Psychological Distress, Health Behaviors, and Benefit Finding in Survivors of Multiple Primary Cancers: Results From the 2010 Livestrong Survey

Belcher, Sarah M.; Low, Carissa A.; Posluszny, Donna M.; Schear, Rebekkah; Kramer, Raegan E.; Donovan, Heidi S.

doi:10.1188/17.onf.703-711

Cited by 10 publications

(17 citation statements)

References 39 publications

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“…Self‐management is increasingly important as cancer care shifts to chronic disease management, and the responsibility of day‐to‐day management shifts from providers to patients and their families. Previous MPC literature supports the importance of self‐management, as survivors with MPC diagnoses have prolonged QOL deficits and view cancer as a chronic illness . Self‐management behaviors are teachable and modifiable and have the potential to improve health.…”

Section: Discussionmentioning

confidence: 98%

“…Diagnoses, treatment, and changes in the disease trajectory result in distress for patients with cancer and occur repeatedly in MPC . Our work, including a review of MPC literature, has identified MPC as a risk factor for psychological distress. The identified path between distress and functional health was not surprising, given the body of literature that has emerged from Lazarus and Folkman's early conceptualization of perceived stress .…”

Section: Discussionmentioning

confidence: 99%

“…Self-management includes day-to-day tasks necessary to maintain health and manage chronic illness. 37 Self-management is increasingly important as cancer care shifts to chronic disease management, and the responsibility of dayto-day management shifts from providers to patients and their fami- 3,4 has identified MPC as a risk factor for psychological distress.…”

Section: Individual Risk Factorsmentioning

confidence: 99%

“…cancer survivors, financial hardship, theoretical models, multiple primary neoplasms, oncology, selfmanagement behaviors, psychological stress 1 | BACKGROUND One in five US cancer survivors has a history of two or more primary cancers. 1 Compared with individuals with single cancers, survivors of multiple primary cancers (MPC) have lower quality of life (QOL), 2 higher psychological distress, 3,4 riskier health behaviors, 5 and poorer physical health. [5][6][7][8] MPC survivors also have greater financial hardship 8,9 and difficulty participating in social roles and activities.…”

Section: Introductionmentioning

confidence: 99%

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Psychobehavioral risk factors for financial hardship and poor functional outcomes in survivors of multiple primary cancers

et al. 2019

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Objective Survivors of multiple primary cancers (MPC) are at increased risk for poor health outcomes compared with survivors of single cancers. Using an adapted psychobehavioral stress‐response model, the study purpose was to identify pathways and individual risk factors associated with poor health outcomes in adults with MPC. Methods Adult MPC survivors (N = 211) with first cancers (stages I‐III) diagnosed within 1 to 10 years were recruited via tumor registry. Employing a cross‐sectional design, established questionnaires were used to operationalize patient characteristics and theoretical constructs including perceived stress, psychological and behavioral responses, financial hardship, social role function, and physical health. Disease and treatment data were obtained via registry and medical records. Structural equation modeling (SEM) was performed to fit, test, and modify the hypothesized psychobehavioral model. Results Following measurement model refinement, an SEM linking self‐management behaviors, distress, financial hardship, and functional health demonstrated a good fit: χ2 (200, N = 206) = 332.06, P < .01; Tucker‐Lewis index (TLI) = .95, comparative fit index (CFI) = .96, standardized root mean residual (SRMR) = .06, root‐mean‐square error of approximation (RMSEA) = .06. Less use of self‐management behaviors predicted higher distress which, in turn, predicted higher financial hardship; higher distress and financial hardship predicted poorer functional health. Several sociodemographic and personal factors predicted self‐management behaviors and distress. Conclusions The hypothesized stress‐response model was partially supported. Data supported pathways among self‐management behaviors, distress, financial hardship, and functional health. Self‐management and distress may represent modifiable intervention targets for MPC survivors. High body mass index (BMI), less education, greater neuroticism, and lower social support were associated with less use of self‐management behaviors and higher distress and should be further evaluated as potential markers of vulnerability.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Individual Risk Factorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Psychobehavioral risk factors for financial hardship and poor functional outcomes in survivors of multiple primary cancers

et al. 2019

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“…Some differences did exist between our sample and other published reports. First, as a result of our inclusion criteria, this sample of patients was, on average, closer to their first cancer diagnosis (M= 5.8 years, SD=2.9) than other published samples (11-17 years), providing the opportunity to examine a new cohort of MPC survivors not previously included in this body of literature (Belcher, Low, Posluszny, Kramer, & Donovan, 2016;. This study also included cancer sites not frequently represented in MPC literature (i.e., lung and thyroid cancer).…”

Section: Conclusion Implications For Nursing Future Studiesmentioning

confidence: 99%

18 - Characterizing Psychobehavioral Risks in Survivors of Multiple Primary Cancers

Belcher¹

2019

Preprint

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Background: As the population ages and cancer survival improves, the incidence of multiple primary cancers (MPC) is increasing. Several studies have documented poorer health outcomes among adults with MPC compared to single-cancer survivors. However, there is a paucity of research focused on understanding factors linking MPC to poor health outcomes and identifying individual (e.g., personality, sociodemographic, clinical) factors that increase risk. Purpose: The purpose of this study was to test a psychobehavioral stress-response model to identify factors associated with MPC health outcomes. We aimed to: 1) test the hypothesized model, examining linear relations among six latent variables: perceived stress, psychological response, behavioral response, financial toxicity, social health, and physical health; 2) explore associations between individual characteristics and upstream latent variables; and 3) describe self-management behaviors of MPC survivors. Methods: This cross-sectional study included MPC survivors recruited through a regional tumor registry whose first cancers (stages I-III) were diagnosed within 1-10 years. Data were collected via 1) a battery of validated questionnaires to measure latent variables and covariates; 2) tumor registry records; and 3) medical records. Structural equation modeling was performed to fit and modify the measurement model, specify the full SEM, and identify significant covariates. Descriptive statistics were conducted to characterize self-management. v Results: 211 participants completed questionnaires. Data fit a four-factor modified measurement model linking self-management, distress, financial toxicity, and functional health. Overweight BMI, graduate education, less neuroticism, and increased social support predicted better self-management. Poorer self-management, greater neuroticism, and lower social support predicted increased distress. Greater distress predicted financial toxicity. Greater distress and financial toxicity predicted poorer functional health. Scores for positive selfmanagement were generally high; obesity rates were above published norms. Conclusions: MPC survivors with higher risk BMI, less education, greater neuroticism, and lower social support should be considered at risk for poorer self-management and negative health outcomes. Self-management behaviors and distress are potentially modifiable intervention targets to reduce financial toxicity and improve functional health. Future research should evaluate the model with a focus on developing the science of MPC self-management and financial toxicity and include longitudinal assessments to identify critical times of increased vulnerability during MPC survivorship. vi

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Trends in the proportion of second or later primaries among all newly diagnosed malignant cancers

Anderson

Mayer

Nichols

2021

Cancer

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BACKGROUND Improvements in cancer survival mean that an increasing number of survivors may live long enough beyond their initial cancer to be diagnosed with additional independent primary cancers. The proportion of newly diagnosed cancers that are second‐ or higher‐order primaries and how this proportion has changed over the past several decades were examined. METHODS Data from the Surveillance, Epidemiology, and End Results (SEER) program were used to identify incident malignant primaries diagnosed between 1975 and 2017. Using the SEER sequence number, the authors tabulated the proportion of all cancers in each calendar year that were second‐ or higher‐order primaries. The average annual percent change (AAPC) was then calculated to assess how this proportion has changed over time. RESULTS Analyses included nearly 4.9 million incident cancers diagnosed during 1975‐2017. The proportion of all cancers that were second‐ or higher‐order increased steadily from 9.77% during 1975‐1984 to 21.03% during 2015‐2017, reflecting an AAPC of 2.41% (95% CI, 2.16%‐2.65%). In 2015‐2017, second‐ or higher‐order cancers were most prevalent among cancers of the bladder (28.79%), followed by lung and bronchus (28.07%), melanoma (27.88%), and leukemia (26.10%). The highest AAPCs over the study period were observed for melanoma (4.05%), leukemia (3.51%), and lung and bronchus (3.36%). CONCLUSIONS The proportion of newly diagnosed cancers that are second‐ or higher‐order has grown rapidly over the past several decades and currently exceeds 20%. Continued monitoring of second and later primaries will be critical for anticipating the future impact on cancer treatment and survivorship care.

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Psychological Distress, Health Behaviors, and Benefit Finding in Survivors of Multiple Primary Cancers: Results From the 2010 Livestrong Survey

Abstract: Targeted distress screening in MPC survivors may allow for early identification and interventions to ameliorate distress and reduce negative downstream health effects.

Cited by 10 publications

References 39 publications

Psychobehavioral risk factors for financial hardship and poor functional outcomes in survivors of multiple primary cancers

Psychobehavioral risk factors for financial hardship and poor functional outcomes in survivors of multiple primary cancers

18 - Characterizing Psychobehavioral Risks in Survivors of Multiple Primary Cancers

Trends in the proportion of second or later primaries among all newly diagnosed malignant cancers

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