Traditional investigations of caregiving link it to increased caregiver morbidity and mortality, but do not disentangle the effects of providing care from those of being continuously exposed to an ailing loved one with serious health problems. We explored this possible confound in a national, longitudinal survey of elderly married individuals (N = 3,376). Results showed that spending at least 14 hr per week providing care to a spouse predicted decreased mortality for the caregiver, independently of behavioral and cognitive limitations of the care recipient (spouse), and of other demographic and health variables. These findings suggest that it may be premature to conclude that health risks for caregivers are due to providing active help. Indeed, under some circumstances, caregivers may actually benefit from providing care.Approximately 21% of the U.S. adult population provides unpaid care to an adult over age 18 (Pandya, 2005, par. 2). There is a growing consensus that caregiving is harmful to physical health, so public-policy researchers have recommended that caregivers receive "relief from the relentless work of family caregiving and its debilitating effects" (Feinberg et al., 2004, Recommendation 3). As reported by Riess-Sherwood, Given, and Given (2002), the physical health consequences of providing care "have been so striking that federal legislation has been enacted to begin granting financial relief to those who provide care in the home in the hopes that this would relieve some of the health effects" (p. 111). These recommendations are based, in part, on evidence that caregivers may experience problems with immune regulation (e.g., see Vitaliano, Zhang, & Scanlan, 2003, for an overview), and Address correspondence to Stephanie L. Brown, Division of General Medicine, 300 N. Ingalls, Room 7D-13, Ann Arbor, MI 48109, stebrown@med.umich.edu. SUPPORTING INFORMATION Additional Supporting Information may be found in the on-line version of this article: Table S1 Table S2 Please note: Wiley-Blackwell are not responsible for the content or functionality of any supporting materials supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article. However, empirical evidence of worsened physical health among caregivers comes from studies that often equate providing active help with being continuously exposed to an ailing loved one with serious health problems (e.g., Christakis & Allison, 2006;Vitaliano et al., 2003). Christakis and Allison, for example, linked caregiving to increased mortality risk on the basis of increased mortality rates among individuals whose spouse had been hospitalized, as opposed to individuals who provided more hours of care to a spouse. In instances like these, it is impossible to know whether the adverse health consequences are due to stress arising from active helping (e.g., hours of care provided to another person), or to other features of the caregiving context that may be harmful, such as anticipatory bereavement ...

Perceptions of how cancer has affected survivors' lives in both positive and negative ways may influence, or be influenced by, their functional abilities and QOL.

Purpose We examined marital outcomes among cancer survivors diagnosed during early adulthood from the 2009 Behavioral Risk Factor Surveillance System dataset. Methods Eligible participants were ages 20–39 years. Of the 74,433 eligible, N=1,198 self-reported a cancer diagnosis between the ages of 18 and 37, were ≥2 years past diagnosis, and did not have non-melanoma skin cancer. The remaining N=67,063 were controls. Using generalized linear models adjusted for age, gender, race, and education, we generated relative risks (RR) and 95 % confidence intervals (95 % CI) to examine survivor status on indicators of ever married, currently married, and divorced/separated. Results Survivors were slightly older than controls [33.0 (SD=3.8) vs. 30.0 (SD=4.0); p<0.001]. Average time since diagnosis was 7.4 years. Most common diagnoses were cervical (females; 45 %) and non-Hodgkin lymphoma (males; 20 %). Survivors were less likely to be currently married than controls (58 % vs. 64 %; RR=0.92, 95 % CI 0.85–0.99). Among ever married participants, survivors were at an increased risk of divorce/separation than controls (18 % vs. 10 %; RR=1.77, 95 % CI 1.43–2.19). Divorce/separation risk persisted for female survivors (RR 1.83, 95 % CI 1.49–2.25), survivors ages 20–29 (RR 2.57, 95 % CI 1.53–4.34), and survivors ages 30–39 (RR 1.62, 95 % CI 1.29–2.04). Conclusions The emotional and financial burdens of cancer may lead to marital stress for younger cancer survivors. Implications for cancer survivors Young survivors may face a higher risk of divorce; support systems are needed to assist them in the years following diagnosis.

Purpose: This study uses qualitative methods to identify barriers to and facilitators of exercise and healthy eating among adolescent and young adult (AYA) cancer survivors (survivors currently aged 18-39 years and diagnosed with cancer anytime in their lives), as reported by survivors and their primary supporters. Methods: Survivors (M age = 27.6 years, SD = 6.6 years) had completed active cancer therapy. Survivors and supporters (i.e., nominated by survivors as someone who was a main source of support) attended separate focus group sessions (five survivor focus groups, five supporter focus groups) and were asked to complete a selfreported questionnaire assessing demographic and cancer history and engagement in exercise and healthy eating. Results: In total, 25 survivors and 19 supporters participated. The three overarching themes identified were barriers to exercise and healthy eating (e.g., lack of resources, negative thoughts and feelings, negative social and environmental influences), facilitators of exercise and healthy eating (e.g., cognitive motivators, tools for health behavior implementation, social relationships), and intervention implications (e.g., informational needs, desire for social support). Conclusion: AYA cancer survivors and their supporters identified barriers to and facilitators of healthy lifestyle behaviors, which should be considered when designing interventions to improve the long-term health of survivors.