Marshalling Social Support: A "Care-Getting" Model for Persons Living with Cancer

Physical health and function trajectories in adults with cancer: psychosocial predictors of class membership

PURPOSE

To prospectively examine different trajectories of recovery, across different aspects of physical health and function and to examine trajectory class membership.

METHODS

This prospective study enrolled 569 recently diagnosed adult cancer patients (Mage = 58.7) between 2019 and 2022 identified through the Rapid Case Ascertainment resource of The Yale Cancer Center. Patients were diagnosed with breast (63.8%), prostate (25.3%), or colorectal cancer (10.9%) within six-months of baseline assessment. Participants completed comprehensive psychosocial and health survey measures (SF-12) through REDCap at five time points. Growth mixture modeling examined unconditional distinct trajectories for four aspects of physical health and function. We fit logistic regression and multinomial logistic regression models to estimate associations between psychosocial predictors of trajectory class membership for each of the four aspects.

RESULTS

We identified distinct trajectories of physical health and function. Over one-third (38.4%) of the sample experienced low and declining scores in their ability to accomplish work/regular daily activities due to physical health. Over half (54.9%) demonstrate moderately stable general health with no improvement over time. A small but significant subset of the sample (3%, 5.7%, 5%) was in the moderate and declining groups with sharp decline in physical function, bodily pain, and general health, after treatment. Different predictors of trajectory class membership were also found.

CONCLUSIONS

Our results showed heterogeneity in physical health and function trajectories and different patterns of predictors for each aspect of physical health and function. Findings have the potential to inform screening and intervention efforts to help those who may need additional support.

Knowledge and attitudes toward expanded carrier screening between the medical staff and general population in China

OBJECTIVE

The purpose of our study was to assess the knowledge and attitudes toward expanded carrier screening (ECS) between the medical staff and general population in China.

STUDY DESIGN

It was a survey-based cross-sectional study in Chinese. We provided an online survey for the general public nationwide. We classified the population into the medical staff and general population to evaluate the knowledge gap and provide a reference for ECS's education programs. Except for obstetrician-gynecologists and nurses in the department of Obstetrics and Gynecology, other medical staff were not included in our study. A total of 1947 questionnaires were collected from July 11, 2020 to February 10, 2021. Two hundred and eighty-four questionnaires were excluded from further analysis. The remaining 1663 cases were incorporated into the final analysis. Data were analyzed using IBM SPSS Statistics 26. Comparisons between categorical variables were tested by the use of crosstabs and χ2 test.

RESULTS

The total awareness rates of the knowledge about monogenic diseases and ECS in the respondents were low, with 35.7%, 26.1%, 3.3%, 23.3%, 24.1%, 55.2%, and 23.4% for questions Q1-Q7, respectively. Medical staff had more knowledge than general population. Knowledge about monogenic diseases and ECS was positively correlated with educational level. Most respondents showed a positive attitude toward ECS: 54.4% thought ECS was necessary, and 80.5% wanted to know more about monogenic diseases.

CONCLUSION

Although the public had little knowledge about monogenic disease and ECS, most of them showed a positive attitude. Our cross-analysis showed that medical staff had more knowledge compared to general population. Pre-test education for ECS can be carried out by medical staff who are not qualified for genetic counseling. ECS training for medical staff, especially obstetrician-gynecologist and nurse in the department of Obstetrics and Gynecology, can reduce the workload of genetic counseling.

Elderly Cancer Survivors Reflect on Coping Strategies During the Cancer Journey

PURPOSE

This paper focuses on perspectives of elderly cancer survivors on their experiences of coping with cancer during various phases of their illness journey, ranging from diagnosis phase to treatment and finally considering post treatment survivorship. Anchored in the stress paradigm, the purpose of this study was to explore the meaning of living with cancer and older adults' orientations to coping with stressors encountered during their cancer journey as reflected in narratives of elderly cancer survivors.

METHODS

A nonclinical sample of 174 older adults who reported a cancer diagnosis were selected from a panel study of successful aging. In-depth interviews with respondents focused on perceived stressors and coping strategies at different phases of their cancer experience. Themes were derived from narratives based on consensus by two raters.

RESULTS

Most of the elderly patients accepted their diagnosis without dismay. Resolve and determination during the diagnosis phase was followed by assuming a more passive role during the treatment phase, relying on expert medical care. During the longer term survivorship phase older adults looked back at the adaptations they found most useful. The majority reported valuing active coping styles. These include seeking social support and instrumental orientations to dealing with the illness followed by religious or spiritual approaches.

CONCLUSIONS

The "on time" interpretation of having a cancer diagnosis in old age may diminish the stressfulness of the diagnosis and may enhance the patients' ability to proactively deal with the reality of their illness.

Proactive aging: a longitudinal study of stress, resources, agency, and well-being in late life

OBJECTIVES

Using the Proactivity Model of Successful Aging, we examined how internal and external resources contribute to the maintenance of psychological well-being and social activities among older adults who experience normative stressors of aging. Outcome variables in this study are collectively referred to as quality of life (QOL). We also examined the mediating role of proactive adaptations between internal and external resources and QOL indicators.

METHOD

Based on five annual interviews of a sample of 1000 community-dwelling older adults in Florida (effective N = 561), we tested the lagged effects of stressors on two indicators of QOL, four years later. In the full longitudinal model, using structural equations, we estimated the direct effects of internal and external resources on QOL, along with indirect effects through proactive adaptations.

RESULTS

Stressors negatively influenced QOL four years later. Internal and external resources led to better QOL four years later, both directly and indirectly through proactive adaptations of marshaling support and planning for the future.

CONCLUSION

These findings lend support to the Proactivity Model of Successful Aging by documenting the value of proactive adaptations (i.e., exercise, planning ahead, and marshaling support) as proximate influences on QOL outcomes (i.e., depressive symptomatology and social activities). Findings suggest that older adults can maintain successful aging even in the face of health-related and social stressors by invoking accumulated resources to deal actively with the challenges of aging.

Self-reported physical and mental health of older adults: the roles of caregiving and resources

OBJECTIVES

This study examined factors associated with self-reported physical and mental health, focusing on caregiving status and the availability of social supports and financial resources.

METHODS

Two bivariate analyses were performed to examine the sociodemographic characteristics as well as perceived health outcomes among caregiving and non-caregiving participants. Two-equation probit models were used to determine independent predictors of self-reported physical and mental health, using data from 1071 community-based adults (≥ 60 years). An additional bivariate analysis was conducted to investigate the characteristics of caregivers who reported better physical health.

RESULTS

Approximately 17% (n=183) of respondents reported being caregivers, and those in caregiving roles tended to be ethnic minorities, married, and have telephone communication with family or friends on a daily basis. Better physical and mental health outcomes were common for caregivers and non-caregivers who reported having more resources (e.g., higher income, better preparedness for future financial need, higher satisfaction with transportation and housing, and no limitation of usual daily activities). However, sociodemographic and social support factors were not significantly associated with physical and mental health among caregivers, unlike their non-caregiver counterparts. In the probit model, caregivers were more likely to be physically healthy compared to non-caregivers (Coefficient=0.34; p-value=0.031). Compared with healthy non-caregivers (n=631), healthy caregivers (n=141) tended to be ethnic minorities, married, and have telephone communication with family or friends on a daily basis.

CONCLUSIONS

Findings suggest that preparing resources and maintaining strong social support systems may foster health status among older family caregivers.

Residential relocation of amenity migrants to Florida: "unpacking" post-amenity moves

OBJECTIVE

This study aimed to unpack characteristics of interstate and intrastate moves undertaken by elderly amenity migrants. The authors examined these moves in the context of Litwak and Longino's life-course typology of migration.

METHOD

In an 11-year longitudinal study, the authors examined the first move made by respondents out of a large Florida retirement community where no services were offered. Data from premove and postmove in-person interviews were used.

RESULTS

This article found five distinct post-amenity move types, reflecting different degrees of dependency: (a) serial amenity moves, (b) positioning moves, (c) informal assistance moves, (d) formal assistance moves, and (e) dependency moves.

DISCUSSION

Findings of this study not only support Litwak and Longino's migration typology but also elaborate and extend it. Only some older adults (20.4%) make counterstream assistance moves. Additional move types reflect new options for late-life migration to enhance person- environment fit.