Assessing longitudinal quality of life in prostate cancer patients and their spouses: a multilevel modeling approach.
ABSTRACT This study aimed at examining the relationship between quality of life (QOL) in prostate cancer (PCa) patients and partners and how baseline demographics, cancer-related factors, and time-varying psychosocial and symptom covariates affect their QOL over time.
Guided by a modified Stress-Coping Model, this study used multilevel modeling to analyze longitudinal data from a randomized clinical trial that tested a family-based intervention to improve QOL in couples managing PCa. Patients and partners from the usual-care control group (N = 134 dyads) independently completed the measurements at baseline, and at 4-, 8-, and 12-month follow-ups.
Correlations of QOL between patients and partners over time were small to moderate. Patients' lower education level, partners' older age, higher family income, and localized cancer at baseline were associated with better QOL in couples. Over time, couples' QOL improved as their social support and cancer-related dyadic communication increased and as couples' uncertainty, general symptoms, and patients' prostate cancer-related sexual and hormonal symptoms decreased.
Evidence indicates that couples' QOL during cancer survivorship is affected by multiple contextual factors (e.g., baseline demographics and time-varying psychosocial factors and symptoms). Intervention research is needed to explore comprehensive strategies to improve couples' QOL during the continuum of PCa survivorship.
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ABSTRACT: A decrease in the quality of life among family caregivers of advanced cancer patients negatively influences the quality of care provided. Thus, evaluating caregiver quality of life and related factors is very significant because it can guide nurses to maintain health status and ability of caregivers to provide caring for their loved one. This study, based on the Stress Process Model, examined causal relationships among caregiver's age, education, income, caregiver burden, family hardiness, coping, social support, and quality of life among family caregivers of patients with advanced cancer. A sample of 275 caregivers was recruited from two tertiary hospitals in the Central Region of Thailand. Data were collected via six questionnaires including a demographic data questionnaire, the Zarit Burden Interview, the Family Hardiness Index, the Jalowiec Coping Scale, the Social Support Questionnaire, and the Ferrans and Powers Quality of Life Index Cancer Version-III and analyzed through use of descriptive statistics and path analysis. The final model of factors influencing quality of life among family caregivers of patients with advanced cancer fitted the empirical data and explained 45% of the variance in caregiver quality of life. The results also indicated caregiver age, social support and family hardiness had significant direct positive effects on caregiver quality of life; whereas, burden had a significant negative direct effect on this, and an indirect effect through social support and family hardiness. The findings suggest that nurses should develop a program focused on reducing burden, enhancing caregivers' support and family hardiness, and helping them to maintain their quality of life. However studies to evaluate this program are needed test this causal model in other populations in Thailand. Pacific Rim Int J Nurs Res 2013 ; 17(4) 304-316Pacific Rim International Journal of Nursing Research. 10/2013; 17(4):304-316.
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ABSTRACT: Uncertainty in cancer patients and survivors about cancer-related symptoms, treatment, and disease course has been related to poorer mental and physical health. However, little is known about whether cancer-related uncertainty relates with specific disease and treatment-related outcomes such as fatigue, insomnia, and affect disruptions. In this paper, we report these associations in younger survivors aged 50 years or less, a population increasing in prevalence. Participants included 313 breast cancer survivors (117 African-Americans and 196 Caucasians) who were aged 24 to 50 years and were 2 to 4 years posttreatment. Self-reported cancer-related uncertainty (Mishel Uncertainty in Illness Scale-Survivor Version), fatigue (Piper Fatigue Scale-Revised), insomnia (Insomnia Severity Index), and negative and positive affect (Positive and Negative Affect Schedule (PANAS)) measures were collected upon study entry. Hierarchical regression analyses controlled for relevant sociodemographic variables include the following: race, age, years of education, number of children, employment status, marital status, monthly income, smoking status, family history of cancer, endorsement of treatment-induced menopause, and religiosity. Over and above these factors, higher cancer-related uncertainty was significantly associated with more self-reported fatigue (β = .43), insomnia (β = .34), negative affect (β = .43), as well as less positive affect (β = -.33), all ps < .01. Younger breast cancer survivors who are 2-4 years posttreatment experience cancer-related uncertainty, with higher levels associated with more self-reported psychophysiological disruptions. Cancer survivors who present in clinical settings with high uncertainty about recurrence or management of long-term effects of treatment may thus benefit from assessment of fatigue, insomnia, and affect.Supportive Care in Cancer 04/2014; · 2.09 Impact Factor
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ABSTRACT: Satisfaction with care is thought to be important for quality of life (QOL) of family caregivers of patients with recurrent or metastasized digestive cancer requiring palliative care. This study aimed to clarify (1) family caregivers' QOL status and (2) factors related to their QOL, including satisfaction with care. Data were collected from 111 family caregivers of patients with recurrent or metastasized digestive cancer. The Short-Form 36 (SF-36) (acute version) was used to measure QOL. Family caregivers' QOL was lower than the national average (Cohen's d = 0.12-0.66). Lower age of patients and family caregivers (standardized regression coefficient (β) = -0.18, β = -0.26) and family caregivers' perceived health (β = 0.22) were related to better physical health of family caregivers, but satisfaction with care was not related to physical health. However, family caregivers' mental health was related to their satisfaction with care (Spearman's rank correlation coefficient (r) = 0.49-0.61, standardized regression coefficient (β) = 0.24-0.42), as well as higher age of family caregivers (β = 0.25), their perceived health (β = 0.30), non-spousal caregiver (β = -0.20), patient lacking a history of surgery aimed at radical treatment (β = -0.22), and patient not hospitalized solely for symptom relief (β = -0.10). Family caregivers of patients with recurrent or metastasized digestive cancer requiring palliative care had lower QOL, both physically and mentally, than the national average. Improvements in satisfaction with care may contribute to improved QOL.Supportive Care in Cancer 05/2014; · 2.09 Impact Factor