Factors associated with the psychological well-being of adults with acute leukemia in remission

Rural living as context: a study of disparities in long-term cancer survivors

PURPOSE/OBJECTIVES

To explore the impact of rurality on health-related quality-of-life (HRQOL) disparities in rural long-term cancer survivors.

DESIGN

Cross-sectional survey.

SETTING

Rural-Urban Continuum Codes (RUCC) 7, 8, and 9.

SAMPLE

91 adults at least five years post-treatment.

METHODS

Mailed surveys measured HRQOL, self-esteem, and social support. Regression models were estimated to isolate (from self-esteem and social support) the effect of level of rurality on HRQOL.

MAIN RESEARCH VARIABLES

HRQOL, self-esteem, social support, and rurality.

FINDINGS

No differences in demographic characteristics existed among RUCCs. Survivors residing in RUCCs 7 or 8 tended to be similar in several dimensions of HRQOL. Survivors living in RUCC 7 reported significantly lower social function and greater financial difficulty and number of symptoms compared to survivors in RUCC 9 (the most remote). Self-esteem and social support strongly correlated with HRQOL.

CONCLUSIONS

The significant impact of rurality on HRQOL beyond self-esteem and social support suggests its role in explaining cancer survivorship disparities and directing practice. Until additional exploration can identify mechanisms behind rurality's impact, consideration of level of rurality as a potential factor in evaluating survivors' HRQOL outcomes is reasonable.

IMPLICATIONS FOR NURSING

Survivor context (e.g., level of rurality) influences HRQOL outcomes. Context or culture-relevant risk minimization and HRQOL optimization nursing practices are indicated.

Objective and subjective stressors and the psychological adjustment of melanoma survivors

This study of 300 melanoma survivors examines the relative contributions of objective illness-related factors (stage of illness at diagnosis, time since diagnosis, and change in physical condition) and of subjective factors (cognitive appraisal) to their psychological adjustment. The findings show that lower appraisal of their situation as a threat, higher appraisal of it as a challenge, and higher appraisal of their subjective ability to cope with it all increased their well-being, while lower threat appraisal and higher appraisal of subjective ability to cope also reduced their distress. These findings, which are consistent with Lazarus and Folkman's stress coping theory, suggest that subjective factors may be more important than objective medical factors in predicting patients' adjustment. With this, more advanced stage at diagnosis contributed to reducing distress, while being married contributed both to higher well-being and reduced distress.

The experience of leukaemia and bone marrow transplant: searching for meaning and agency

This qualitative study examines the experience of haematological cancer as described by ten people who have been through leukaemia or lymphoma and a bone marrow transplant. The focus is on the interaction of these participants with this challenging experience and the meaning it had for them. The descriptions of their thoughts, feelings and actions as they negotiated the period from diagnosis to treatment and survival reveal that these people brought both the present values in their life, as well as a life-long pattern of dealing with adversity, into their confrontation of a life-threatening illness. Issues of personal meaning and agency (the capacity to act and control valued aspects of one's life) were found to be paramount. These results are then discussed with a view to their implications for patient care.

Coping with melanoma--ten strategies that promote psychological adjustment

The coping strategies discussed above are not right for everyone, but there is good evidence that they are generally helpful to patients who are dealing with cancer, including melanoma. The bottom line is that these strategies help patients feel better and stronger. They feel better because they are facing the illness squarely and working through its emotional impacts, and yet also keeping a perspective on it so that it does not define them or take over their lives. Through all the trials and challenges that cancer can bring, they are keeping their wits about them and able to carry on. They feel stronger because they have support, from other people and from within themselves. They have taken stock of their most cherished reasons for living, which strengthens and sustains them in their fight against cancer. And yet they also feel that their survival is not the only important objective; the quality of their lives and relationships, the values they live by, and their spirituality also deserve attention and effort. They have the peace of knowing that their death from cancer, if it comes to that, will not obliterate the meaning, value, and joy that their life has given to them and their loved ones.

Quality of life for long-term survivors of cancer: influencing variables

The study's purpose was to describe the relations among self-esteem, learned resourcefulness, and social support, and to show how they predict health-related quality of life (HRQL) for long-term survivors of cancer. With advances in oncology and increased survival, variables influencing the HRQL of long-term survivors of cancer must be explored. The design was descriptive and correlational. Five instruments were sent to 456 long-term survivors in southern California. Data were analyzed for 62 of 111 consenting individuals, most of whom were married, retired, white, college-educated, female survivors of breast cancer older than 60 years of age treated by radiation and surgery. Subjects with higher self-esteem reported higher HRQL (r = 0.69; p = 0.00). Learned resourcefulness had a significant negative relation with HRQL (r = -0.32; p = 0.01). Social support was operationalized as functional components, network properties, and recent loss. Only the loss component of social support had a significant negative relation with HRQL (r = -0.38; p = 0.00). Together, the three variables explained more than half of the variance (R2 = 0.53) of HRQL, with self-esteem being the strongest predictor. The HRQL of long-term survivors of cancer may increase with interventions such as both survivor- and nurse-led support groups aimed at supporting and improving self-esteem. In addition, education to anticipate social support losses may further enhance HRQL.

Psychometric properties of the Japanese version of the Mental Adjustment to Cancer (MAC) scale

This paper describes a study of the psychometric properties of the Japanese version of the mental adjustment to cancer (MAC) scale developed in England. The scale was completed by 455 Japanese cancer patients. The internal consistency was similar to that of the original version (Cronbach's alpha coefficients for the subscales ranged from 0.60 to 0.78) and the Japanese version had moderate to moderately high stability (correlation coefficients were above 0.64). Correlations between the MAC scale score and emotional states measured by the Profile of Mood States (POMS) indicated the concurrent validity. The results suggest that the Japanese version, like the original MAC scale, is a reliable and valid clinical research tool in Japan.

Predictors of patients' mental adjustment to cancer: patient characteristics and social support

Because being diagnosed with cancer is considered to be extremely stressful, cancer patients' mental adjustment has been widely studied. Previous studies have revealed that cancer patients' mental adjustment is correlated with the quality of life and the degree of psychological distress and have suggested that one of the most adaptive adjustments is 'fighting spirit' whereas one of the most maladaptive is 'helplessness/hopelessness'. However, little is known about the association between patients' mental adjustment to cancer and their spouses characteristics or social support network. This paper describes a study of cancer patients' characteristics and social support factors as predictors of the patients' responses to having cancer. A total of 455 ambulatory cancer patients completed the Mental Adjustment to Cancer (MAC) scale and participated in a structured interview about their characteristics and social support. The results of multiple regression analysis suggested that size of household, performance status, support from physicians and satisfaction with support were predictive of patients' fighting spirit, whereas age, education, size of household, performance status and satisfaction with support were predictive of helplessness/hopelessness.

Personality, marital, and occupational factors associated with quality of life

In three studies that employed community-based samples the relationship between personality, marital, and job-related factors and quality of life was examined. Study 1 indicated that hardiness and self-esteem were important components of overall quality of life. The marital communication skills of expressiveness and intimacy were identified as major aspects of overall quality of life in the second study. In Study 3, satisfaction with various job characteristics was related to overall quality of life. These studies start to provide definition to the quality of life concept in terms of personality characteristics, skills, and beliefs that have potential for modification.