Living post treatment: definitions of those with history and no history of cancer

When Breast Cancer Survivorship Discourse Doesn't Work: Reflections From a Patient

Within this narrative, I document my experiences with breast cancer. On 2 separate occasions, diagnoses did not qualify me for survivor identity within the current interpretation of breast cancer survivorship discourse. Yet each time, I underwent treatments that were necessary, but physically and emotionally difficult. I briefly discuss how breast cancer survivorship discourse is interpreted, including how this discourse has benefitted women, but also, the challenges in survivorship discourse adoption (including how the current survivorship definition differs). I then discuss my struggles in feeling like I could not assume breast cancer survivorship discourse, including the confusion and despair, as well as feeling ineligible for support groups. Briefly, one suggestion for change is made.

Interventions to improve physical activity in colorectal cancer survivors: protocol for a systematic review and meta-analysis of randomized controlled trials

AIM

To examine the effectiveness of physical activity (PA) interventions on changes in PA among colorectal cancer survivors, including an examination of theoretical versus atheoretical-driven approaches, with a special focus on their effectiveness across ethnic and racial minorities.

DESIGN

Systematic review with aggregated data meta-analyses.

DATA SOURCES

Using six databases (Cochrane Central Register of Controlled Trials, PubMed, PsycINFO, CINAHL with full text, Scopus and Web of Science), we will screen for randomized controlled trials written in English from May 1, 1993 up to December 31, 2020.

REVIEW METHODS

Dual study-selection and data abstraction will be performed. The Behavior Change Technique Taxonomy (v1) will be used to examine behavior change techniques among selected studies, while the Theory Coding Scheme will be used to assess the extent of theory use. Risk of bias will be assessed using the revised Cochrane risk-of-bias tool for randomized trials, while the strength of the evidence will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation instrument. In addition, intervention delivery will be appraised using the Template for Intervention Description and Replication. Changes in PA from each study will be calculated using the standardized mean difference effect size (Hedge's g). Results will be pooled using the inverse-variance heterogeneity model. Heterogeneity (Cochran's Q) and inconsistency (I² ) will be examined, while small-study effects (publication bias) will be evaluated using the Doi plot and LFK Index. Meta-regression will also be conducted to examine for potential associations between changes in physical activity and selected covariates (theoretical versus atheoretical-driven approaches, race/ethnicity).

DISCUSSION

This systematic review will identify specific racial/ethnic minorities for whom interventions are most effective and summarize the evidence of the effectiveness of theoretical vs. theoretical based intervention.

IMPACT

This systematic review can direct policymakers and practitioners towards actions that are likely to bring about positive physical activity behaviour change.

Factors Associated with "Survivor Identity" in Men with Breast Cancer

Cancer patients vary in their comfort with the label “survivor”. Here, we explore how comfortable males with breast cancer (BC) are about accepting the label cancer “survivor”. Separate univariate logistic regressions were performed to assess whether time since diagnosis, age, treatment status, and cancer stage were associated with comfort with the “survivor” label. Of the 70 males treated for BC who participated in the study, 58% moderately-to-strongly liked the term “survivor”, 26% were neutral, and 16% moderately-to-strongly disliked the term. Of the factors we explored, only a longer time since diagnosis was significantly associated with the men endorsing a survivor identity (OR = 1.02, p = 0.05). We discuss how our findings compare with literature reports on the comfort with the label “survivor” for women with BC and men with prostate cancer. Unlike males with prostate cancer, males with BC identify as “survivors” in line with women with BC. This suggests that survivor identity is more influenced by disease type and treatments received than with sex/gender identities.

Cancer survivorship reimagined: A qualitative study on evolving interpretative repertoires of cancer and survivorship using participant-produced photography

OBJECTIVE

As more people live with cancer and for longer time periods, it is important to understand the growing diversity in lived experiences of survivorship. This study explored interpretative repertoires around cancer and their implications for survivorship from the perspectives of people with cancer to inform communication in cancer care.

METHODS

The sample included 11 participants (7 male, 4 female) with diverse cancer diagnoses and prognoses recruited through two public cancer care centres in Queensland, Australia. A narrative analysis of sequential interviews (n = 20) and photographs produced by the participants (n = 455) was conducted.

RESULTS

Four interrelated metaphors and narratives emerged in the interpretative repertoires of participants: cancer as a presence, survivorship as a struggle for meaning, survivorship as movement and survivorship as confluence. Continuities with "battle" and "journey" terminology were evident. However, these were subtly adapted and reimagined within participants' own lived experience. This was particularly pronounced among participants with incurable cancers, as they strived to make sense of contradictions within cancer survivorship.

CONCLUSION

The findings offer in-depth insights into the complexity and nuances of cancer survivorship. Such insights can contribute to facilitating successful and open-ended communication between cancer care providers, people with cancer and their families.

Patient, client, consumer, survivor or other alternatives? A scoping review of preferred terms for labelling individuals who access healthcare across settings

OBJECTIVES

Use of the term 'patient' has been recently debated, compared with alternatives including 'consumer' and 'client'. This scoping study aimed to provide an integrated view of preferred labels across healthcare contexts and countries to clarify labelling preferences of individuals accessing healthcare.

DESIGN

Scoping study.

DATA SOURCES

A preliminary literature search using GoogleScholar, Medline, Embase and PsycINFO found 43 key papers discussing terminology for labelling individuals accessing healthcare services. We then used citation chaining with PubMed and GoogleScholar to identify studies discussing term preferences among healthcare recipients.

ELIGIBILITY CRITERIA

No date limits were applied, and all healthcare settings were considered. Primary research studies examining terminology preferences of individuals accessing healthcare, published in peer-reviewed journals were eligible.

DATA EXTRACTION AND SYNTHESIS

All authors extracted data regarding preferred term and study characteristics, and assessed reporting quality of the studies using criteria relevant to our design.

RESULTS

We identified 1565 articles, of which 47 met inclusion criteria. Six articles that examined preference for personal address (eg, first name) were excluded. Of the remaining 41 studies, 33 examined generic terms ('patient', 'client', 'consumer') and 8 focused on cancer survivorship. Of the 33 examining generic terms, 27 reported a preference for 'patient' and four for 'client'. Samples preferring 'client' were typically based in mental health settings and conducted in the USA. Of the eight cancer survivorship studies, five found a preference for 'survivor', and three 'someone who had had cancer'.

CONCLUSIONS

Overall, healthcare recipients appear to prefer the term 'patient', with few preferring 'consumer'. Within general clinical and research contexts, it therefore seems appropriate to continue using the label 'patient' in the absence of knowledge about an individual's preferences. Reasons for preferences (eg, familiarity, social identity) and the implications of labelling for healthcare have not been investigated adequately, necessitating future empirical (including qualitative) research.

"Still a Cancer Patient"-Associations of Cancer Identity With Patient-Reported Outcomes and Health Care Use Among Cancer Survivors

Background

The concept of cancer identity is gaining attention as more individuals are living with cancer as a chronic illness. Research is limited, and results suggest that a self-identity as “cancer patient” rather than a “cancer survivor” is associated with depression and lower health-related quality of life (HRQL). We aimed to identify factors associated with patient identity and investigate the associations between patient identity and treatment, health care use, psychosocial distress, and HRQL.

Methods

We used data from the population-based CAncEr Survivorship: A multi-Regional (CAESAR) study. Breast, colorectal, and prostate cancer survivors diagnosed during 1994–2004 completed a postal survey on patient identity, HRQL, psychological distress, and health care use in 2009–2011. We calculated odds ratios and the 95% confidence interval of having a patient identity. Analyses were adjusted for age, sex, education, and cancer stage, where appropriate.

Results

Of the 6057 respondents, colorectal cancer survivors (25%) were least likely to consider themselves patients, and prostate cancer survivors (36%) the most likely. Being male, younger age, comorbidity, higher cancer stage, and disease recurrence were associated with patient identity. Treatment was associated with patient identity, except among female colorectal cancer survivors. Having a patient identity was associated with higher health care use within the past 12 months. Survivors who still consider themselves patients were more likely to be depressed and reported significantly lower HRQL.

Conclusions

A significant proportion of cancer survivors still consider themselves patients five to 15 years postdiagnosis. Sensitivity to individuals’ self-identity should be considered when exploring their cancer experience.

The salience of cancer and the "survivor" identity for people who have completed acute cancer treatment: a qualitative study

PURPOSE

Globally, there are nearly 33 million persons who have survived 5 or more years after a diagnosis of cancer [1]. We explore the salience of cancer in such people's self-concept as an important element for creating patient-centered care for those living with a cancer history.

METHODS

Our data are responses to a free-listing exercise and subsequent qualitative interviews with 53 individuals aged between 45 and 74 who were diagnosed with non-Hodgkin's lymphoma or breast or prostate cancer at least 3 years prior and had completed acute treatment. Participants lived in the Baltimore-Washington region of the USA.

RESULTS

Cancer was not necessarily salient to participants' current self-concept, and espousal of a "survivor" identity is complex. We construct a typology of seven contrasting meanings of "survivor" based upon participants' narratives (factual, beaten, functional, temporary, adversity, passage of time, and lucky or blessed) and present interviewees' rationales as to why they did or did not adopt a survivorship identity.

CONCLUSIONS

We examine the complexity of "survivorship" as an identity and people's affiliation with it, as well as how this relates to other salient and fluid elements of people's sense of self within a life course perspective.

IMPLICATIONS FOR CANCER SURVIVORS

Understanding how cancer factors into people's self-concept throughout the life course is important for designing effective, patient-centered programs that acknowledge diverse experiences and expectations and possible changes with the passage of time.

Perception of cancer recurrence risk: more information is better

OBJECTIVE

Breast cancer is the most common cancer among women worldwide. Given the advances in extending survival, the number of recently diagnosed breast cancer patients and longer-term breast cancer survivors is growing. The goals of this study were to better understand (1) perceptions of provider cancer recurrence risk communication, (2) perceived risk of breast cancer recurrence in cancer patients and survivors, and (3) accuracy of perceived risk.

METHODS

A survey was conducted on women with a prior breast cancer (n=141).

RESULTS

Approximately 40% of women perceived that providers had not talked about their breast cancer recurrence risk; although only 1 person reported not wanting a physician to talk to her about her risk. Women were largely inaccurate in their assessments of risk. Greater worry, living in a rural area, and longer time since diagnosis were associated with greater inaccuracy. Women tended to think about distal recurrence of cancer as often of local recurrence.

CONCLUSIONS

Perceived risk of breast cancer recurrence was inaccurate, and patients desired more communication about recurrence risk.

PRACTICE IMPLICATIONS

Consistent with findings from other studies, greater efforts are needed to improve the communication of cancer recurrence risk to patients. Attention should be paid to those from rural areas and to distal cancer recurrence in women with a previous history of breast cancer.

A phoenix rising: who considers herself a "survivor" after a diagnosis of breast cancer?

PURPOSE

The purpose of this study is to investigate factors associated with patients' identification of themselves as survivors after a diagnosis of breast cancer.

METHODS

A self-administered survey was deployed through the nonprofit organization Breastcancer.org . As part of a larger study, we collected data on treatment, mental health, perceived prognosis, concerns about recurrence, and the question, "Do you consider yourself a survivor of breast cancer?"

RESULTS

Of the 629 survey respondents, 492 (78 %) considered themselves survivors of breast cancer. Factors independently associated with an affirmative response were (1) believing that one's prognosis was "very good" compared to others (p = <0.001), (2) recalling being told that treatment was curative (p = 0.04), (3) having better mental health (p = 0.002), and (4) having received chemotherapy (p = 0.01).

CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS

The disparate factors associated with the identification of oneself as a survivor-both the perception of having a very good prognosis and having received chemotherapy (reflecting high-risk disease rather than a good prognosis)--are intriguing. Clinicians caring for women with breast cancer should be sensitive to the fact that not everyone considers herself a survivor. Addressing transitions at the end of treatment and during the follow-up period may be challenging for clinicians and patients alike. Awareness of the complexities of survivor identification may help clinicians in counseling their patients.

Epigenetic therapy for breast cancer

Both genetic and epigenetic alterations can control the progression of cancer. Genetic alterations are impossible to reverse, while epigenetic alterations are reversible. This advantage suggests that epigenetic modifications should be preferred in therapy applications. DNA methyltransferases and histone deacetylases have become the primary targets for studies in epigenetic therapy. Some DNA methylation inhibitors and histone deacetylation inhibitors are approved by the US Food and Drug Administration as anti-cancer drugs. Therefore, the uses of epigenetic targets are believed to have great potential as a lasting favorable approach in treating breast cancer.