Changes in fatigue, health-related quality of life and physical activity after a one-week educational program for cancer survivors.

Background: Rehabilitation aims to improve function, but the effects of different programs are not clear. The aims of the present study were to: (1) compare the level of fatigue and health-related quality of life (HRQOL) of cancer survivors admitted to a one-week inpatient educational program (IEP) to the general population (NORMS), (2) examine changes in fatigue, HRQOL and physical activity after the IEP and (3) examine the proportions of survivors for female and male separately with clinically relevant improvement (>10% of maximum scale). Methods: Cancer survivors ≥18 years, diagnosed with breast-, prostate- or gastrointestinal cancer within the last 10 years, about to attend a one-week IEP were invited to an observational study with a pre-post design. The IEP included lectures, group discussions and physical activity. The participants completed a questionnaire on the arrival day (T0) and three months after the stay (T1). Fatigue was assessed by the Fatigue Questionnaire and HRQOL by Short Form-36. Results: Compared to NORMS, both female and male participants had significantly higher mean levels of fatigue and poorer HRQOL at T0 and T1. From T0 to T1, among all participants physical fatigue was reduced from 12.6 (SD 3.9) to 11.8 (SD 3.8; p < .001), mental fatigue from 6.3 (SD 2.2) to 6.0 (SD 2.2; p = .044) and total fatigue from 19.0 (SD 5.3) to 17.8 (SD 5.4; p = .001). Among female participants, 30% experienced clinically relevant improvement in physical fatigue, 28% in total fatigue and 36% in general health. Of male participants, 31% displayed a clinically relevant improvement in role limitations physical. Conclusion: Participants in the IEP reduced their levels of fatigue and improved aspects of HRQOL, more often observed among female participants than among males. Because of the lack of a control group it is not possible to conclude whether the changes were due to the IEP.

Gender differences in health status and benefits of a one-week educational programme for caregivers of cancer patients.

OBJECTIVE: The aims of this study were to investigate differences between female and male caregivers' health status before and 3 months after a one-week educational programme, self-reported needs for support and changes in health status over time. METHODS: Caregivers were partners of cancer patients aged ≥18 years who participated in the programme. Questionnaires were completed at baseline and 3 months after the programme. RESULTS: At baseline, 167 caregivers completed the questionnaire, 55% were females and the mean age 60.2 years (range 31-79). Female caregivers reported poorer vitality (p = 0.016) and more chronic fatigue compared to male caregivers (28% vs. 13%, p = 0.036). Females more frequently reported need for support: psychological counselling (21% vs. 3%, p = 0.001), group conversations (51% vs. 28%, p = 0.003), nutritional counselling (39% vs. 17%, p = 0.002) and recreational stay (46% vs. 24%, p = 0.004). Significant benefits within-group changes were observed among female caregivers in role physical, general health, vitality, social functioning, mental and total fatigue, whereas no significant within-group changes were observed for males. However, in adjusted analyses no significantly between-group gender differences in mean changes were observed. CONCLUSION: More studies are needed to better understand the differences and possible effects of programmes among female and male caregivers in order to develop relevant support.

Perceived needs for different components in a rehabilitation program among cancer survivors with chronic fatigue compared to survivors without chronic fatigue.

BACKGROUND: Knowledge about the user' needs is important to develop targeted rehabilitation for cancer patients with chronic fatigue (CF). The aims of the study were to examine prevalence of CF in cancer survivors attending an one-week inpatient educational program (IEP) and to identify characteristics of those with CF. Further to examine the perceived needs for different components in a rehabilitation program, need of complex rehabilitation (at least two components) and aspects of health-related quality of life (HRQoL) among survivors with CF versus those without CF. MATERIAL AND METHODS: Cancer survivors ≥18 years, diagnosed with different types of cancer within the last 10 years and attending a one-week IEP were invited to this cross-sectional study. CF was assessed by the Fatigue Questionnaire, perceived needs by asking a question about needs for different components in a rehabilitation program and HRQoL was assessed by The Medical Outcomes Study Short Form 36. RESULTS: Of 564 participants, 45% reported CF. Breast cancer, mixed cancer types (including small groups with different cancer types) and comorbidities increased the risk for having CF. Compared to participants without CF, the participants with CF reported more frequently need for physical training (86% vs. 65%, p < 0.001), physiotherapy (71% vs. 55%, p < 0.001) and nutrition counseling (68% vs. 53%, p = 0.001). Among participants with CF, 75% reported need for three or more components whereas 54% reported need for the same number of components among those without CF (p < 0.001). CONCLUSION: Almost half of the cancer survivors attending the IEP had CF. Physical training, physiotherapy and nutrition counseling were the most frequently reported needs and significantly more often observed in participants with CF than without CF. A higher percentage of those with CF reported need for a complex rehabilitation compared to those without CF. More research is necessary to obtain more knowledge to further make targeted programs to better match cancer survivors' needs.

Return to work among self-employed cancer survivors.

PURPOSE: The aim of this study is to investigate whether salaried and self-employed workers differ regarding factors relevant for return to work after being diagnosed with cancer. The possible mediators of an effect of self-employment on work ability were also investigated. METHODS: A total of 1115 cancer survivors (1027 salaried and 88 self-employed) of common invasive cancer types who were in work at the time of diagnosis completed a mailed questionnaire 15-39 months after diagnosis. RESULTS: Twenty-four percent of self-employed cancer survivors reported that they had not returned to work at the time of the survey, and 18 % of those who were salaried had not. While 9 % of the self-employed had received disability or early retirement pension, only 5 % had received such a pension among salaried employees. Compared with the salaried workers, the self-employed people reported significantly more often reduced work hours (P < 0.001), negative cancer-related financial (P < 0.001), and occupational changes (P = 0.005) and low overall health (P = 0.02), quality of life (P = 0.04), and total work ability (P = 0.02). The negative effect of self-employment on total work ability seems to be mediated by reduced work hours and a negative cancer-related financial change. CONCLUSIONS: Compared with salaried, self-employed workers in Norway, they seem to struggle with work after cancer. This may be because the two groups have different work tasks and because self-employed people have lower social support at work and less legal support from the Working Environment Act and public health insurance. IMPLICATIONS FOR CANCER SURVIVORS: Self-employed people with cancer should be informed about the work-related challenges they may encounter and be advised to seek practical help from social workers who know about the legal rights of self-employed people.

Lifestyles of cancer survivors attending an inpatient educational program-a cross-sectional study.

PURPOSE: Cancer survivors have increased risk for adverse health effects, but the risk can be reduced by adopting a healthy lifestyle. Knowledge of lifestyle in terms of physical activity (PA), diet (intake of fruit and vegetables [F&V]) and smoking behaviors of cancer survivors enrolled in an inpatient educational program and identification of subgroups not meeting the lifestyle guidelines are needed to set up more targeted programs. METHODS: We invited 862 cancer survivors, ≥18 years, diagnosed within the last 10 years and about to attend a 1-week educational program, to participate in this cross-sectional study. Sixty-seven percent (n = 576) returned the questionnaire before the start of the program. PA, F&V intake (5-A-Day) and smoking behaviors were self-reported. Logistic regression analyses were used to identify the characteristics of those not meeting the guidelines. RESULTS: Sixty-three percent were women, median age was 60 years (range 28-83), 52 % had high education and median time since diagnosis was 12 months (range 2-119). Fifty-five percent did not meet the PA guidelines, 81 % did not meet the 5-A-Day guidelines and 12 % were current smokers. In multivariate analyses, age ≥60 years and low education were associated with not meeting the PA guidelines, and male gender and low education were associated with not meeting the 5-A-Day guidelines. Living alone was associated with smoking. CONCLUSIONS: The majority of cancer survivors attending an educational program do not meet the public guidelines for PA and diet. Special attention should be given to those who are male, over age 60 years and with low education.

What is covered by "cancer rehabilitation" in PubMed? A review of randomized controlled trials 1990-2011.

OBJECTIVE: This focused review examines randomized controlled studies included by the term "cancer rehabilitation" in PubMed. The research questions concern the type of interventions performed and their methodological quality. DESIGN: Using the Medical Subject Headings (MeSH) terms: neoplasm AND rehabilitation, all articles with randomized controlled studies that included adult cancer patients, written in English, were extracted from PubMed. Papers covering physical exercise, psychiatric/psychological treatment or social support only were excluded as they had been reviewed recently. Abstracts and papers were assessed by 3 pairs of reviewers, and descriptive information was extracted systematically. Methodological quality was rated on a 10-item index scale, and the cut-off for acceptable quality was set at ≥ 8. RESULTS: A total of 132 (19%) of the 683 identified papers met the eligibility criteria and were assessed in detail. The papers were grouped into 5 thematic categories: 44 physical; 15 art and expressive; 47 psycho-educative; 21 emotionally supportive; and 5 others. Good quality of design was observed in 32 studies, 18 of them uni-dimensional and 14 multi-dimensional. CONCLUSION: Published randomized controlled studies on cancer rehabilitation are heterogeneous in terms of content and samples, and are mostly characterized by suboptimal design quality. Future studies should be more specific and well-designed with sufficient statistical strength.

Change in employment status of 5-year cancer survivors.

AIMS: To follow the employment status of 5-year cancer survivors for 5 years after diagnosis with their first lifetime invasive cancer and to identify socio-demographic, work-related and cancer-related predictors of employment status after 5 years. METHODS: This prospective registry study concerned all 3278 people in Norway (18-61 years old) diagnosed with their first lifetime invasive cancer in 1999 and alive in 2004 and a cancer-free control group (n = 6368) matched by sex, age, educational level and employment status in 1998. RESULTS: The employment rate among male cancer survivors declined steadily every year, from 94% the year before diagnosis (1998) to 77% 5 years after diagnosis (2004). This change did not differ significantly from that of male controls. The employment rate of female survivors also declined steadily, from 87% (1998) to 69% (2004). This decline was greater than that among female controls, and in 2004 survivors had a significantly lower employment rate. For both men and women, the significant pre-diagnosis predictors of being employed in 2004 concerned higher socio-economic position. For both sexes, lung cancer survivors had the highest decline in employment rate, and male skin cancer survivors had a lower decline in employment rate than controls. Socio-demographic and work-related factors explained more of the variance in employment status than did cancer diagnosis. CONCLUSION: The employment rate among 5-year cancer survivors did not change significantly except for female survivors. Low socio-economic position is a risk factor for decline in employment rate and should be focused on to prevent cancer-related inequity.

Sick leave patterns among 5-year cancer survivors: a registry-based retrospective cohort study.

PURPOSE: The aims of this study were to observe the sick leave rates of cancer survivors for five consecutive years following a first lifetime diagnosis of invasive cancer and to identify socio-demographic and clinical predictors of sick leave taken in the fifth year after diagnosis. METHODS: This registry study comprised 2,008 Norwegian individuals (18-61 years old) with their first lifetime diagnosis of invasive cancer in 1999 and alive in 2004 and a cancer-free control group (n = 3,240) matched by sex, age, educational level, and employment status in 1998. Sick leave was defined as at least one sick leave period >16 days within the year in question. RESULTS: A total of 75 % of the long-term cancer survivors (LTCSs) took sick leave within the first 12 months after their diagnosis. The sick leave rate stabilized at a slightly higher level in the following 4 years compared to the year before diagnosis, with approximately 23 % of the male and 31 % of the female LTCSs taking sick leave. Being single with children, having low education, working in health and social work sector, or having taken sick leave the year before diagnosis (1998) predicted the sick leave taken 5 years after diagnosis (2004) among LTCSs. Compared to the controls, LTCSs with rectal, lymphogenic, breast, or "other" types of cancer had significantly higher sick leave rates 5 years after diagnosis. Socio-demographic factors explained more of the variance in sick leave than did clinical factors. CONCLUSION: Employed LTCSs struggle with their ability to work 5 years after diagnosis. More research is needed to identify factors that would promote LTCSs' health and ability. IMPLICATIONS FOR CANCER SURVIVORS: A socioeconomic and work environmental perspective seems necessary for achieving effective occupational rehabilitation and preventing sick leave among LTCSs.

Worksite adjustments and work ability among employed cancer survivors.

OBJECTIVES: This study was conducted to determine how many cancer survivors (CSs) make worksite adjustments and what kinds of adjustments they make. Changes in work ability among employed CSs were explored, and clinical, sociodemographic, and work-related factors associated with the current total work ability were studied. METHODS: CSs of the ten most common invasive types of cancer for men and women in Norway completed a mailed questionnaire 15-39 months after being diagnosed with cancer. Included in the analyses were all participants who worked both at the time of diagnosis and at the time of the survey and who had not changed their labor force status since diagnosis (n = 563). The current total work ability was compared to the lifetime best (0-10 score). RESULTS: Twenty-six percent of the employed CSs had made adjustments at work, and the most common adjustment was changing the number of work hours per week. Despite the fact that 31% and 23% reported reduced physical and mental work abilities, respectively, more than 90% of the CSs reported that they coped well with their work demands. The mean total work ability score was high (8.6) among both men and women. Being self-employed and working part-time at the time of diagnosis showed significant negative correlations with total work ability, while a favorable psychosocial work environment showed a significant positive correlation. CSs with low work ability were more often in contact with the occupational health service and also made more worksite adjustments than others. CONCLUSION: The prospects of future work life seem optimistic for Norwegian employed CSs who return to work relatively soon after primary treatment.

"The impact of cancer scale" version 1: psychometric testing of the Norwegian translation in a heterogeneous sample of cancer survivors.

PURPOSE: The impact of cancer scale version 1 (IOC-1) from 2006 has only been tested psychometrically in a heterogeneous sample of 193 American long-term cancer survivors (LTSs). The Norwegian version of IOC-1 compares the psychometric findings of that study with those observed in a heterogeneous sample of 809 Norwegian LTSs. METHODS: We performed exploratory (EFA) and confirmatory (CFA) factor analyses, tests of internal consistency, correlational studies with various other tests and a change over time examination in order to test reliability and validity of the IOC-1. RESULTS: The American factor structure of the IOC-1 with 10 dimensions showed adequate fit with CFA in the Norwegian sample, but internal consistency was insufficient in 2 dimensions. EFA of the Norwegian sample found a 9 factor solution that also showed adequate fit on CFA, and with sufficient internal consistencies for all dimensions. The SF-36 dimensions, anxiety, depression, neuroticism, fatigue and body image all showed low correlations with the positive dimensions of the IOC-1, but higher correlations with the IOC-1 negative dimensions. The IOC-1 dimensions showed considerable stability over time. CONCLUSIONS: In our big heterogeneous sample of LTSs, the Norwegian version of the IOC-1 showed discriminant and concurrent validity, and reliability was supported.

Social support at work and work changes among cancer survivors in Norway.

AIMS: To investigate how cancer survivors (CSs) experience the cancer-related support they get at the workplace, the proportion of CSs who change work due to cancer and the sociodemographic and work-related factors associated with CSs' work changes. METHODS: CSs of the 10 most common invasive types of cancer for men and women in Norway completed a mailed questionnaire 15-39 months after primary treatment. All CSs who were working when diagnosed were included in the analyses (n = 1115). Leaving the workforce and making other important changes in paid work were regarded as work changes. RESULTS: When diagnosed with cancer, 84% of the CSs experienced their supervisor as caring vs. 90% for colleagues. At the time of the survey, 84% were still working; 24% had made changes in work due to the cancer. Work changes due to cancer were most common among CSs who reported low supervisor support related to the cancer (odds ratio (OR) 0.78) and high physical (OR 2.48) and psychological job demands (OR 1.39) at the time of diagnosis. Work changes were more common among self-employed CSs than among employees (OR 2.03). CSs with high education (OR 0.59) and medium income (OR 0.66) made fewer work changes than other CSs, but these differences were not significant when controlled for the work factors. CONCLUSIONS: Close follow-up by supervisors should be a key element in workplace health promotion programmes for CSs. Further, the programmes should target both physical and psychosocial work factors.

A comparative study of cancer patients with short and long sick-leave after primary treatment.

BACKGROUND: Sick-leave after primary cancer treatment has hardly been studied. This study compares Norwegian cancer patients (CPs) with shorter (≤8 months) and longer (≥9 months) sick-leave after primary cancer treatment. Our aim was to characterize factors associated with these two types of sick-leave in order to identify possible factors for interventions by which long-term sick-leaves may be avoided. METHODS: A mailed questionnaire was completed by a sample of Norwegian CPs 15 to 39 months after primary treatment of the ten most common invasive types of cancer. The groups with shorter (n=359) and longer (n=481) sick-leaves (SSL vs LSL) were compared with each other by self-reported information as to socio-demographic and cancer-related variables, health, quality of life, work ability, work situation and supportive interventions. RESULTS: The LSL consisted of 78% females, and 76% of them had breast or gynaecological cancer. A higher proportion of patients with low level of education, economical problems, treated with chemotherapy, hormones and multimodal treatment belonged to LSL compared to SSL. Significantly more LSL had recurrences of cancer, co-morbidity, regular use of medication, and poorer self-rated health, quality of life and work ability. Compared to SSL, more LSL reported needs for and offers of supportive care such as physiotherapy, physical activities and psychosocial support. A multivariate regression analysis showed that reduced work ability, changes in employment due to cancer, lack of support from supervisors at work, and having had combined treatment were significantly associated with being LSL. CONCLUSIONS: Longer sick-leave after primary cancer treatment is associated with combined cancer treatment, lack of support from supervisors and reduced overall work ability. Interventions and counselling related to the work place and reduced work ability could be of value for prevention of long-term sick-leaves.

Are there sex differences in the work ability of cancer survivors? Norwegian experiences from the NOCWO study.

BACKGROUND: This study investigated gender differences concerning work ability in working cancer survivors (CSs) and compared them to those of matched population-based controls. METHODS: A mailed questionnaire was completed by 446 Norwegian CSs (226 breast cancer, 166 testicular and 54 prostate cancer) with good prognosis 2-6 years after primary treatment and 588 controls (319 females and 269 males). Overall current work ability (OCWA) was the primary outcome measure, and ten indices of the physical, mental and social skill aspects of work ability (WA) were also studied. RESULTS: The mean OCWA score was higher amongst male CSs compared to females (p = 0.04). The mean OCWA score was similar in male CSs and controls (p = 0.17), whilst female CSs had significantly lower mean OCWA score than controls (p < 0.001). Mental WA neuroticism was higher amongst women in both CSs (p = 0.009) and controls (p = 0.001), and the same pattern was found for physical WA concerning the symptom score (p = 0.003 and <0.001, respectively). Sex had no significant association with OCWA in multivariate analyses. Significant associations were observed for physical and mental WA, but not for social skills. CONCLUSIONS: OCWA was significantly better in male CSs than in female CSs. Male CSs did not differ from their controls, whilst female CSs scored significantly poorer than their controls. CSs with reduced overall work ability should be identified, and their mental and physical work ability should be examined independent of sex.

Received and needed social support at the workplace in Norwegian and Finnish stage 1 breast cancer survivors: a study from the Nordic Study Group of Cancer and Work (NOCWO).

BACKGROUND: Cross-cultural studies of comparable patients can identify differences of health care services and point to issues of possible improvement. In this cross-sectional study we compared self-reported received and needed social support at the workplace of disease-free breast cancer survivors (BCSs) stage I from Norway and Finland. METHODS: Age-matched samples of 135 BCSs from Norway and 148 from Finland were examined using a questionnaire including socio-demographic factors, employment data, measurements of social support at work from supervisors, colleagues and the occupational health service (OHS), and several other measurements. RESULTS: Finnish BCSs had significantly higher education and a higher rate of full-time employment than Norwegian ones. With adjustment for education and work time, Finnish compared to Norwegian BCSs reported significantly less received social support from supervisors, while they received significantly more social support from OHS. No differences were observed in received support from colleagues between Finnish and Norwegian BCSs. Somatic health was most strongly associated with received and needed support from supervisors, colleagues and OHS. CONCLUSIONS: The differences in received and needed social support at work observed between Norwegian and Finnish BCSs treated for stage I disease challenge strengthening of OHS for Norwegian BCSs and increased attention by supervisors in Finnish BCSs.

Is cancer survivorship associated with reduced work engagement? A NOCWO Study.

INTRODUCTION: This study explores work engagement in employed tumor-free cancer survivors (CSs) compared to matched controls from the general population (NORM). METHODS: The sample consisted of 446 CSs tumor-free after primary treatment [226 females with breast cancer and 220 males (166 testicular cancer and 54 prostate cancer)] diagnosed 2-6 years prior to the study. All had returned to work and had favourable prognosis. NORM sample consisted of 588 employed controls (319 females, 269 males). All CSs and NORM filled in a mailed questionnaire covering demography, morbidity, and work-related issues including work engagement which was self-rated by the Utrecht Work Engagement Scale (UWES). RESULTS: No differences in work engagement were observed between the CSs and NORM measured by the UWES total scale score or by the Dedication and Absorption domain scores. The Vigor domains score was statistically lower among CSs (p = .03), but the effect size was only 0.19. The CSs reported significantly poorer work ability, poorer health status, greater numbers of disease symptoms, more anxiety, and reduced physical quality of life, and scored significantly higher on both neuroticism and extraversion. CONCLUSIONS/IMPLICATIONS FOR CSS: In spite of poorer health CSs who had returned to work after their treatment for breast, prostate, and testicular cancer showed similar work engagement as individuals without cancer. In such CSs employers have no reason to expect reduced work engagement. Future research should preferably have a prospective and comparative design.

A study of work changes due to cancer in tumor-free primary-treated cancer patients. A NOCWO study.

GOALS OF WORK: The goal of this study is to explore the characteristics of tumor-free cancer survivors (CSs) who after their primary treatment were still working but made work changes due to cancer and compare them to survivors who did not. PATIENTS AND METHODS: The sample consisted of 431 CSs (219 females with breast cancer, 212 males with testicular (N = 150) or prostate cancer (N = 62)) diagnosed 2-6 years prior to the study. All CSs had good prognosis and had returned to work after primary treatment. All CSs filled in a mailed questionnaire covering demography, morbidity, life style, mental distress, fatigue, quality of life and job strain. RESULTS: Seventy-two CSs (17%) had made work changes due to cancer during the observation period, and 359 (83%) had not. Among CSs who made work changes, significantly more were females; they showed significantly poorer physical and mental work ability, worked fewer hours per week, reported more comorbidity, and had lower physical and mental quality of life and more neuroticism, compared to the nonchange group. Work changes were moderately correlated with current work ability. CONCLUSIONS: The majority of CSs did not report any work changes due to cancer during the 2-6-year observation period, which is an encouraging finding. A minority had done work changes, and this group consisted mainly of women and was also characterized by poorer physical and mental quality of life and poorer mental work ability due to cancer. The issue of work changes and work ability should be considered in the follow-up of cancer survivors.

A controlled study of job strain in primary-treated cancer patients without metastases.

To explore job strain in Norwegian primary-treated cancer survivors compared to matched controls from the general population. The study has a cross-sectional, matched case-control design. A sample of 417 employed cancer survivors (208 females with breast cancer and 209 males with testicular or prostate cancer) who had been diagnosed 1-5 years prior to the study and were tumor-free rated themselves on the Demands-Control-Support Questionnaire (DCSQ). Their ratings were compared to those of 417 employed controls from the general population, matched with the survivors on time of investigation, gender, age and municipality of living. No differences in job strain were observed between cancer survivors and controls, or between subgroups of survivors, except that female survivors experienced more strain than males. In certain subgroups statistically significant differences on the DCSQ were found: older survivors showed higher scores on demands than their controls, female survivors reported lower control and higher strain than male survivors, and older male survivors felt higher demands than younger ones. However, the effect sizes of these differences were so small (< 0.20) that they hardly were relevant for the work situation. In multivariate analyses survivorship versus control status was not significantly associated with any of the DCSQ measures. The job strain of these cancer survivors did not differ in any work relevant way from their controls, and survivorship status was not significantly associated with job strain. A longer follow-up of survivors is necessary in order to draw conclusion about the stability of these findings over time.

The associations between living conditions, demography, and the 'impact of cancer' scale in tumor-free cancer survivors: a NOCWO study.

GOALS OF WORK: The "impact of cancer" scale (IOC) is a new questionnaire that explores attitudes in the physical, psychological, social, and spiritual/existential domains in cancer survivors. This study explores the associations between demography, living conditions (LCs), and the IOC dimensions in disease-free Norwegian survivors who have been treated for breast, prostate, or testicular cancer. MATERIALS AND METHODS: A questionnaire covering demography, LCs, and the IOC was mailed to 852 cancer survivors; 459 (54%) participated. A living condition index (LCI) was calculated based on self-reported education, employment, annual income, health, housing expenditures, and social participation. MAIN RESULTS: Survivors with a low LCI level viewed their situation significantly worse on four of five negative IOC dimensions than those with high LCI level. No significant LCI-related differences were observed for the mean scores of positive IOC dimensions. Significant associations were observed between gender, health status, employment, and five to six IOC dimensions. LCs were more often associated with the negative IOC dimensions than the positive ones. CONCLUSIONS: The significant associations between LCs and dimensions of the IOC in tumor-free cancer survivors show that LCs should be considered when health care professionals assist cancer survivors in dealing with the impact the cancer experience had on their lives.