Author

Julie McNulty

Date

5-2013

Document Type

Dissertation

Degree Name

Ph.D.

Institution

Oregon Health & Science University

Abstract

Cancer survivors are living longer, growing in number as the proportion of older adults in the population increases, and are now recognized as being at risk for decrements in health and well-being due to cancer and cancer treatment. Effects of treatment may persist many years after diagnosis and new treatment-related problems can appear years after treatment is completed. Challenges that confront survivors are not simply a continuation of experiences that occur during the cancer treatment phase; they are unique problems in the cancer illness trajectory, as the person treated for cancer transitions from the acute to the chronic phases of the illness. Persistent effects include physical and psychological symptoms, and social and spiritual impact. Rural-dwelling survivors are viewed as having higher levels of risk for decrements in health and well-being due to decreased access to healthcare, specialty services, and support resources. The purpose of this descriptive and mixed methods design study is to explore and compare the impact of cancer in rural and urban-dwelling adult cancer survivors in two regions of the Pacific Northwest, Alaska and Oregon. The majority of iv areas in the state of Oregon are considered rural but there is road access to all the inhabited areas of the state and the weather is not as severe as that of Alaska. Rural Alaskans live in some of the most remote and isolated regions of the United States with extreme geographical and weather challenges and high travel costs. The convenience sample (N=132) included adult survivors of all cancer types who had completed cancer treatment and were cancer-free. Participants were recruited through distributing emails and flyers to cancer survivorship programs, support group leaders, oncology and primary care providers, and networking strategies. Data was collected via a web based survey (88%) and survey completed on paper and mailed (12%). The sample was predominantly middle aged, with a mean age of 58, and included 84% women. Time since treatment was completed ranged from 3 months to 36 years (mean 6.7). The most common types of cancer reported by the sample included breast (54%), gynecologic (9%), lymphoma (8%), head and neck (7%) and colorectal (5%). Measures included the Impact of Cancer, version 2 (IOCv2) and the Memorial Symptom Assessment Scale short form (MSAS-SF). Means and standard deviations for the major variables from the total sample were IOC positive impact scale (M = 4.09, SD = .65), IOC negative impact Scale (M = 2.67, SD = .82), employment concerns (M = 2.60, SD = 1.11), relationship concerns partnered (M = 2.71, SD = .74), relationship concerns non-partnered (M = 2.72, SD = 1.3), MSAS-SF v physical symptom scale (M = 1.21, SD = .61). Comparison across the regions showed statistically significant differences in body concerns [(F (1, 132) = 4.08, p< .05, worry F (1, 132) = 4.98, p< .05, negative impact F (1, 132) = 4.38, p< .05, and employment concerns F (1, 132) = 18.48, p< .05]. Overall, the Alaska rural group reported the most positive outcomes. A subsample of 19 cancer survivors were interviewed and qualitative findings revealed a temporal pattern of late survivorship, with major posttreatment themes identified as reconciling, cancer/life perspective, survivor identity, and long-term impact. Themes reflecting rural/urban differences included access to healthcare, travel, care coordination/navigation, connecting and community, thinking about death and dying, public/private journey, and advocacy. Three profiles of intensity and impact also emerged from the qualitative data. The results of this study challenge prevalent assumptions about rural-dwelling cancer survivors and their risk for negative outcomes. Findings provide insight into the differences and similarities between rural and urban cancer survivors. From the qualitative findings, a preliminary framework of survivorship emerged, which extends into later stages of survivorship. Unique themes, not previously described as rural/urban differences, were discovered, and a profile of rural survivorship emerged, with a common thread being community. Access to healthcare may not be the driver of the survivorship experience. Symptoms have a strong vi impact. There is an opportunity to influence healthcare providers and develop programs serving this growing population with their complex issues, building on the strengths of both rural and urban living, and the engagement of the cancer survivor community.

Identifier

doi:10.6083/M4N014VZ

School

School of Nursing

Included in

Nursing Commons

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