Elderly cancer survivorship: an integrative review and conceptual framework

Life-space mobility trajectory patterns and associated characteristics in older cancer survivors: a secondary data analysis

BACKGROUND

Life-space mobility (LSM) measures the size of the real-world geographic area an individual purposely transverses in their daily life. While older cancer survivors often have declines in LSM that negatively affects their quality of life, independence, and social engagement the factors that predispose to adverse outcomes are unknown. Understanding different patterns of LSM and its decline can help identify those needing support. The purpose of this study was to identify: (1) LSM trajectory patterns and (2) factors associated with those patterns in older cancer survivors.

METHODS

This paper reports a secondary data analysis of 153 participants with cancer ≥ 65 years from the University of Alabama Study of Aging. LSM was assessed using the UAB Life-Space Assessment-Composite score (LSA-C) at study entry and every 6 months for 96 months (LSA-C < 60 = restricted LSM). LSM trajectory patterns based on the LSA-C were determined using group-based trajectory analysis. A classification tree analysis revealed factors that predicted the trajectory patterns.

RESULTS

Participants (n = 153) were a mean age of 76.1 (SD 6.33), mostly male (58%), White (58%), married (55%) or widowed (37%), and had a diagnosis of prostate (37.3%), breast (20.3%), or colon (11.8%) cancer. Three LSM trajectory patterns were identified: (1) high start and stable (37.3%) with unrestricted LSM (LSA-C = 81.2) at study entry, which remained stable over time, (2) high start progressive decline (27.5%) with unrestricted LSM (LSA-C = 78.0) at study entry that progressively declined, and (3) low start progressive decline (35.3%) with restricted LSM level (LSA-C = 42.0) at study entry, which progressively declined. Each pattern was associated with a unique set of demographic and clinical characteristics. Baseline physical performance score was the most important predictor of the LSM trajectory patterns.

CONCLUSIONS

Three distinct LSM trajectory patterns, each with unique demographic and clinical characteristics, were identified. Because older cancer survivors have distinct LSM patterns, interventions should be tailored to address specific characteristics and clinical needs. LSM measurement can contribute to assessment of older adults generally and should become part of standard assessment in older cancer survivors.

Quality of life in older patients with cancer and related unmet needs: a scoping review

BACKGROUND

Older patients form the largest group of cancer patients yet remain underrepresented in clinical research. This scoping review aims to synthesize findings on quality of life (QoL) in older adults with cancer, comparing them to younger counterparts and older individuals without cancer, and identifying associated factors.

METHODS

PubMed and PsychINFO databases were searched for articles published until January 2024. Studies were included with exclusively older adults with cancer (≥ 65 years), age-mixed samples (mean/median ≥ 70 years), or that report results separately for older and younger adults with cancer. Out of 6, 397 identified studies, 87 met the inclusion criteria.

RESULTS

Most studies were cross-sectional, conducted in 14 countries with a mean age of 74.2 years. Physical QoL (PQoL) demonstrates an age-related decline, primarily influenced by comorbidity burden, physical activity, and lifestyle. In contrast, mental QoL (MQoL) remained stable or increased with advancing age, reflecting resilience and effective coping by older patients. While cognitive and role functioning tended to show stable or declining values with age, findings regarding social functioning were mixed. Socioeconomic factors, e.g. education, income, or marital status, mainly impacted MQoL, as well as other QoL domains. Symptom management and social support represent unmet needs that contribute to QoL impairments. Older adults with cancer underreport symptoms they perceive as normal for their age, experience ageism in healthcare, and reduced social participation.

INTERPRETATION

Comprehensive, multidisciplinary cancer care is essential for older adults with cancer, focusing on the prevention of functional health decline, geriatric assessment, socioeconomic health disparities, and enhancing symptom management.

Identifying central dimensions of quality of life including life-related values, preferences and functional health in older patients with cancer: a scoping review protocol

Background

Older patients with cancer already represent the largest proportion of cancer survivors which will further increase in the upcoming years. However, older patients are highly underrepresented in clinical research, leading to a detrimental knowledge gap. Research on important aspects of quality of life (QoL) and associated factors for older patients with cancer is insufficient to date.

Aim

The objective of this scoping review therefore is to investigate the dimensions of QoL including functional health, life-relevant values and preferences in older adults with cancer across all tumor entities and health care settings. It will further identify medical, sociodemographic, psychosocial and geriatric aspects associated with QoL in the elderly and compare these with younger cancer patients and older non-cancer cases.

Methods

Published articles investigating QoL dimensions and associated factors in older patients with cancer, i.e., exclusively patients ≥65 years or mean/median age ≥ 70 years for age-mixed samples, or that compare results of older with younger cancer patients or with older non-cancer cases will be considered for this scoping review. Older patients with cancer across all tumor entities, disease stages and health care setting will be included. PubMed and PsychINFO databases will be searched for relevant articles. Abstracts and titles will be screened for basic inclusion, and two independent reviewers will conduct a full text screening to evaluate the age criteria and decide on the final inclusion of the study. Data on study and participant characteristics, QoL dimensions and geriatric factors will be extracted using a data extraction sheet. Results will be summarized descriptively to address the objectives of this review.

Discussion

The findings of this scoping review will provide valuable insights into central dimensions of QoL, including values, preferences and functional health in older adults with cancer, and help to improve targeted interventions and healthcare planning.

Restricted life-space mobility impacts physical but not mental quality of life in older cancer survivors

BACKGROUND

Older cancer survivors often value quality of life (QOL) over survival. Life-space mobility (LSM), defined as the individual's spatial geographic mobility range, is an important QOL indicator in older adults with chronic illnesses; however, this relationship is unexplored in older cancer survivors.

METHODS

We examined the longitudinal associations and causal relationships between LSM and QOL in 153 older cancer survivors (≥65 years) from the University of Alabama at Birmingham (UAB) Study of Aging. LSM was assessed using the UAB Life-Space Assessment-Composite score (LSA-C), and QOL was assessed by the SF-12 Mental Component Score (MCS12) and Physical Component Score (PCS12) at 0 (study entry), 6, 18, 36, 54, and 72 months. We examined the causal relationship between LSM and QOL using a cross-lagged panel model (CLPM).

RESULTS

The cohort (n = 153) was 76 years old on average and predominantly White (58%), female (58%), and married (55%). Longitudinal analyses found LSM decreased over time (p < 0.0001), and this decrease was associated with decreased QOL (PCS12, p < 0.0001, MCS12, p < 0.0001). In the CLPM causal analysis, lower LSM resulted in worse PCS12 (p < 0.001), but not worse MSC12.

CONCLUSIONS

Restricted LSM resulted in worse physical QOL over 72 months in a sample of 153 older cancer survivors. Developing and evaluating interventions to preserve greater LSM could be a promising approach to improving QOL.

Adapting an Evidence-Based Exercise and Education Program for Older Breast Cancer Survivors for the REJOIN Trial

Physical activity (PA) promotes survival and mitigates symptoms in older breast cancer survivors (BCS), especially to reduce joint pain associated with adjuvant hormonal treatment. The purpose is to describe the adaptation process for an evidence-based exercise and education curriculum (i.e., Fit & Strong!) to support older BCS participating in the Using Exercise to Relieve Joint Pain and Improve Aromatase Inhibitor Adherence in Older Breast Cancer Survivors trial. We reviewed all educational materials with scientific/clinical experts to identify necessary content changes. Next, we conducted semistructured phone interviews with BCS to review all educational materials and conducted a real-time pretest for the trial. Overall, BCS found the adapted materials and experience acceptable (mean score of 9.2/10 for satisfaction). Content changes included simplifying exercise instructions, prioritizing content related to the trial goals, and updating photographs. Because of COVID, the pretest was conducted via Zoom. Our multistep adaptation process provided an acceptable intervention to meet the needs of older BCS. Lessons learned will be applied to the forthcoming pilot trial.

Quality of life and health status in older adults (≥65 years) up to five years following colorectal cancer treatment: Findings from the ColoREctal Wellbeing (CREW) cohort study

Objective

Colorectal cancer (CRC) is common in older adults, with more than 70% of diagnoses in people aged ≥65 years. Despite this, there is a knowledge gap regarding longer-term outcomes in this population. Here, we identify those older people most at risk of poor quality of life (QoL) and health status in the five years following CRC treatment.

Materials and methods

CREW is a UK longitudinal cohort study investigating factors associated with health and wellbeing recovery following curative-intent CRC surgery. Participants completed self-report questionnaires pre-surgery, then at least annually up to five years. Longitudinal analyses explored the prevalence and pre-surgery risk factors of poor QoL (QLACS-GSS) and health status (EQ-5D: presence/absence of problems in five domains) in older (≥65 years) participants over five years.

Results

501 participants aged ≥65years completed questionnaires pre-surgery; 45% completed questionnaires five years later. Oldest-old participants (≥80 years) reported poorer QoL (18% higher QLACS-GSS) and 2–4 times higher odds of having problems with mobility or usual activities, compared with the youngest-old (65–69 years) over follow-up. Baseline higher self-efficacy was significantly associated with better QoL (10–30% lower QLACS-GSS scores compared to those with low self-efficacy) and lower odds of problems in all EQ-5D domains. Adequate social support was significantly associated with better QoL (8% lower QLACS-GSS) and lower odds of problems with usual activities (OR = 0.62) and anxiety/depression (OR = 0.56).

Conclusion

There are important differences in QoL and health status outcomes for the oldest-old during CRC recovery. CREW reveals pre-surgery risk factors that are amenable to intervention including self-efficacy and social support.

Study design and methods for the using exercise to relieve joint pain and improve AI adherence in older breast cancer survivors (REJOIN) trial

BACKGROUND

Aromatase Inhibitors (AIs) are recommended for survival in post-menopausal breast cancer survivors (BCS) with hormone-sensitive disease. AI Adherence is suboptimal, especially in older BCS. Joint pain is a common AI-related symptom that is associated with low AI adherence. The Using Exercise to Relieve Joint Pain in Older Breast Cancer Survivors (REJOIN) Trial will evaluate the efficacy of a self-management intervention (exercise + education) to increase knowledge/self-efficacy for symptom management, reduce joint pain and potentially increase AI adherence in older BCS planning to take AIs.

METHODS

This randomized controlled pilot trial will include sedentary BCS, 65 years and older, diagnosed with stage I-III hormone-sensitive breast cancer, who have completed primary cancer treatment and are planning to initiate AIs. We will adapt an evidence-based physical activity program for older adults that includes bi-weekly, supervised exercise sessions plus 30 min of education. The 16-week intervention program includes: 8-weeks of supervised sessions plus 8-weeks of self-guided home sessions with periodic phone coaching. We will conduct geriatric assessments plus measurements of exercise, joint pain, and AI adherence (baseline, 4, 6 and 12 months).

DISCUSSION

REJOIN is one of the first trials to exclusively target older BCS using a self-management intervention, informed by geriatric assessment and exercise physiology, to improve health outcomes in survivorship. The REJOIN trial could lay the foundation for transdisciplinary research that bridges the gap between clinical and public health perspectives in healthy aging, with the opportunity to translate clinical interventions into non-pharmacological tools for a growing, yet underserved population of older survivors.

TRIAL REGISTRATION

NCT03955627.

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

OBJECTIVES

Studies 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 METHODS

We 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.

RESULTS

We 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.

CONCLUSION

Long-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.

A conceptual model of social networks and mechanisms of cancer mortality, and potential strategies to improve survival: an invited commentary

In this article, the importance of social factors for cancer survivorship has been theoretically considered and empirically studied. This commentary and Kroenke's narrative review highlight how social network theory and methods may innovatively expand this substantive body of work. First, we add to a new understanding of cancer survivorship through: (a) discussing the delineation and differences between multiple social factors of interest across existing conceptual models; (b) characterizing their relationships to each other and to cancer survivorship through a social network lens; and (c) overall, sharing terminology and strengthening connections within this diverse body of literature. Second, we note opportunities for future research in terms of (a) simultaneous measurement of multiple social factors at different levels and (b) adaptation of designs to leverage and measure the theorized mechanisms. This commentary describes how incorporation of social network research can optimize research, practice, and policy contributions regarding cancer survival and survivorship.

A Valuable but Demanding Time Family Life During Advanced Cancer in an Elderly Family Member

This study explores experiences of elderly patients with cancer and their family members with regard to what is important and difficult in the family relationships during the palliative phase. Family group interviews were conducted with 26 families. The data were analyzed using qualitative content analysis. Three themes emerged: "Ensuring a positive final time together," "Avoiding tension and conflict," and "Concealing thoughts, feelings, and needs." The main theme, "A valuable but demanding time," indicates that although families find this phase of life challenging, they emphasize the importance of ensuring that this time is spent together in a positive way as a family.

Psychological interventions to improve the quality of life in Indian lung cancer patients: A neglected area

The incidence of lung cancer is very high and evidence suggests that patients experience imbalanced emotional capabilities due to less survival rate compared to other cancers. Direct and indirect psychological interventions are mandatory to improve the outcome of lung cancer treatment. Although such interventions are being practiced in developed nations, the effects of psychological interventions on the treatment outcome in the Indian context are lacking. Since there is a definite correlation between treatment outcome and psychological issues, it is high time that clinicians in developing countries including India adopt practices to enhance the quality of life of lung cancer patients.

An Association of Cancer Physicians' strategy for improving services and outcomes for cancer patients

The Association of Cancer Physicians in the United Kingdom has developed a strategy to improve outcomes for cancer patients and identified the goals and commitments of the Association and its members.

Predicting participation in meaningful activity for older adults with cancer

PURPOSE

Participation in activity that is personally meaningful leads to improved emotional and physical well-being and quality of life. However, little is known about what predicts participation in meaningful activity by older adults with cancer.

METHODS

Seventy-one adults aged 65 years and older with a diagnosis of cancer were enrolled. All adults were evaluated with the following: a brief geriatric assessment, the meaningful activity participation assessment (MAPA), and the Possibilities for Activity Scale (PActS). The MAPA measures participation in meaningful activity, and the PActS measures what older adults believe they should and could be doing. A regression approach was used to assess the predictors of meaningful activity participation.

RESULTS

The PActS (B = .56, p < .001) was the strongest predictor of meaningful activity participation.

CONCLUSIONS

What older adults with cancer feel they should and could do significantly predicted meaningful participation in activities above and beyond clinical and demographic factors. In future research, perceptions of possibilities for activity may be useful in the design of interventions targeted to improve meaningful participation in older adults with cancer.

Cancer screening in the older adult: issues and concerns

Making individual recommendations for cancer screening in older adult patients may be difficult and time consuming, because of the need to incorporate complex issues of life expectancy, health status, risks and benefits, and individual values and wishes. In this article, current recommendations and related risks and benefits are summarized. Specific issues and concerns are addressed, with suggestions for strategies to assist older adults in making screening decisions.

Population-level trends in posttreatment cancer survivors' concerns and associated receipt of care: results from the 2006 and 2010 LIVESTRONG surveys

There is a need to better understand the posttreatment concerns of the nearly 14 million survivors of cancer alive in the United States today and their receipt of care. Using data from 2,910 posttreatment survivors of cancer from the 2006 or 2010 LIVESTRONG Surveys, the authors examined physical, emotional, and practical concerns, receipt of care, and trends in these outcomes at the population level.

RESULTS

89% of respondents reported at least one physical concern (67% received associated posttreatment care), 90% reported at least one emotional concern (47% received care), and 45% reported at least one practical concern (36% received care). Female survivors, younger survivors, those who received more intensive treatment, and survivors without health insurance often reported a higher burden of posttreatment concerns though were less likely to have received posttreatment care. These results reinforce the importance of posttreatment survivorship and underscore the need for continued progress in meeting the needs of this population. Efforts to increase the availability of survivorship care are extremely important to improve the chances of people affected by cancer living as well as possible in the posttreatment period.

Breast cancer in African Americans: from patient to survivor

PURPOSE

The purpose of this synthesis is to explore the experience of the transition from cancer patient to survivor in African Americans with breast cancer, addressing the risk/ protective factors that have an influence on successful transition using the social ecological model.

METHODS

The investigator searched CINAHL, PubMed, and PsycInfo databases. Articles were assessed for content addressing risk and protective factors of transition in African American breast cancer survivorship. Eleven research articles were obtained and synthesized.

RESULTS

Risk and protective factors exist at all levels of the social ecological model. Emotional issues are prevalent after the cessation of cancer treatment, enhanced by the lack of social support in this population. Spirituality was shown to be present in many levels as a protective factor during this period.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The entrance to survivorship represents a time of increased stressors and subsequent coping. Through careful identification of influencing factors, health care providers can develop strategies to attenuate the emotional distress and negative complications of the transition specific to this vulnerable population. Illuminating the experiences of African American women during this transition period provides insight into the interventional needs during and after the cessation of breast cancer treatment.

Co-morbidity and predictors of health status in older rural breast cancer survivors

Purpose

More than 66% of the 200,000 newly diagnosed annual breast cancers in the US occurs in women over 55 years. Treatment advances result in excellent survival, yet older breast cancer survivors with co-morbidity may live longer, but not better after cancer. Decline in physical function, increased social isolation, and diminished economic resources increase vulnerability among older women. Rural women represent an underserved population. The purpose is to examine associations between comorbidity and predictors of health status among older rural breast cancer survivors.

Methods

Baseline data of 331 BCS age 55–90 years enrolled in the Rural Breast Cancer Survivors Study. Four surveys were used for data collection. Self-reported prescription medications were used as proxy for co-morbidity. Bivariate tests of association and multivariable recursive partitioning techniques were used for analysis.

Results

Mean number of prescription medication categories reported was 3.68 (SD = 2.3; range = 0–12). Common prescription categories were: anti-hormonal, anti-hypertensive, and cholesterol- reducing agents. 69% was overweight or obese. BMI >31 was significantly associated with both poorer physical and mental health. Multivariate analyses indicated physical health status was predicted by BMI, comorbid conditions, social support, and adverse changes in economic lifestyle. The same variables, with the exception of BMI, were predictors of mental health status.

Conclusions

Assessing co-morbid conditions, mental health status, social support, and economic burden after breast cancer treatment may better inform cancer survivorship care and comprehensive geriatric assessment.

Older breast cancer survivors: can interaction analyses identify vulnerable subgroups? A report from the American Cancer Society Studies of Cancer Survivors

PURPOSE/OBJECTIVES

To explore interactions among personal, cancer, aging, and symptom variables relative to physical function (PF) in older adult breast cancer survivors to better identify vulnerable subgroups.

DESIGN

Secondary analysis of the American Cancer Society Studies of Cancer Survivors II.

SETTING

U.S. population-based mail and telephone survey.

SAMPLE

2,885 breast cancer survivors from 14 different state cancer registries stratified by cancer type and time since diagnosis. A total of 184 female breast cancer survivors, aged 70 years or older, had complete data on variables of interest and were, therefore, included in this analysis.

METHODS

Chi-Square Automatic Interaction Detector (CHAID) analysis was used to examine variable interactions.

MAIN RESEARCH VARIABLES

PF, symptom bother, comorbidity, social support, length of survivorship, treatment, stage, body mass index, physical activity, emotional health, and personal characteristics.

FINDINGS

An interaction effect between symptom bother and comorbidity was found in 39% of older adult breast cancer survivors, and an interaction effect between symptom bother and marital status was found in 40%. The most vulnerable group (8%) had high symptom bother and more than four comorbid conditions.

CONCLUSIONS

Symptom bother, comorbidity, and marital status were found to have significant interactions such that high comorbidity and high symptom bother were significantly related to lower PF. Married participants with lower symptom bother had significantly higher PF scores. Comorbidity may be the best predictor of PF for the extreme ends of the symptom bother continuum. Advancing age alone was not a sufficient predictor of PF in this analysis.

IMPLICATIONS FOR NURSING

Specific attention to symptom reports, comorbidity, and marital status can guide identification of older adult cancer survivors in need of ongoing survivorship care. The findings support use of a comprehensive assessment and tailored approach to care based on factors other than age.

KNOWLEDGE TRANSLATION

CHAID interaction analysis may be useful in exploring complex nursing problems, such as the needs of older adult cancer survivors, and help oncology nurses develop appropriate interventions and referrals.

Outcomes of a culturally responsive health promotion program for elderly Korean survivors of gastrointestinal cancers: a randomized controlled trial

This single-blind, prospective, randomized controlled trial was designed to evaluate the effects of a culturally responsive health promotion program for elderly Korean (CHP-K) survivors of gastrointestinal (GI) cancers. The program consisted of 8 weeks of Qi exercise and face-to-face counseling on physical and psychological factors. A total of 63 Korean GI cancer survivors, aged ≥65 years, who had completed their active cancer treatment, were recruited from a cancer center in South Korea. Outcomes included the amount of exercise, body weight, BMI, the Patient Generated Subjective Global Assessment scale, the M.D. Anderson Symptom Inventory, and self-efficacy and self-esteem scales. Repeated measures MANCOVA revealed a significant difference over time between the groups (Wilks' Lambda F1,62 = 5.361, p = 0.007). Univariate RM-ANCOVA for each outcome measure revealed statistically significant differences between groups. These results suggested that the participation in the CHP-K may have enhanced the health of elderly Korean GI cancer survivors.

"Chemo brain"--is cancer survivorship related to later-life cognition? Findings from the health and retirement study

OBJECTIVE

Studies have shown a correlation between cancer and cognition referred to as "chemo brain." This study investigated the relationship between cancer and later-life cognition using nationally representative data.

METHOD

Analysis of the 2006 Health and Retirement Study investigated the (a) effects of cancer survivorship on the total cognition score using linear regression in adults age 65+ (n = 9,814) and (b) the effects of cancer treatment on the total recall index using linear regression in adults age 50+ (n = 657).

RESULTS

Total cognition score is not associated with cancer survivorship. The association between long-term cancer survivorship and cognition score was significant (p < .05; b = .276). Total recall index is not associated with chemotherapy.

DISCUSSION

These results support other research suggesting that chemo brain may be biased by expectation as well as favored by research that relies upon self-reported cognitive measures versus cognitive testing. The study was limited by the cross-sectional design.

Spirituality measurement in African American cancer survivors: a critical literature review

PURPOSE

Spirituality is a mechanism that supports coping with chronic illnesses such as cancer, and has been frequently used in the African American (AA) population. Measures of spirituality are needed, which are culturally sensitive, appropriate, and psychometrically sound.

DESIGN

A critical literature review was performed to identify instruments measuring spirituality as a response to illness.

METHOD

Whittemore and Knafl's method was used to search pertinent databases for instrumentation assessing spirituality and its applicability in AA cancer survivors.

FINDINGS

In all, 13 research articles detailing nine instruments were obtained and included for analysis. Of the nine instruments, only two (Perspectives of Support From God Scale and Connections to God Scale) were psychometrically tested in populations of AAs who had completed primary treatment for their cancer. Cultural validity was tested in only the Perspectives of Support From God Scale, showing a deficit in the assessment of cultural appropriateness of these instruments to the population.

CONCLUSIONS

Further research is needed to confirm validity of these measures. Cognitive pretesting and assessment of cross-cultural validity can be used to ensure proper understanding of terminology and avoid potential biases. Repeated testing of the instrument in the desired population is necessary to confirm that constructs and items are understood and cognitively processed as intended.

Best Practice Guidelines in Assessment, Risk Reduction, Management, and Surveillance for Post-Breast Cancer Lymphedema

Breast cancer-related lymphedema (LE) is a progressive, chronic disease that affects millions of cancer survivors and primarily results from surgical lymphatic vessel/node removal and radiation therapy. Patient education and support for importance of early detection is essential in helping health care providers detect lymphedema early, when there is the best chance to prevent progression. Improved imaging and surgical techniques have decreased the incidence of LE; however, effective risk-reduction and treatment have historically lacked the level of evidence necessary to standardize effective treatment. The purpose of this article is to report an extensive review of literature, including highlighted multidisciplinary studies within the past three years, in order to update best practice guidelines in assessment, risk reduction, management, and surveillance for post-breast cancer lymphedema.

Cancer survivor rehabilitation and recovery: protocol for the Veterans Cancer Rehabilitation Study (Vet-CaRes)

Background

Cancer survivors are a rapidly growing and aging population in the U.S., but there are many challenges associated with the survivorship experience such as functional disabilities and psychosocial distress. When viewed next to the general population, Veterans are especially at risk for these challenges as they are older and have a high incidence of co-morbid conditions. While the Institute of Medicine (IOM) has called for further cancer survivorship research to address these challenges, we still know little about this experience from the perspective of aging Veterans.

Methods/design

We conducted a longitudinal, mixed-methods study over the course of three and a half years at the Boston and Houston VA Medical Centers. We recruited 170 Veterans diagnosed with head and neck, colorectal and esophageal/gastric cancers that were identified from the VA tumor registry. Veterans completed three in-depth interviews, conducted at 6, 12 and 18 months after pathology confirmation, measuring the physical, social and psychological factors related to cancer survivorship. The longitudinal design allowed us to assess any changes in cancer related disability and distress over time.

Discussion

Weekly teleconference study team meetings were a key aspect to the research process. Issues related to recruitment, data management and analysis, and the dissemination of research results was discussed. Interviewers presented detailed case reports of completed interviews that allowed us to refine our interview protocols. We also discussed issues relevant to the Veteran population of which we were previously unaware and some of the challenges of the research process itself. This novel study produced a robust data set that documents the functional and psychosocial cancer survivorship experiences of aging Veterans. The longitudinal design will help us more fully understand the recovery patterns for this specific population, and identify the unique needs and gaps in health services.

The effect of aging and cancer on the symptom experience and physical function of elderly breast cancer survivors

BACKGROUND

The majority of cancer survivors are aged ≥ 65 years, yet, historically, cancer research has focused infrequently on older patients. The objective of this study was to examine predictors of physical function within a framework that integrates the gerontologic and oncologic needs of older cancer survivors.

METHODS

Path analysis tested 759 women who were breast cancer survivors aged ≥ 70 years from the American Cancer Society Study of Cancer Survivors II to examine the cancer, aging, and personal characteristics that had an impact on symptoms and physical functioning.

RESULTS

High levels of symptom bother (β = -.42) and comorbidities (β = -.21) were strongly associated with lower physical function. Comorbidity and social support (β = .21) indirectly influenced symptom bother through emotional status (β = -.35). The model demonstrated good fit with the data (chi-square statistic, 50.6; adjusted chi-square statistic, 2.8; P < .001; goodness-of-fit index, .98; root mean square error of approximation, .049 [confidence interval, .03-.05]).

CONCLUSIONS

The current findings supported prior research indicating that the majority of older survivors of breast cancer are doing well, but there is a subset of survivors that requires ongoing attention to symptoms, comorbidities, emotional health, and social support to thrive after cancer treatment.