A Systematic Review: The Effect of Cancer on the Divorce Rate

Impact of a Breast Cancer Diagnosis on Finances and Marital Status in Young Women

PURPOSE

A breast cancer diagnosis can impact every aspect of a woman's life, particularly for women diagnosed before age 45 when they are in the process of establishing stability in their personal and professional lives. This study investigated the impact of a breast cancer diagnosis on employment, finances, and personal relationships among young breast cancer survivors.

METHODS

We conducted descriptive statistical analysis of survey data from 315 women diagnosed with breast cancer before age 45. Surveys were administered electronically and included 40 questions on demographics asking about employment, insurance, income, and marital status at two time points: at diagnosis and at the time the survey was completed. Descriptive and regression analyses were conducted. The McNemar-Bowker Test of Symmetry was used to calculate the significance of changes in employment, insurance, income, and marital status at the two time points.

RESULTS

We found significant changes following diagnosis in employment and insurance. Prior to diagnosis, 68.6% of respondents were employed full time, compared to 52.4% following diagnosis - falling from 212 to 162 respondents. Individuals who were unable to work increased by 14.6% after diagnosis, rising from 4 to 49 respondents. The decline in full-time employment was highest among those with a diagnosis of Stage IV cancer (33.9%), with the number of full-time worker respondents falling from 79 to 41. We found a significant change in insurance (p < .001) with a decline in individuals with private or no insurance of 4.7% and 3.4%, respectively, while those with public insurance increased by 8.1%.

CONCLUSION

Our findings suggest that young breast cancer survivors are particularly vulnerable to changes in employment, with more than a tenfold increase in the number of young women who reported being unable to work following diagnosis. Our findings also indicate a significant shift from private to public insurance, particularly for individuals living with Stage IV cancer. These results point to opportunities to address the specific needs of young women diagnosed with breast cancer and improve their overall quality of life.

Changes in Relationship Dynamics in Men and Women After Receiving the Diagnosis of Breast Versus Prostate Cancer: A Population-based Study

Background

Relationship changes after cancer are prevalent yet underexplored. This investigation aimed to assess factors influencing relationship changes between participants receiving the 2 most common gender-specific cancer diagnoses: breast and prostate.

Methods

Anonymous surveys were administered via Amazon Mechanical Turk. Eligible participants were 18 years or older and diagnosed with breast or prostate cancer. Relationship satisfaction and mental health were assessed via Personal Health Questionnaire Depression Scale (PHQ-8), General Anxiety Disorder (GAD-7), and Self-Esteem and Relationship Questionnaire.

Results

Of the 186 study respondents, 85.4% (159) had breast cancer and 14.5% (27) had prostate cancer. More breast cancer participants reported that their relationship worsened after cancer diagnosis (breast: 40.9%, prostate: 11.1%), whereas a majority of prostate cancer patients reported improved relationships (breast: 17%, prostate: 66.7%; P < 0.001). However, most participants reported no relationship status change (breast: 66.7%, prostate: 77.8%; P = 0.508) and remained with the same partner postdiagnosis (breast: 84.9%; prostate: 77.8%). Breast cancer participants reported higher self-esteem compared with prostate cancer participants (P = 0.019). There was no significant difference in overall Self-Esteem and Relationship Questionnaire (P = 0.140), PHQ-8 (P = 0.689), and GAD-7 (P = 0.871) scores. Average PHQ-8 and GAD-7 scores indicated moderate depression (breast: 12.62, prostate: 12.88) and moderate anxiety (breast: 10.96, prostate: 11.06).

Conclusions

Breast cancer participants reported greater perceived changes in their relationship postdiagnosis. This study supports routine, active, and pre-emptive involvement of a mental health provider for patients with cancer to improve mental health outcomes.

A Content Analysis of Cancer-Related Changes in Perceptions of Self, Relationships, and Health Among LGBTQI+ Cancer Survivors Across the Life Course: Findings From OUT: The National Cancer Survey

BACKGROUND

The LGBTQI+ population makes up at least 7.6% of the US population. LGBTQI+ populations are at increased risk of experiencing LGBTQI+-related discrimination and cis-heteronormativity in healthcare leading to poorer health outcomes throughout the cancer care continuum. We aimed to explore LGBTQI+ cancer survivors' perspectives of how cancer has changed their perceptions of self and relationships using data from OUT: The National Cancer Survey.

METHODS

We conducted an inductive qualitative content analysis of responses to four open-ended questions from OUT: The National Cancer Survey. Data were collected from September 2020 to April 2021. Eligible participants were 18 years of age or older at time of survey, had been previously diagnosed with cancer, identified as LGBTQI+, and currently lived in the US. Open-ended survey questions asked about the impact of cancer on LGBTQI+ cancer survivors' perceptions of self and relationships. To maximize inter-rater reliability, 20% of the survey responses were double coded. Chi-squared tests assessed differences in changes across the life-course.

RESULTS

Of the participants in the OUT survey (N = 2382), 86.9% (N = 2069) provided responses to at least one of the four open-ended questions. The content analysis sample participants were primarily aged 40-59 (39.3%) and 60-79 (49.4%), gay (54.7%), cisgender men (59.4), White (89.7%), and not on active treatment (77.4%). A total of 5179 codes were applied to the 2069 responses. A total of 5 overarching categories and 18 sub-categories were identified. Themes included: (1) changes in perceptions of self; (2) changes to relationships; (3) changes to health and (4) LGBTQI+ specific unmet needs. The most commonly reported categories were changes in perceptions of self (77%, n = 1593) and changes to health (47%, n = 972). Most cancer-related changes were more frequently reported by young adult survivors.

CONCLUSIONS

This content analysis illuminates the unique challenges that the LGBTQI+ population faces while navigating through the cancer care continuum.

Neuropsychological assessment, intervention, and best practices for women with non-Central nervous system cancer: A scoping review of current standards

Objective: Existing literature has sought to characterize the broad cognitive impact of non-central nervous system cancer and its treatment, including chemotherapy, radiation, surgery, and hormonal regulation. However, despite the frequency of women that are diagnosed with breast and gynecological cancer, there is limited research on the specific cognitive experiences of women undergoing cancer treatment. Presently, the current literature lacks concise guidance for neuropsychologists to support the cognitive health of women facing cancer, despite the acknowledged impact of cancer interventions and chronic illness on cognitive outcomes. Method: Applying scoping review criteria outlined by Peters et al. (2015) and adhering to Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a comprehensive examination of literature spanning multiple databases (Google Scholar, PubMed, PsychINFO) with a focus on the cognitive impact of cancer treatment on women. Conclusions: Women are subject to unique treatment-related outcomes due to the impact of hormonal alterations, differences in metabolization of certain chemotherapies, and psychosocial risk factors. Despite the known impact of cancer intervention, chronic illness, and cancer-related sequelae on cognitive outcomes, the current literature does not parsimoniously outline best practices for neuropsychologists to promote the health of women experiencing cancer. The current paper (1) provides an overview of the cognitive implications of cancer treatment with an intentional focus on cancers that are more prevalent in women versus men, (2) addresses the characteristics of this impact for women undergoing cancer intervention(s), and (3) provides possible intervention and treatment strategies for mental health providers and neuropsychologists.

Impairment of vocational activities and financial problems are frequent among German blood cancer survivors

Little is known about changes in the personal living conditions of long-term blood cancer survivors in Germany. To gather information about social relationships, work life, overall well-being, and religion, we performed a questionnaire-based retrospective study on 1551 survivors who had been on follow-up for ≥ 3 years (median, 9 years). Most survivors reported that marital status and relationships with relatives and friends remained constant before and after blood cancer. Vocational activities were temporarily impaired for 47.5%, with a median time of 11 months to return to work. More than a third of the patients (35.6%) discontinued work permanently, with disability and retirement pension rates of 7.9% and 38.1%, respectively, at the time of the survey. Financial problems due to reduced income were reported by 26.2%, in particular after relapse or allogeneic transplantation. Patient reports addressing their quality of life showed large variations. It was best in acute leukemia survivors without a history of allogeneic transplantation and worst in patients with myeloproliferative disorders. Religion tended to become more important after blood cancer. In conclusion, vocational impairment and financial problems are frequent among German blood cancer survivors. Efforts should be made at an early stage to reestablish the patients' ability to work.

A Random Forest Model for Post-Treatment Survival Prediction in Patients with Non-Squamous Cell Carcinoma of the Head and Neck

BACKGROUND

Compared to squamous cell carcinoma, head and neck non-squamous cell carcinoma (HNnSCC) is rarer. Integrated survival prediction tools are lacking.

METHODS

4458 patients of HNnSCC were collected from the SEER database. The endpoints were overall survivals (OSs) and disease-specific survivals (DSSs) of 3 and 5 years. Cases were stratified-randomly divided into the train & validation (70%) and test cohorts (30%). Tenfold cross validation was used in establishment of the model. The performance was evaluated with the test cohort by the receiver operating characteristic, calibration, and decision curves.

RESULTS

The prognostic factors found with multivariate analyses were used to establish the prediction model. The area under the curve (AUC) is 0.866 (95%CI: 0.844-0.888) for 3-year OS, 0.862 (95%CI: 0.842-0.882) for 5-year OS, 0.902 (95%CI: 0.888-0.916) for 3-year DSS, and 0.903 (95%CI: 0.881-0.925) for 5-year DSS. The net benefit of this model is greater than that of the traditional prediction methods. Among predictors, pathology, involved cervical nodes level, and tumor size are found contributing the most variance to the prediction. The model was then deployed online for easy use.

CONCLUSIONS

The present study incorporated the clinical, pathological, and therapeutic features comprehensively and established a clinically effective survival prediction model for post-treatment HNnSCC patients.

Social Wellbeing in Cancer Survivorship: A Cross-Sectional Analysis of Self-Reported Relationship Closeness and Ambivalence from a Community Sample

Improvements in early screening and treatment have contributed to the growth of the number of cancer survivors. Understanding and mitigating the adverse psychosocial, functional, and economic outcomes they experience is critical. Social wellbeing refers to the quality of the relationship with partners/spouses, children, or significant others. Close relationships contribute to quality of life and self-management; however, limited literature exists about social wellbeing during survivorship. This study examined positive and negative self-reported changes in a community sample of 505 cancer survivors. Fourteen items assessed changes in communication, closeness with partner/children, stability of the relationship, and caregiving burden. An exploratory factor analysis was conducted using a robust weighted least square procedure. Differences by sociodemographic and clinical characteristics were investigated. Respondents were mostly male, non-Hispanic white, and ≥4 years since diagnosis. Two factors, labeled Relationship Closeness and Ambivalence, emerged from the analysis. Women, younger survivors, individuals from minority groups, and those with lower income experienced greater negative changes in social wellbeing. Variations by treatment status, time since diagnosis, and institution were also reported. This contribution identifies groups of cancer survivors experiencing affected social wellbeing. Results emphasize the need to develop interventions sustaining the quality of interpersonal relationships to promote long-term outcomes.