Cervical cancer survivorship in a population based sample
ABSTRACT Though cervical cancer is preventable, this cancer nonetheless poses serious mortality and morbidity threats to American women and women globally. The purpose of this study is to utilize a multidimensional framework to assess Health-related Quality of Life (HRQOL) and its salient predictors among a population based sample of cervical cancer survivors.
A cross-sectional design was used with a population-based sample ascertained from the California Cancer Surveillance Program. Descriptive, bivariate and multivariate regression analyses were conducted.
Participants were 560 cervical cancer survivors: English-speaking Latina- (n=88), Spanish-speaking Latina- (n=199) and European- (n=273) Americans. The greatest concerns were documented for family/social and emotional well-being, and body image and sexual health. In general, Latina-Americans reported poorer overall HRQOL, functional, emotional, and social/family wellbeing compared to European-Americans. Differences in HRQOL persisted by ethnic/language group after controlling for covariates. Radiation, comorbidity, role limitations, perceived health status, psychological wellbeing, body image, sexual impact, doctor-patient relationship, and social support were significant predictors of overall HRQOL. The regression model explained 58% of the variance in predicting HRQOL.
These cervical cancer survivors reported poor to moderate HRQOL with persistent psychosocial challenges. Our findings indicate that lower SES, monolingual Latinas are at greatest risk for poor HRQOL outcomes. Clinicians should pay attention to their patients' socio-ecological context as a risk factor for poorer outcomes; and provide early referrals to resources that are low cost and culturally and linguistically appropriate.
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ABSTRACT: Little population-based research has been done on social, economic, and environmental factors affecting quality of life (QOL) among long-term cancer survivors. This research assesses the impact of disease and nondisease factors on QOL among long-term survivors of cervical cancer. In a collaborative, observational study, data were obtained from cancer registries, interviews, and self-administered questionnaires. Comparisons of QOL were made between women with cervical cancer histories and women from the general population. A total of 715 women 4-28 years postdiagnosis were identified from cancer registries in Connecticut (N = 208), Detroit Metropolitan Area (N = 211), New Mexico (N = 197), and Hawaii (N = 99). QOL was measured according to four SF-36 dimensions-physical functioning, social functioning, bodily pain, and general health status. Means on SF-36 measures among women with cervical cancer histories were close to or higher than women in the general population. In a multiple regression analysis, economic disadvantage negatively predicted physical functioning (B = -13.4, SE = 2.1), social functioning (B = -13.2, SE = 2.4), bodily pain (B = -12.6, SE = 2.5), and general health (B = -12.8, SE = 2.1). Residence in New Mexico negatively predicted several QOL dimensions. No impact of race was detected when income was controlled. Disease stage did not predict QOL. Cervical cancer does not generally reduce QOL among long-term survivors. Economic disadvantage and residential location affect QOL through mechanisms yet to be determined. Women diagnosed with cervical cancer have good prospects for high quality of life; socioeconomic status strongly affects quality of life over the long term.Journal of Cancer Survivorship 04/2014; DOI:10.1007/s11764-014-0352-8 · 3.29 Impact Factor
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ABSTRACT: Abstract Objective: International research suggests that many women with gynecological cancers have unmet supportive care needs that often correlate with greater psychological distress and poorer quality of life. The United States has a diverse population and evolving healthcare system, so this study aims to identify the support needs of women with gynecologic cancer in this geographic region. Furthermore, there are numerous health disparities with regards to cancer care; therefore, a second aim of this study is to explore health disparities in unmet support needs. Method: Fifty-one women with gynecologic cancers completed an adapted version of the Supportive Care Needs Survey. Sociodemographic and cancer-related information were also collected. Results: Findings revealed a high frequency of unmet support needs, particularly in the psychological, physical, and practical domains. Additionally, disparities in levels of support needs were found to be dependent on income and minority status. Specifically, unmet needs in the physical/daily living and practical domains were dependent on income, and minorities reported significantly higher support needs in the sexuality and psychological need domains than their majority counterparts. Conclusions: These results highlight the potential benefits of enhanced multidisciplinary services to better assess and address patients' needs. Nonetheless even with enhanced services, the findings, consistent with other health disparities research, suggest lower income affects access to care, so more research is needed on how to overcome these barriers.Journal of Psychosocial Oncology 08/2014; 32(6). DOI:10.1080/07347332.2014.955240 · 1.04 Impact Factor
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ABSTRACT: A better understanding about the factors associated with cervical cancer survival disparities is an important step in developing more effective cervical cancer intervention strategies. This study investigates cervical cancer survival disparities from three different perspectives based on data from the Texas Cancer Registry from 1995 to 2005. These perspectives are race/ethnicity, area socioeconomic status (SES), and geographic locations. We examined the role of both individual- and contextual-level factors in cervical cancer survival disparities using a multilevel survival analysis. Individual-level factors included race/ethnicity, age at diagnosis, year of diagnosis, tumor grade, stage at diagnosis, and type of treatment received. Contextual-level factors are census-tract-level variables, including demographic characteristics, health insurance expenditure, behavioral factors, extent of urbanization, and spatial access to primary care physicians. This study reveals that African-Americans had a higher mortality risk (HR, 1.19; 95% CI, 1.03-1.38) especially if stage was unknown (HR, 1.72; 95% CI, 1.08-2.75) compared with non-Hispanic whites. Among women diagnosed at regional or distant stage, Hispanics had a survival advantage over their non-Hispanic white counterparts (HR, 0.80; 95% CI, 0.69-0.94). We also identified geographic areas where longer-than-expected or shorter-than-expected cervical cancer survival was statistically significant. Only a small portion of these disparities were explained by individual- and contextual-level factors. This study suggests that Race/Ethnicity, SES, and geography are associated with cervical cancer survival in Texas.Applied Geography 01/2015; 56:21-28. DOI:10.1016/j.apgeog.2014.10.004 · 3.08 Impact Factor