Perceived Risk, Trust and Health-related Quality of Life Among Cancer Survivors

Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
Annals of Behavioral Medicine (Impact Factor: 4.2). 02/2010; 39(1):91-7. DOI: 10.1007/s12160-010-9163-y
Source: PubMed


To design effective interventions that improve cancer survivors' health-related quality of life (HRQoL), it is necessary to understand how HRQoL is related to cancer cognitions and interpersonal/social factors.
This study investigated whether perceived risk of recurrence is associated with HRQoL and whether trust in the follow-up care physician moderates the perceived risk/HRQoL relationship.
A cross-sectional survey of cancer survivors (N = 408).
Higher perceived risk was associated with worse mental and physical HRQoL. Higher trust was associated with better mental (but not physical) HRQoL. The inverse association between perceived risk and mental HRQoL was eliminated among those with high trust in their physicians. Trust did not moderate the perceived risk/physical HRQoL relationship.
Addressing survivors' perceived risk of recurrence and improving the provider-patient relationship may enhance interventions to improve mental HRQoL among cancer survivors. However, the causal relationships among the constructs should be explicated.

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    • "In sum, it is unclear whether predisease risk perceptions are associated with postdisease benefits or harms. Low perceived risk may promote health by buffering chronic stress responses and enabling goal pursuit, either in response to the threat of disease or during recovery (Barefoot et al., 2011; Waters et al., 2010). On the other hand, low perceived risk may be detrimental to postdisease health by heightening affective responses to an unexpected diagnosis (Shepperd & McNulty, 2002) and leaving people unprepared for life with the disease (Lehman et al., 1987). "
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    ABSTRACT: Objective: The present study used longitudinal data to explore whether subjective well-being in cancer survivors was related to predisease judgments of their likelihood of getting cancer. Method: Subjective well-being was assessed in terms of affective well-being (frequency of positive and negative affective states) and satisfaction with one's life overall. The sample consisted of 158 participants in the National Survey of Midlife Development in the U.S. (MIDUS) who developed cancer during the 8-10 years between the first and second waves of the survey (average time since diagnosis = 3.37 years; SD = 2.48), and 3,243 control participants who reported no history of cancer at either wave. Results: Controlling for demographic variables and well-being at Wave 1, the effect of cancer on well-being depended on whether, prior to being diagnosed, people judged themselves to be at low or high risk of cancer. For those perceiving a high risk, a cancer diagnosis had a modest but significant negative impact on affect and life satisfaction, whereas no negative impact emerged for those perceiving a low risk. Similar effects were not observed for heart attack risk perceptions, or for measures of trait optimism or depression, suggesting that the effect was domain-specific. Conclusions: Low precancer risk perceptions were associated with long-term benefits for subjective well-being in people who developed cancer.
    Health Psychology 03/2014; 33(9). DOI:10.1037/hea0000074 · 3.59 Impact Factor
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    • "Cancer patients, regardless of smoking-related cancer or not, should quit smoking because of the health consequences of cigarette smoking. To increase quitting among cancer survivors, cessation programs should stress the relevance of smoking to cancer (increase perceived susceptibility/risk of not quitting and perceived benefits of quitting) [31-34]. "
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    ABSTRACT: Background It has been estimated that there are approximately 12 million cancer survivors in the United States. Continued smoking after a cancer diagnosis is linked to adverse effects among cancer survivors on overall survival, treatment effectiveness, and quality of life. Little is known about who is more likely to quit smoking after his/her cancer diagnosis. The objective of this study is to evaluate factors associated with smoking cessation in cancer survivors, which to date has not been well studied. Method The National Health and Nutrition Examination Survey (NHANES) 1999–2008 surveys were used in this study. A total of 2,374 cancer survivors aged 20 and over with valid smoking status in the NHANES 99–08 survey were included in this study. Among them, 566 cancer survivors who regularly smoked at the time of their cancer diagnosis were included in the analyses. Results Around 50.6% of cancer survivors smoked regularly prior to their cancer diagnosis and only 36.1% of them quit smoking after their cancer diagnosis. Racial disparity was observed in smoking cessation among cancer survivors. Hispanics (OR = 0.23, 95% CI = 0.10-0.57) were less likely to quit smoking than Whites after their cancer diagnosis. Conclusion Two-thirds of cancer survivors continued smoking after cancer diagnosis. Our study observed that the high risk group of continued smokers among cancer survivors is made up of those who are female, younger, Hispanic, with longer smoking history, underweight or with normal weight and without smoking-related cancer. These findings suggest that smoking cessation for cancer survivors should target on the high risk subgroups.
    BMC Public Health 09/2012; 12(1):784. DOI:10.1186/1471-2458-12-784 · 2.26 Impact Factor
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    • "The field of using or not using help when (suspected) sick with cancer can be complex, as shown in research on lay navigators where some patients declined navigation, but agreed with the staff to be monitored [50]. The women in our study were not offered a new NN, if they could not use the help from the contacting NN, and it could be questioned whether the non-use could be related to something personal about the NN. "
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    ABSTRACT: Fragmentation in healthcare can present challenges for patients with suspected cancer. It can add to existing anxiety, fear, despair and confusion during disease trajectory. In some circumstances patients are offered help from an extra contact person, a Nurse Navigator (NN). Scientific studies showing who will benefit from the extra help offered are missing. This study aims to explore who could benefit from the help on offer from a nurse appointed as NN in the early part of a cancer trajectory, and what would be meaningful experiences in this context. A longitudinal study with a basis in phenomenology and hermeneutics was performed among Danish women with gynecological cancer. Semi-structured interviews provided data for the analysis, and comprehensive understanding was arrived at by first adopting an open-minded approach to the transcripts and by working at three analytical levels. Prior experience of trust, guarded trust or distrust of physicians in advance of encountering the NN was of importance in determining whether or not to accept help from the NN. For those lacking trust in physicians and without a close relationship to a healthcare professional, the NN offered a new trusting relationship and they felt reassured by her help. Not everyone could use the help offered by the NN. This knowledge is vital both to healthcare practitioners and to administrators, who want to do their best for cancer patients but who are obliged to consider financial consequences. Moreover patients' guarded trust or distrust in physicians established prior to meeting the NN showed possible importance for choosing extra help from the NN. These findings suggest increased focus on patients' trust in healthcare professionals. How to find the most reliable method to identify those who can use the help is still a question for further debate and research.
    BMC Health Services Research 06/2012; 12(12(1)):168. DOI:10.1186/1472-6963-12-168 · 1.71 Impact Factor
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