2008). Cancer worldwide. Retrieved from <a target="_blank" href='http://info.cancerresearchuk.org/cancerstats/geographic/world'>http://in...

Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Disease, 40, 373-383. doi: 10.1016/0021-9681(87)90171-8

Clark, P. G., Nigg, C. R., Greene, G., Riebe, D., & Saunders, S. D. (2002). The Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR): Translating theory into research. Health Education Research, 17, 552-561. doi: 10.1093/her/17.5.552

Clough-Gorr, K. M., Fink, A. K., & Silliman, R. A. (2008). Challenges associated with longitudinal survivorship research: Attrition and a novel approach of re-enrollment in a six-year follow-up study of older breast cancer survivors. Journal of Cancer Survivorship, 2, 95-103. doi: 10.1007/s11764-008-0049-y

Dow, K. H., Ferrell, B. R., Leigh, S., Ly, J., & Gulasekaram, P. (1996). An evaluation of the quality of life among long-term survivors of breast cancer. Breast Cancer Research and Treatment, 39, 261-273. doi: 10.1007/BF01806154

Ferrell, B. R., Dow, K. H., & Grant, M. (1995). Measurement of the quality of life in cancer survivors. Quality of Life Research, 4, 523-531.

Fossa, S. D., Vassilopoulou-Sellin, R., & Dahl, A. A. (2008). Long-term physical sequelae after adult-onset cancer. Journal of Cancer Survivorship, 2, 3-11. doi: 10.1007/s11764-007-0039-5

Fromm, K., Andrykowski, M. A., & Hunt, J. (1996). Positive and negative psychosocial sequelae of bone marrow transplantation: Implications for quality of life assessment. Journal of Behavioral Medicine, 19, 221-240. doi: 10.1007/BF01857767

Fujimori, M., Kobayakawa, M., Nakaya, N., Nagai, K., Nishiwaki, Y., Inagaki, M., & Uchitomi, Y. (2006). Psychometric properties of the Japanese version of the Quality of Life-Cancer Survivors Instrument. Quality of Life Research, 15, 1633-1638. doi: 10.1007/s11136-006-0038-4

Gotay, C. C., Moinpour, C. M., Unger, J. M., Jiang, C. S., Coleman, D., Martino, S., … Albain, K. S. (2007). Impact of a peer-delivered telephone intervention for women experiencing a breast cancer recurrence. Journal of Clinical Oncology, 25, 2093-2099. doi: 10.1200/JCO.2006.07.4674

Hopko, D. R., Bell, J. L., Armento, M. E., Robertson, S. M., Hunt, M. K., Wolf, N. J., & Mullane, C. (2008). The phenomenology and screening of clinical depression in cancer patients. Journal of Psychosocial Oncology, 26, 31-51. doi: 10.1300/J077v26n01_03

Jacobs, S. R., Jacobsen, P. B., Booth-Jones, M., Wagner, L. I., & Anasetti, C. (2007). Evaluation of the Functional Assessment of Cancer Therapy-Cognitive Scale with hematopoietic stem cell transplant patients. Journal of Pain and Symptom Management, 33, 13-23. doi: 10.1016/j.jpainsymman.2006.06.011

Joly, F., Alibhai, S. M., Galica, J., Park, A., Yi, Q. L., Wagner, L., & Tannock, I. F. (2006). Impact of androgen deprivation therapy on physical and cognitive function, as well as quality of life of patients with nonmetastatic prostate cancer. Journal of Urology, 176, 2443-2447. doi: 10.1016/j.juro.2006.07.151

Kohout, F. J., Berkman, L. F., Evans, D. A., & Cornoni-Huntley, J. (1993). Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. Journal of Aging and Health, 5, 179-193. doi: 10.1177/089826439300500202

Kornblith, A. B., Herndon, J. E., Weiss, R. B., Zhang, C., Zuckerman, E. L., Rosenberg, S., & Holland, J. C. (2003). Long-term adjustment of survivors of early-stage breast carcinoma 20 years after adjuvant chemotherapy. Cancer, 98, 679-689. doi: 10.1002/cncr.11531

Kornblith, A. B., Powell, M., Regan, M. M., Bennett, S., Krasner, C., Moy, B., … Winer, E. (2007). Long-term psychosocial adjustment of older versus younger survivors of breast and endometrial cancer. Psycho-Oncology, 16, 895-903. doi: 10.1002/pon.1146

Land, S. R., Wickerham, D. L., Costantino, J. P., Ritter, M. W., Vogel, V. G., Lee, M., … Ganz, P. A. (2006). Patient-reported symptoms and quality of life during treatment with tamoxifen or raloxifene for breast cancer prevention: The NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA, 295, 2742-2751. doi: 10.1001/jama.295.23.joc60075

McGregor, B. A., Antoni, M. H., Boyers, A., Alferi, S. M., Blomberg, B. B., & Carver, C. S. (2004). Cognitive-behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer. Journal of Psychosomatic Research, 56, 1-8. doi: 10.1016/S0022-3999(03)00036-9

Mosher, C. E., Redd, W. H., Rini, C. M., Burkhalter, J. E., & Duhamel, K. N. (2009). Physical, psychological, and social sequelae following hematopoietic stem cell transplantation. Psycho-Oncology, 18, 113-127. doi: 10.1002/pon.1399

Nail, L. M. (2001). Long-term persistence of symptoms. Seminars in Oncology Nursing, 17, 249-254. doi: 10.1053/sonu.2001.27916

Nail, L. M., Jones, L. S., Green, D., Schipper, D. L., & Jensen, R. (1991). Use and perceived efficacy of self-care activities in patients receiving chemotherapy. Oncology Nursing Forum, 18, 883-887.

National Cancer Policy Board. (2006). From cancer patient to cancer survivor: Lost in transition. Retrieved from <a target="_blank" href='http://www.nap.edu/books/0309095956/html'>http://www.nap.edu/books/03090...

Ohira, T., Schmitz, K. H., Ahmed, R. L., & Yee, D. (2006). Effects of weight training on quality of life in recent breast cancer survivors: The Weight Training for Breast Cancer Survivors (WTBS) study. Cancer, 106, 2076-2083. doi: 10.1002/cncr.21829

Onishi, T., Nishikawa, K., Hasegawa, Y., Yamada, Y., Soga, N., Arima, K., … Sugimura, Y. (2007). Assessment of health-related quality of life after radiofrequency ablation or laparoscopic surgery for small renal cell carcinoma: A prospective study with Medical Outcomes Study 36-Item Health Survey (SF-36). Japanese Journal of Clinical Oncology, 37, 750-754. doi: 10.1093/jjco/hym107

Pollack, L. A., Greer, G. E., Rowland, J. H., Miller, A., Doneski, D., Coughlin, S. S., … Ulman, D. (2005). Cancer survivorship: A new challenge in comprehensive cancer control. Cancer Causes and Control, 16(Suppl. 1), 51-59. doi: 10.1007/s10552-005-0452-x

Syrjala, K. L., Langer, S. L., Abrams, J. R., Storer, B., Sanders, J. E., Flowers, M. E., & Martin, P. (2004). Recovery and long-term function after hematopoietic cell transplantation for leukemia or lymphoma. JAMA, 291, 2335-2343. doi: 10.1001/jama.291.19.2335

Tannock, I. F., Ahles, T. A., Ganz, P. A., & Van Dam, F. S. (2004). Cognitive impairment associated with chemotherapy for cancer: Report of a workshop. Journal of Clinical Oncology, 22, 2233-2239. doi: 10.1200/JCO.2004.08.094

Tomich, P. L., & Helgeson, V. S. (2004). Is finding something good in the bad always good? Benefit finding among women with breast cancer. Health Psychology, 23, 16-23. doi: 10.1037/0278-6133.23.1.16

van Dis, F. W., Mols, F., Vingerhoets, A. J., Ferrell, B., & van de Poll-Franse, L. V. (2006). A validation study of the Dutch version of the Quality of Life-Cancer Survivor (QOL-CS) questionnaire in a group of prostate cancer survivors. Quality of Life Research, 15, 1607-1612.

Vardy, J., Rourke, S., & Tannock, I. F. (2007). Evaluation of cognitive function associated with chemotherapy: A review of published studies and recommendations for future research. Journal of Clinical Oncology, 25, 2455-2463. doi: 10.1200/JCO.2006.08.1604

Visser, M. R., & Smets, E. M. (1998). Fatigue, depression, and quality of life in cancer patients: How are they related? Supportive Care in Cancer, 6, 101-108. doi: 10.1007/s005200050142

Walker, B. L., Nail, L. M., Larsen, L., Magill, J., & Schwartz, A. (1996). Concerns, affect, and cognitive disruption following completion of radiation treatment for localized breast or prostate cancer. Oncology Nursing Forum, 23, 1181-1187.

Ware, J. E., Kosinski, M., Bjorner, J. B., Turner-Bowker, D. M., Gandek, B., & Maruish, M. E. (2007). User's manual for the SF-36 health survey (2nd ed.). Lincoln, RI: QualityMetric.

Yabroff, K. R., Lawrence, W. F., Clauser, S., Davis, W. W., & Brown, M. L. (2004). Burden of illness in cancer survivors: Findings from a population-based national sample. Journal of the National Cancer Institute, 96, 1322-1330. Retrieved from http://jnci.oxfordjournals.org/cgi/content/full/96/17/1322 <a target="_blank" href='http://jnci.oxfordjournals.org/cgi/content/full/96/17/1322'>http://jnci....