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Examining cancer survivorship trajectories: Exploring the intersection between qualitative illness narratives and quantitative screening instruments

Published online by Cambridge University Press:  28 December 2017

Chelsea Ratcliff ,
Aanand D. Naik ,
Lindsey Ann Martin  and
Jennifer Moye
Chelsea Ratcliff
Affiliation:
South Central Mental Illness Research, Education and Clinical Center, Houston, Texas Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas Baylor College of Medicine, Houston, Texas
Aanand D. Naik
Affiliation:
Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas Baylor College of Medicine, Houston, Texas
Lindsey Ann Martin
Affiliation:
South Central Mental Illness Research, Education and Clinical Center, Houston, Texas Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas Baylor College of Medicine, Houston, Texas
Jennifer Moye*
Affiliation:
VA Boston Healthcare System, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts New England Geriatric Research, Education and Clinical Center, Boston and Bedford, Massachusetts
*
Author correspondence: Jennifer Moye, VA Boston Healthcare System, 150 South Huntington Avenue, Jamaica Plain, MA 02130. E-mail: Jennifer.moye@va.gov
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Abstract

Objective

This article examines the associations of quantitatively refined trajectories of adjustment to cancer survivorship determined by previously published qualitative narrative analysis.

Method

Patients completed measures of cancer-related worry (Cancer Related Worries Scale), depression (Patient Health Questionnaire-9), posttraumatic growth (Benefit Finding Scale), and open-ended survey questions 6, 12, and 18 months postdiagnosis of head and neck, esophageal, gastric, or colorectal cancer. Previously published narrative analysis revealed five distinct survivorship “paths,” which were combined into four paths in the present article: Moving On, Seeing the World Differently, Taking One Day at a Time, and Never the Same. To determine the association of qualitatively determined paths with quantitatively assessed adjustment (i.e., Cancer Related Worries Scale, Patient Health Questionnaire-9, Benefit Finding Scale), we used linear multilevel modeling to regress the adjustment variables on time, path, the time-by-path interaction, and relevant covariates (age, stage, cancer site, ethnicity, and Deyo score).

Results

There was a significant main effect of path on cancer worry, depression, and posttraumatic growth (p < 0.02 for all). Patients in the Moving On group reported consistently low worry, depression, and growth compared to the other groups. Patients in the Seeing the World Differently and Taking One Day at a Time paths both reported moderate worry and depression; but those in the Seeing the World Differently path reported the highest posttraumatic growth, whereas patients in the Taking One Day at a Time path reported little growth. Finally, patients in the Never the Same path reported the highest worry and depression but lowest posttraumatic growth.

Significance of results

This longitudinal study reinforces the notion that cancer survivorship is not a one-size-fits-all experience nor a dichotomized experience of “distress” or “no distress.” Additionally, this hypothesis-generating study suggests future directions for potential self-report measures to help clinicians identify cancer survivors’ trajectory to develop a more patient-centered survivorship care plan.

Keywords

Cancer survivorshipillness narrativeposttraumatic growthcancer worrydepression
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 6 , December 2018 , pp. 712 - 718
Copyright
Copyright © Cambridge University Press 2017 

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References

American College of Surgeons (2015). Cancer program standards 2012: Ensuring patient-centered care. Version 1.2.1. Available from https://www.facs.org/~/media/files/quality%20programs/cancer/coc/programstandards2012.ashx.Google Scholar
Andersen, BL, DeRubeis, RJ, Berman, BS, et al. (2014) Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: An American Society of Clinical Oncology guideline adaptation. Journal of Clinical Oncology 32(15), 1605–1619.Google Scholar
Avis, NE, Smith, KW, McGraw, S, et al. (2005) Assessing quality of life in adult Cancer Survivors (QLACS). Quality of Life Research 14(4), 1007–1023.Google Scholar
Boyes, AW, Girgis, A, D'Este, CA, et al. (2013) Prevalence and predictors of the short-term trajectory of anxiety and depression in the first year after a cancer diagnosis: A population-based longitudinal study. Journal of Clinical Oncology 31(21), 2724–2729.Google Scholar
Bredart, A, Merdy, O, Sigal-Zafrani, B, et al. (2016) Identifying trajectory clusters in breast cancer survivors’ supportive care needs, psychosocial difficulties, and resources from the completion of primary treatment to 8 months later. Supportive Care in Cancer 24(1), 357–366.Google Scholar
Carlson, LE, Doll, R, Stephen, J, et al. (2013) Randomized controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). Journal of Clinical Oncology 31(25), 3119–3126.Google Scholar
Carver, CS and Antoni, MH (2004) Finding benefit in breast cancer during the year after diagnosis predicts better adjustment 5 to 8 years after diagnosis. Health Psychology 23(6), 595.Google Scholar
Chandwani, KD, Thornton, B, Perkins, GH, et al. (2010) Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. Journal of the Society for Integrative Oncology 8(2).Google Scholar
Classen, C, Butler, LD, Koopman, C, et al. (2001) Supportive-expressive group therapy and distress in patients with metastatic breast cancer. A randomized clinical intervention trial. Archives of General Psychiatry 58(5), 494–501.Google Scholar
Deimling, GT, Bowman, KF, Sterns, S, et al. (2006) Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psycho-Oncology 15(14), 306–320.Google Scholar
DeSantis, CE, Lin, CC, Mariotto, AB, et al. (2014). Cancer treatment and survivorship statistics. Cancer 64(4), 252–271.Google Scholar
Deshields, T, Tibbs, T, Fan, MY, et al. (2006) Differences in patterns of depression after treatment for breast cancer. Psycho-Oncology 15(5), 398–406.Google Scholar
Dunn, LB, Cooper, BA, Neuhaus, J, et al. (2011) Identification of distinct depressive symptom trajectories in women following surgery for breast cancer. Health Psychology 30(6), 683.Google Scholar
Feros, DL, Lane, L, Ciarrochi, J, et al. (2013). Acceptance and Commitment Therapy (ACT) for improving the lives of cancer patients: A preliminary study. Psycho-Oncology 22(2), 459–464.Google Scholar
Foley, KL, Farmer, DF, Petronis, VM, et al. (2006) A qualitative exploration of the cancer experience among long-term survivors: Comparisons by cancer type, ethnicity, gender, and age. Psycho-Oncology 15(3), 248–258.Google Scholar
Gibbons, RD, Hedeker, D, Elkin, I, et al. (1993) Some conceptual and statistical issues in analysis of longitudinal psychiatric data: Application to the NIMH Treatment of Depression Collaborative Research Program dataset. Archives of General Psychiatry 50(9), 739–750.Google Scholar
Gibbons, RD, Hedeker, D, Waternaux, C, et al. (1988) Random regression models: A comprehensive approach to the analysis of longitudinal psychiatric data. Psychopharmacology Bulletin 24(3), 438–443.Google Scholar
Greenstein, M and Breitbart, W (2000) Cancer and the experience of meaning: A group psychotherapy program for people with cancer. American Journal of Psychotherapy 54(4), 486–500.Google Scholar
Harrison, SE, Watson, EK, Ward, AM, et al. (2011) Primary health and supportive care needs of long-term cancer survivors: A questionnaire survey. Journal of Clinical Oncology 29(15), 2091–2098.Google Scholar
Hart, SL, Hoyt, MA, Diefenbach, M, et al. (2012) Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer. Journal of the National Cancer Institute 104(13): 990–1004.Google Scholar
Helgeson, VS, Reynolds, KA, and Tomich, PL (2006) A meta-analytic review of benefit finding and growth. Journal of Consulting and Clinical Psychology 74(5), 797.Google Scholar
Henselmans, I, Helgeson, VS, Seltman, H, et al. (2010) Identification and prediction of distress trajectories in the first year after a breast cancer diagnosis. Health Psychology 29(2), 160.Google Scholar
Hopko, DR, Bell, JL, Armento, MEA, et al. (2008) Cognitive-behavior therapy for depressed cancer patients in a medical care setting. Behavior Therapy 39(2):126–136.Google Scholar
Hou, WK, Law, CC, Yin, J, et al. (2010) Resource loss, resource gain, and psychological resilience and dysfunction following cancer diagnosis: A growth mixture modeling approach. Health Psychology 29(5), 484.Google Scholar
Institute of Medicine, Commission on Cancer (2006) From cancer patient to cancer survivor: Lost in transition. Washington, DC: National Academies Press.Google Scholar
Jacobsen, PB and Andrykowski, MA (2015) Tertiary prevention in cancer care: Understanding and addressing the psychological dimensions of cancer during the active treatment period. American Psychologist 70(2), 134–145.Google Scholar
Khan, NF, Rose, PW, and Evans, J (2012) Defining cancer survivorship: A more transparent approach is needed. Journal of Cancer Survivorship 6(1), 33–36.Google Scholar
Koch, L, Jansen, L, Brenner, H, et al. (2013) Fear of recurrence and disease progression in long-term (≥ 5 years) cancer survivors—a systematic review of quantitative studies. Psycho-Oncology 22(1), 1–11.Google Scholar
Kroenke, K, Spitzer, RL, and Williams, JB (2001) The PHQ-9. Journal of General Internal Medicine 16(9), 606–613.Google Scholar
Lam, WW, Bonanno, GA, Mancini, AD, et al. (2010) Trajectories of psychological distress among Chinese women diagnosed with breast cancer. Psycho-Oncology 19(10), 1044–1051.Google Scholar
Martin, LA, Moye, J, Street, RL Jr, et al. (2014) Reconceptualizing cancer survivorship through veterans’ lived experiences. Journal of Psychosocial Oncology 32(3), 289–309.Google Scholar
Mehnert, A, Berg, P, Henrich, G, et al. (2009) Fear of cancer progression and cancer-related intrusive cognitions in breast cancer survivors. Psycho-Oncology 18(12):1273–1280.Google Scholar
Mojtabaie, M and Gholamhosseini, S (2014) Effectiveness of Acceptance and Commitment Therapy (ACT) to reduce the symptoms of anxiety in women with breast cancer. Journal of Social Issues & Humanities 4(2), 522–527.Google Scholar
Moryl, N, Coyle, N, Essandoh, S, et al. (2010) Chronic pain management in cancer survivors. Journal of the National Comprehensive Cancer Network 8(9), 1104–1110.Google Scholar
Moye, J, Wachen, JS, Mulligan, EA, et al. (2014) Assessing multidimensional worry in cancer survivors. Psycho-Oncology 23(2), 237–240.Google Scholar
Naik, AD, Martin, LA, Karel, M, et al. (2013) Cancer survivor rehabilitation and recovery: Protocol for the Veterans Cancer Rehabilitation Study (Vet-CaRes). BMC Health Services Research 13(1), 93.Google Scholar
National Comprehensive Cancer Network (2008) NCCN clinical practice guidelines in oncology: Distress Management.Google Scholar
Páez, M, Luciano, MC, Gutiérrez, O (2007) Psychological treatment for breast cancer: Comparison between acceptance based and cognitive control based strategies. Psicooncología 4, 75–95.Google Scholar
Pirl, WF, Fann, JR, Greer, JA, et al. (2014) Recommendations for the implementation of distress screening programs in cancer centers: Report from the American Psychosocial Oncology Society (APOS), Association of Oncology Social Work (AOSW), and Oncology Nursing Society (ONS) Joint Task Force. Cancer 120(19), 2946–2954.Google Scholar
Pots, WTM, Fledderus, M, Meulenbeek, PAM, et al. (2016) Acceptance and commitment therapy as a web-based intervention for depressive symptoms: Randomised controlled trial. The British Journal of Psychiatry 208(1) 69–77.Google Scholar
Ratcliff, CG, Milbury, K, Chandwani, KD, et al. (2016) Examining mediators and moderators of yoga for women with breast cancer undergoing radiotherapy. Integrative Cancer Therapies 15(3), 250–262.Google Scholar
Resick, PA, Wachen, JS, Dondanville, KA, et al. (2017) Effect of group vs individual cognitive processing therapy in active-duty military seeking treatment for posttraumatic stress disorder: A randomized clinical trial. Journal of the American Medical Association Psychiatry 74(1):28–36.Google Scholar
Salsman, JM, Segerstrom, SC, Brechting, EH, et al. (2009) Posttraumatic growth and PTSD symptomatology among colorectal cancer survivors: A three-month longitudinal examination of cognitive processing. Psycho-Oncology 18(1), 30–41.Google Scholar
Schneider, S, Moyer, A, Knapp-Oliver, S, et al. (2010) Pre-intervention distress moderates the efficacy of psychosocial treatment for cancer patients: A meta-analysis. Journal of Behavioral Medicine 33(1), 1–14.Google Scholar
Simard, S and Savard, J (2009) Fear of cancer recurrence inventory: Development and initial validation of a multidimensional measure of fear of cancer recurrence. Supportive Care in Cancer 17(3):241–251.Google Scholar
Skaali, T, Fossa, SD, Bremnes, R, et al. (2009) Fear of recurrence in long-term testicular cancer survivors. Psycho-Oncology 18(6):580–588.Google Scholar
Stanton, AL, Bower, JE, and Low, CA (2006) Posttraumatic growth after cancer. In Handbook of posttraumatic growth: Research and practice. Calhoun, LG and Tedeschi, RG (eds), pp. 138–175) Mahwah, NJ: Erlbaum.Google Scholar
Stanton, AL (2012) What happens now? Psychosocial care for cancer survivors after medical treatment completion. Journal of Clinical Oncology 30(11), 1215–1220.Google Scholar
Stanton, AL, Rowland, JH, and Ganz, PA (2015). Life after diagnosis and treatment of cancer in adulthood: Contributions from psychosocial oncology research. American Psychologist 70(2), 159.Google Scholar
Thewes, B, Butow, P, Zachariae, R, et al. (2011) Fear of cancer recurrence: A systematic literature review of self-report measures. Psycho-Oncology 21(6), 571–587.Google Scholar
Tomich, PL and Helgeson, VS (2004) Is finding something good in the bad always good? Benefit finding among women with breast cancer. Health Psychology 23(1), 16.Google Scholar
Wang, Y, Yi, J, He, J, et al. (2014) Cognitive emotion regulation strategies as predictors of depressive symptoms in women newly diagnosed with breast cancer. Psycho-Oncology 23(1), 93–99.Google Scholar