Cancer Survivorship, Models, and Care Plans: A Status Update.

This article provides a synopsis of the status of cancer survivorship in the United States. It highlights the challenges of survivorship care as the number of cancer survivors has steadily grown over the 40 years since the signing of the National Cancer Act in 1971. Also included is an overview of various models of survivorship care plans (SCPs), facilitators and barriers to SCP use, their impact on patient outcomes, and implications for clinical practice and research. This article provides a broad overview of the cancer survivorship, including models of care and survivorship care plans.

Quality of life in older women with early-stage breast cancer in the first year of survivorship.

PURPOSE/OBJECTIVES: To describe quality-of-life (QOL) changes in older women with early-stage breast cancer in the first year of survivorship and report on the effectiveness of a psychoeducational intervention on survivors' QOL. DESIGN: Secondary analysis, descriptive, repeated measure. SETTING: An academic setting in the southeastern United States. SAMPLE: 50 early-stage breast cancer survivors, aged 65 years and older. METHODS: Data were drawn from the Breast Cancer Education Intervention (BCEI) research study. Data for a six-month time period within the survivors' first year were available for an experimental group participating in a psychoeducational intervention and a control group. MAIN RESEARCH VARIABLES: Overall QOL and physical, psychological, social, and spiritual well-being subscales. FINDINGS: Older women reported positive overall QOL within the first year of survivorship, but overall QOL declined slightly over time. Physical and psychological well-being declined over time. Social well-being initially improved over time, but then declined. Spiritual well-being initially declined over time, then improved. Survivors had a downward trend in overall QOL during the study time period; however, experimental group participants had a smaller decline in QOL compared to control group participants. CONCLUSIONS: QOL in older breast cancer survivors within the first year is positive. However, overall QOL declines over time. The BCEI attenuated decline of QOL in the experimental group compared to the control group. IMPLICATIONS FOR NURSING: Few studies focus on older breast cancer survivors. This descriptive study is one of the first to describe changes in QOL and report the effect of interventions for older breast cancer survivors. Oncology nurses are in a position to recognize QOL issues and help older women maintain QOL in the first year of survivorship after treatment.

No less a man: reconstructing identity after prostate cancer.

Few diagnoses present as great a challenge to one's life as cancer. Many men each year are confronted with a diagnosis of early stage prostate cancer and find themselves making decisions about treatment in the face of side effects that present often devastating effects, including problems controlling one's urine and an inability to perform sexually. In this paper, we explore the narratives of men who, having chosen and undergone treatment for early stage prostate cancer, are living with the consequences. Faced with what Charmaz calls an 'identity dilemma', how do these men linguistically construct their identities in the face of challenges to their bodily, personal, and social integrity? Drawing upon theories of social languages and Discourses, we examine how men linguistically resolve the identity dilemmas they encounter and in turn construct an identity in response to a question about the quality of their lives in the face of the adverse event of prostate cancer. We present an analysis of the interview narratives of two men and show how they 're-collage' an identity in the face of fundamental changes in their functioning as men. We argue that these men draw upon alternative discourses to construct themselves as whole, competent, and 'no less a man'.

The value of the marginalia as an adjunct to structured questionnaires: experiences of men after prostate cancer surgery.

In both research and clinical settings, men who survive prostate cancer emphasize the need for more open communication about the challenges they face. They explain that symptomatic dysfunction associated with treatment is grounded in complex social situations and relationships. Yet, structured quality of life questionnaires preclude expressions of the elaborate accounts they often evoke. We explore this in the case of prostate cancer. Seventy-one patients who had undergone radical prostatectomy at a mid-Atlantic University Medical Center, a Veterans Affairs medical center affiliated with the same university, or were US members of an international prostate cancer support group completed a survey protocol including assessments of urinary morbidity, psychosocial adjustment to illness (PAIS), and health status (SF-36). At the conclusion, a single open-ended item was offered; 48 offered an extended response. The open-ended item was recorded and analyzed qualitatively. Data were summarized according to four main themes: (1) quality of patient-physician communication; (2) change in sexual identity; (3) fear of cancer; and (4) the humiliation of urinary incontinence. Future research on outcomes of treatment and clinical inquiry must focus on methods that systematically capture patients' experiences.

Incontinence after prostatectomy: coping with incontinence after prostate cancer surgery.

PURPOSE/OBJECTIVES: To describe the nature of postprostatectomy urinary incontinence, determine how men manage postsurgery urinary incontinence, identify men's perceptions of adequacy of preoperative counseling, and identify men's expectations regarding the probability of postsurgery incontinence. DESIGN: Survey. SETTING: United States. SAMPLE: Members of US TOO International, who experienced urinary incontinence after surgery. METHODS: Copies of the survey (N = 370) were mailed to all chapters of US TOO International, a prostate cancer support group, for distribution to members. A letter of invitation also was posted on the US TOO International Web site and in the monthly newsletter. Men who desired to complete the survey (N = 130) called the researcher's office, and a copy of the survey and a stamped return envelope was mailed to them. Surveys returned to the researchers from June 1998 to January 1999 were included in the analyses. MAIN RESEARCH VARIABLES: Urinary incontinence, management of urinary incontinence, and coping. FINDINGS: 166 men returned surveys. The majority was Caucasian (95%) and married (83%). The median age was 67 years, 87% of the men rated their health as good or excellent, and 114 men (69%) reported becoming incontinent after surgery. Most men experienced stress incontinence symptoms. The majority (89 of 111 men) reported that they were told preoperatively that urinary incontinence was a possible complication. Overall, regardless of length of time since surgery, men (74%) thought that incontinence was an important problem to resolve. Men used containment devices such as pads, special undergarments, and even sanitary napkins as management strategies. The majority of men (54%) used pelvic muscle exercises, especially those who were fewer than two years postsurgery (72%). CONCLUSIONS: Urinary incontinence is a prevalent postoperative complication for men, even up to five years after surgery, and a source of great distress for some. Men reported stress and urge incontinence symptoms and used an array of strategies to contain their urine. Finding effective treatments for postprostatectomy urinary incontinence and receiving adequate information before surgery is important to these men. IMPLICATIONS FOR NURSING: As the number of men who undergo surgical treatment for prostate cancer increases, nurses need to be equipped with the necessary knowledge and information to answer preoperative concerns and provide effective strategies for managing postoperative urinary incontinence.

Engaging black older adults and caregivers in urban communities in health research.

The under-representation of the Black population in research may lead to poor health outcomes for them and a decreased capacity to generalize results to Black populations. This article describes ways in which sensitivity to cultural distinctions of Black older adults and their current or future caregivers can enhance their recruitment and retention in research. Cultural mores play an important role in the shaping of one's perceptions, definitions, responses to disease, and participation in health regimens. Similarly, one's cultural orientation plays a role in how a person is effectively recruited and retained in resear Wenger's translation process model uses cultural meaning to inform research decisions. This model was used in a recent study of Black older adults and their caregivers and will be described in this article. Effectively engaging Black individuals in health research is essential for improving their health.