A double whammy: health promotion among cancer survivors with preexisting functional limitations

Allostatic Load, Mobility Disability, and Viral Effects in Cancer: A Structural Equation Model

A growing number of cancers have been linked to specific oncogenic viruses and physiological stress. Recently, two separate studies linked mobility limitations to allostatic load and four major cancer types. The objective of this study was to determine if cancer occurrence regresses on three latent domains of Allostatic Load, Level of Physical Functioning (i.e., Mobility Disability), and Viral Exposure. We compared several structural equation models using adult participant (n = 17,969) data from three National Health and Nutrition Examination Survey (NHANES) periods. The primary two-level model with three exogenous latent factors and a single Cancer endogenous latent factor demonstrated a strong fit (GFI = 0.948, RMSEA = 0.024), and the model had a non-significant Chi-Square indicative of a strong model.What is already known on this subjectAllostatic load represents how the body responds to physiological stress and is associated with increased morbidity/mortality, including cancers.Viruses are the causative agents of 15-20% of cancers and can be stress activated.People with mobility limitations experience significantly higher allostatic loads and secondary health conditions, and one recent study indicates a heightened risk for certain cancers.What this study addsThis study is original in its testing of a conceptual model that links together cancer outcomes with latent factors/variables including disability/mobility limitations, allostatic load, and viral exposure.The study indicates that there might be important associations between allostatic load, disability burden, and viral exposure/activation on the occurrence of cancer.The research suggests the need for stress reduction, preventative health interventions, and additional supports for people with disabilities and their caregivers.

Perspectives of Patients with Pre-existing Mobility Disability on the Process of Diagnosing Their Cancer

BACKGROUND

Mobility disability is the most common disability among adult Americans, estimated at 13.7% of the US population. Cancer prevalence is higher among people with mobility disability compared with the general population, yet people with disability experience disparities in cancer screening and treatment.

OBJECTIVE

We explored experiences of patients with mobility disability with the process of cancer diagnosis.

DESIGN

Open-ended individual interviews, which reached data saturation. Interviews were transcribed verbatim for conventional content analysis.

PARTICIPANTS

We interviewed 20 participants with pre-existing mobility disability that required the use of an assistive device or assistance with performance of activities of daily living and who were subsequently diagnosed with cancer (excluding melanoma).

KEY RESULTS

Concerns coalesced around five broad categories: inaccessibility of medical diagnostic equipment affecting the process of cancer diagnosis, attitudes of clinical staff about accommodating disability, dismissal of cancer signs/symptoms as emotional responses to chronic health conditions, misattributing cancer signs/symptoms to underlying disability, and attitudes about pursuing legal action for substandard care. Participants provided examples of how erroneous assumptions and potentially biased attitudes among clinicians interfered with the process of their cancer diagnosis, sometimes contributing to an insufficient workup and diagnostic delays.

CONCLUSIONS

Physical and attitudinal barriers affect the process of cancer diagnosis in people with mobility disability. Though people with mobility disability may be clinically complex, clinicians should be aware of the risks of diagnostic overshadowing (i.e., the misattribution of cancer signs/symptoms to underlying disability) and other erroneous assumptions that may affect timeliness of cancer diagnosis and quality of care. Further efforts, including educating clinicians about challenges in caring for persons with disability, should be considered to improve the process of cancer diagnosis for this population.

TRIAL REGISTRATION

N/A.

Exploring Cancer Treatment Experiences for Patients With Preexisting Mobility Disability

OBJECTIVE

We explored the process of cancer care for patients with preexisting mobility disability, focusing on treatment decisions and experiences.

DESIGN

We recruited 20 participants with preexisting mobility disability, requiring use of an assistive device or assistance with activities of daily living, subsequently diagnosed with cancer (excluding skin cancers). We conducted open-ended individual interviews, which reached data saturation and were transcribed verbatim for conventional content analysis.

RESULTS

Concerns coalesced around 4 themes: disability-related healthcare experiences affect cancer treatment decisions; concerns about cancer treatment worsening functional impairments; access barriers; and limited provider awareness and biases about treating people with disability. Residual fear from previous medical interventions and concerns about exacerbating functional impairments influenced cancer treatment preferences. Participants also raised concerns that their underlying disability may be used to justify less aggressive treatment. Nevertheless, cancer treatment did exacerbate mobility difficulties for some participants. Inaccessible hospital rooms, lack of accessible medical equipment, and attitudinal barriers complicated treatments.

CONCLUSIONS

People with preexisting mobility disability experience barriers to cancer treatment, compromising quality of care and potentially outcomes. Further training and proactive planning for accommodating disability during cancer treatment and rehabilitation are warranted.

TO CLAIM CME CREDITS

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CME OBJECTIVES

Upon completion of the article, the reader should be able to: (1) Recognize inadequate accommodations that compromise the diagnosis and treatment of a new cancer in patients with preexisting disability; (2) Recommend involving rehabilitation specialists in the process of care and clinical decision making from the time of cancer diagnosis for patients with preexisting disability newly diagnosed with malignancy; and (3) In the setting of accessibility barriers, facilitate efforts to accommodate patients with preexisting disability to improve quality of care in diagnosing and treating cancer.

LEVEL

Advanced.

ACCREDITATION

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Advocacia em saúde na enfermagem oncológica: revisão integrativa da literatura

RESUMO Objetivo Identificar a produção científica acerca do tema advocacia do paciente por enfermeiros no contexto da oncologia. Método revisão integrativa com busca e seleção dos estudos primários realizadas em fevereiro de 2020 em quatro bases de dados relevantes na área da saúde: Lilacs, SciELO, Cochrane e PubMed. A amostra foi composta por 11 estudos de um universo de 395 artigos. Os 11 estudos foram agrupados em duas categorias. Resultados A partir da síntese das evidências foi possível elaborar as categorias conforme as temáticas mais abordadas, são elas: “Situações vivenciadas pelos pacientes e enfermeiros em que é necessária a advocacy” e “Estratégias que aprimoram o exercício de advocacy” que foi subdividida em três subcategorias: Self-advocacy; Sistemas de apoio e advocacy para os pacientes; Comunicação centrada no paciente (CCP) e Tomada de decisão compartilhada (TDC). Conclusões e implicações para a prática A importância do exercício de advocacy pelos enfermeiros em oncologia é evidente nos estudos, pautando-se na necessidade da comunicação, educação, apoio e reconhecimento da necessidade para intervir quando necessário, considerando a ética como guia para auxiliar na tomada de decisões, reforçando a necessidade de reflexões sobre a temática fortalecendo e embasando tecnicamente a prática profissional.

A Conceptual Framework of Self-advocacy in Women With Cancer

Researchers define self-advocacy as the ability of an individual with cancer to overcome challenges in getting their preferences, needs, and values met. While imperative in all health care settings, self-advocacy is especially important in cancer care. The goal of this article is to present a conceptual framework for self-advocacy in cancer. We review foundational studies in self-advocacy, define the elements of the conceptual framework, discuss underlying assumptions of the framework, and suggest future directions in this research area. This framework provides an empirical and conceptual basis for studies designed to understand and improve self-advocacy among women with cancer.

The experience of financial burden for people with multimorbidity: A systematic review of qualitative research

Background

Multimorbidity prevalence is increasing globally. People with multimorbidity have higher health care costs, which can create a financial burden.

Objective

To synthesize qualitative research exploring experience of financial burden for people with multimorbidity.

Search strategy

Six databases were searched in May 2019. A grey literature search and backward and forward citation checking were also conducted.

Inclusion criteria

Studies were included if they used a qualitative design, conducted primary data collection, included references to financial burden and had at least one community‐dwelling adult participant with two or more chronic conditions.

Data extraction and synthesis

Screening and critical appraisal were conducted by two reviewers independently. One reviewer extracted data from the results section; this was checked by a second reviewer. GRADE‐CERQual was used to summarize the certainty of the evidence. Data were analysed using thematic synthesis.

Main results

Forty‐six studies from six continents were included. Four themes were generated: the high costs people with multimorbidity experience, the coping strategies they use to manage these costs, and the negative effect of both these on their well‐being. Health insurance and government supports determine the manageability and level of costs experienced.

Discussion

Financial burden has a negative effect on people with multimorbidity. Continuity of care and an awareness of the impact of financial burden of multimorbidity amongst policymakers and health care providers may partially address the issue.

Patient or public contribution

Results were presented to a panel of people with multimorbidity to check whether the language and themes ‘resonated’ with their experiences.

Exploring attitudes about developing cancer among patients with pre-existing mobility disability

OBJECTIVE

Mobility disability affects approximately 13.7% of the United States population, representing the most common disability type. People with mobility disability experience disparities in cancer screening and higher prevalence of some cancers compared to the general population. We sought to explore the attitudes of people with pre-existing mobility disability about their cancer diagnosis.

METHODS

We conducted open-ended individual interviews with 20 participants who had pre-existing mobility disability requiring use of an assistive device or assistance with performance of activities of daily living (ADLs), subsequently diagnosed with cancer (excluding skin cancers). Interviews reached data saturation and were transcribed verbatim for conventional content analysis.

RESULTS

Concerns coalesced around three major themes: sense of control over health conditions, seeking support, and recommendations for other people with disability seeking cancer care. Some participants described feeling a loss of control over their cancer diagnosis that they did not have regarding disability, while others suggested that disability presented greater challenges than their cancer diagnosis. Participants described seeking various forms of support, including emotional support (e.g., from friends and family), informational support (e.g., recommendations for seeking care), instrumental support (e.g., ADLs), and appraisal (e.g., self-reflection of personal qualities for fighting cancer). They provided recommendations, highlighting importance of self-advocacy and being attuned to changes in health status.

CONCLUSIONS

We found that people with pre-existing mobility disability and cancer express complex attitudes towards their cancer diagnosis. Findings may inform efforts to improve quality of relevant supports to meet the psychosocial needs of this population.

WeCanConnect: Development of a Community-Informed mHealth Tool for People with Disabilities and Cancer

BACKGROUND

Cancer care for people with disabilities (PWD) is rife with uncertainty and obstacles. Not only do PWD have to contend with cancer and treatment-related sequelae, but also its impact on disabling conditions and functional capacity, as well as a health care system lacking accessibility and disability competence. Peer support can address important needs for emotional and informational support. mHealth tools for smart phones, tablets, or laptops hold promise to deliver such support in an accessible and scalable manner. This concept is unexplored for use among PWD with cancer.

OBJECTIVES

To describe a community-based participatory study that 1) identifies consumer-reported support needs and priorities among PWD and cancer and 2) integrates consumer perspectives into the design of an mHealth cancer support tool to address these needs and priorities.

METHODS

Part 1 is a thematic analysis of semistructured, qualitative interviews with a purposive sample of experts in health and cancer care for PWD (n = 7) and a convenience sample of cancer survivors with preexisting disabilities (n = 9). In part 2, results were integrated to develop an mHealth peer support tool to addresses identified needs.

RESULTS

Themes included 1) barriers across the cancer care continuum, 2) strengths within the disability community, and 3) recommendations for mHealth and peer support. Based on the qualitative findings, we designed a mHealth tool for peer support and information sharing among PWD with cancer.

CONCLUSION

Consumer-informed mHealth tools hold great potential to leverage strengths in the disability community to address emotional and informational needs created by a lack of disability competence across the cancer care continuum.

Living with and beyond cancer with comorbid illness: a qualitative systematic review and evidence synthesis

Purpose

To identify the qualitative evidence on the experience of cancer and comorbid illness from the perspective of patients, carers and health care professionals to identify psycho-social support needs, experience of health care, and to highlight areas where more research is needed.

Methods

A qualitative systematic review following PRISMA guidance. Relevant research databases were searched using an exhaustive list of search terms. Two reviewers independently screened titles and abstracts and discussed variations. Included articles were subject to quality appraisal before data extraction of article characteristics and findings. Thomas and Harden’s thematic synthesis of extracted findings was undertaken.

Results

Thirty-one articles were included in the review, covering a range of cancer types and comorbid conditions; with varying time since cancer diagnosis and apparent severity of disease for both cancer and other conditions. The majority of studies were published after 2010 and in high income countries. Few studies focused exclusively on the experience of living with comorbid conditions alongside cancer; such that evidence was limited. Key themes identified included the interaction between cancer and comorbid conditions, symptom experience, illness identities and ageing, self-management and the role of primary and secondary care.

Conclusions

In addition to a better understanding of the complex experience of cancer and comorbidity, the review will combine with research prioritisation work with consumers to inform an interview study with the defined patient group.

Implications for Cancer Survivors

Expanding this evidence base will help to illuminate developing models of cancer patient-centred follow-up care for the large proportion of patients with comorbid conditions.

Electronic supplementary material

The online version of this article (10.1007/s11764-019-0734-z) contains supplementary material, which is available to authorized users.

Are long-term cancer survivors and physicians discussing health promotion and healthy behaviors?

PURPOSE

This study aimed to (1) describe the proportion of survivors reporting that a physician discussed strategies to improve health and (2) identify which groups are more likely to report these discussions.

METHODS

Lung cancer and colorectal cancer (CRC) survivors (>5 years from diagnosis) (n = 874) completed questionnaires, including questions on whether, in the previous year, a physician discussed (1) strategies to improve health, (2) exercise, and (3) diet habits. Chi-square tests and logistic regression models were used to examine whether the likelihood of these discussions varied by demographic and clinical characteristics.

RESULTS

Fifty-nine percent reported that a physician discussed strategies to improve health and exercise, 44% reported discussions on diet, and 24% reported no discussions. Compared to their counterparts, survivors with lower education were less likely to report discussing all three areas, but survivors with diabetes were more likely. Survivors ≥ 65 years old were less likely to report discussing strategies to improve health and diet. Males and CRC survivors reported discussing diet more than their female and lung cancer counterparts, respectively.

CONCLUSION

The frequency of health promotion discussions varied across survivor characteristics. Discussions were more frequently reported by some groups, e.g., survivors with diabetes, or among individuals less likely to engage in healthy behaviors. In contrast, males and older and less educated survivors were less likely to have these discussions.

IMPLICATIONS FOR CANCER SURVIVORS

Decreasing physician barriers and encouraging patients to discuss health promotion, especially in the context of clinical care for older survivors and those with low education, is essential for promoting the overall well-being of cancer survivors.

Nurturing Advocacy Inclusion to Bring Health Equity in Breast Cancer among African American Women

This paper will present the multiple roles and the impact of cancer advocates. The emerging literature provides evidence for the consideration and integration of African American BC survivors as advocates in practice, policy and research relevant to cancer prevention and control. We present a practical outline for organizational assessment for the inclusion of advocates in these arenas. This assessment can be conducted by all levels of partners, including community advocacy and scientific organizations.