Diabetes mellitus among cancer survivors.

INTRODUCTION: Cancer and cancer treatments are associated with diabetes mellitus in some patients. The purpose of this review is to look at the association and potential impact of diabetes mellitus on the health profiles of a large cohort of cancer survivors. MATERIALS AND METHODS: This is a descriptive, cross-sectional study of long-term cancer survivors who reported that they have diabetes. Of 8,559 respondents to a mailed survey, 696 (8.1%) reported diabetes mellitus (DM). We analyzed the responses to discern the potential impact of demographics, cancer type, or disease treatments on glycemia as well as the potential impact of DM on socioeconomic parameters (education, family and work). RESULTS: Survivors of gynecological cancer, chronic leukemia, or gastrointestinal cancer reported DM most frequently, although no statistical correlations could be demonstrated for DM and specific cancer types. The frequency of DM was higher among survivors than in the general U.S. population. Cancer survivors with DM were more likely to report that cancer affected their overall health (42.3 vs. 34.3%) and ability to work. They also reported more health problems. CONCLUSIONS: Diabetes mellitus affects a minority of long-term cancer survivors and may have an impact on their physiologic and psychosocial well-being. IMPLICATIONS FOR CANCER SURVIVORS: Systematic assessment for DM is suggested for all cancer survivors because DM appears to be an important co-morbidity for this growing segment of our population.

Breast cancer: relationship between menopausal symptoms, physiologic health effects of cancer treatment and physical constraints on quality of life in long-term survivors.

AIMS AND OBJECTIVES: The purpose of this study is to describe the relationship between menopausal symptoms, physiologic health effects of cancer treatment and the physical contributors to quality of life in long-term survivors of breast cancer. BACKGROUND: The treatment of menopausal symptoms is hotly debated, especially for women with breast cancer. Common treatments for menopausal symptoms are considered to be contraindicated in women with breast cancer. DESIGN: This is a descriptive, cross-sectional study of long-term breast cancer survivors; a subset of a study that responded to a mailed survey targeting long-term cancer survivors treated at The University of Texas M.D. Anderson Cancer Center. METHODS: In 291 breast cancer patients information was available that included items that commonly relate to menopausal symptoms including hot flushes, painful sexual intercourse, inability to concentrate, fatigue and sleep disturbances. RESULTS: Ninety per cent were Caucasian American and the mean time since diagnosis was 16 +/- 8 years. All patients had been treated with surgery, (60%) with radiotherapy, (68%) with chemotherapy and (37%) with hormonal therapy. Forty-six per cent of the breast cancer survivors indicated that having breast cancer affected their overall health. Self-reported health effects were more common in those survivors who had received a combination of chemotherapy and radiotherapy. A menopausal quality of life score was determined using the items about hot flushes, ability to concentrate, painful sexual intercourse, fatigue, unhappiness and sleep disturbances. CONCLUSIONS: This study reminds us that breast cancer and menopause are independent issues. Quality of life parameters need to be rigidly defined and time sensitive. There are complex interactions between quality of life indicators and specific physiologic consequences of treatment. However, menopausal signs and symptoms may not be different for the breast cancer survivor and they should not be confused with the quality of life/psychosocial issues of the cancer survivor. RELEVANCE TO CLINICAL PRACTICE: Menopause is not a disease process but a normal developmental stage for women. It is important for nurses not only to understand the client needs of the menopausal woman, but also to be able to differentiate between quality of life issues related to menopause and to cancer treatment in order to provide holistic nursing care.

Ethnic/racial influences on the physiologic health of cancer survivors.

BACKGROUND: Improvements in early detection, treatment, and general supportive care allow more people to survive cancer. Information regarding the long-term health impact of cancer and cancer treatments on these survivors of adult-onset malignancies is gradually accumulating. Although information is limited overall, it is apparent that the cancer experience differs across ethnically/racially diverse populations. METHODS: In the current report, the authors characterized and compared health profiles among ethnic/racial groups within a large cohort (n > 6000) of long-term survivors of cancer. In addition, the authors focused on survivors of cervical carcinoma, because they constitute a substantial and relatively homogeneous portion of the overall cohort. RESULTS: The authors observed significant differences among African American, Hispanic American, and Caucasian American cancer survivors in terms of age at diagnosis, time since diagnosis, family dynamics, education, type of malignancy, and perceived influences of cancer on specific physiologic health problems. Among survivors of cervical carcinoma, there were significant ethnic/racial differences in terms of disease histology as well as the impact of the disease on overall health. CONCLUSIONS: The current study reveals significant ethnic/racial differences among cancer survivors and highlights the need for further investigation of the relation between cancer survivorship and ethnicity/race.

Health profiles in 5836 long-term cancer survivors.

Increasingly, prolonged survival follows the diagnosis of cancer. Cancer therapies result in complex and lasting health effects that create unique health-care needs for the survivors but are poorly understood (especially in survivors of adult cancers). Cancer survivors were asked to respond to a mailed health survey and provide medical and social information pertaining to their cancer experience. Information about demographics and perceived disease-related medical problems was analyzed. We analyzed the response of 5,836 survivors of adult cancers. Two-thirds of the responses came from women, and the response rate was 51% in both sexes. The mean interval since cancer diagnosis was 18.0 +/- 8.5 years. Younger survivors and men were more likely to report that cancer had affected their health. The health effect most commonly reported by survivors was arthritis/osteoporosis (26% of respondents). Survivors of Hodgkin's disease prominently reported thyroid and lung problems (33.8% of responders with the diagnosis). Prior diagnosis of lymphoma was associated with frequent mention of memory loss (14.7%). The passage of time decreased some perceived effects (memory loss) but increased others (arthritis/osteoporosis, cataracts). Compared with the general population, the incidence of several age- and gender-adjusted health conditions in cancer survivors is different. This group of cancer survivors reported generally good health but outlined multiple lasting medical problems. The health survey described represents 1 approach to the development of comprehensive information about the health needs of cancer survivors.

Internet message board use by patients with cancer and their families.

The Life After Cancer Care (LACC) Internet Web site and message board were created at a comprehensive cancer center to provide up-to-date information about different types of cancer, treatments, late effects, and research findings. The message board enables patients with cancer to exchange information on a more personal basis. During the 16-month period since the creation of the Web site, 972 people logged on to the message board and 284 people posted 619 messages. Most (64%) posted only one message. The posted messages were related most frequently to cancers of the breast, gastrointestinal system, lung, gynecologic system, head and neck, and colon. Sixty percent of the people posting messages were cancer survivors; the remaining 40% were family or friends of survivors. The most frequent query themes were concerns about treatment, support, and long-term side effects of treatment. Individuals with cancer were significantly more likely to post messages about long-term side effects of treatment than family and friends. Message boards are a useful tool for sharing information with others who have similar experiences. Message board entry data also provide valuable information that can be used to refine the boards. Message boards have not been used traditionally in healthcare research but hold considerable promise as an information resource for people affected by cancer.

Cancer survivors. Work related issues.

New and more effective treatments for cancer have resulted in individuals living longer with a better quality of life. Many more survivors are employed in the workplace. Cancer is no longer only an issue for survivors and their families; it has become an issue for the employer and the workplace. This article describes survey results of 4,364 long term cancer survivors in which they were asked to respond to items describing their ability to work, job discrimination, and quality of life. Thirty-five percent of survivors were working at the time they completed the survey, and 8.5% considered themselves unable to work. This research has shown that age, gender, ethnic group, and cancer type affected the working status of the survivors. Of survivors continuing to work, 7.3% indicated they had experienced job discrimination. The results indicate most cancer survivors do not perceive employment related problems, and are readily assimilated into the work force. Job discrimination and the ability to work is a quality of life issue.