Preparedness and Cancer-Related Symptom Management among Cancer Survivors in the First Year Post-Treatment.

BACKGROUND: Many cancer survivors feel unprepared for the physical and psychosocial challenges that accompany the post-treatment care transition (i.e., re-entry phase), including management of cancer-related symptoms. Few studies have investigated personal and contextual factors associated with the extent of preparedness for re-entry or how they are related to cancer-related symptom management. PURPOSE: Data from the American Cancer Society's Cancer Survivor Transition Study examined (1) characteristics of breast, prostate, and colorectal cancer survivors (n = 1188) within the first year of completing treatment who are most and least prepared for re-entry; and (2) how preparedness level and other characteristics are related to cancer-related symptom management. METHODS: Stanton and colleagues' [1] conceptual model of survivorship guided the selection of interpersonal/environmental, individual, and disease/treatment-related characteristics as potential contributors to levels of preparedness and cancer-related symptom management using regression tree and multivariate linear regression analyses. RESULTS: Survivors, on average, felt moderately prepared for the transition to post-treatment care. Lowest levels of preparedness were found among survivors with relatively high depressive symptoms, low perceived quality of oncology-provided survivorship care, and limited discussion about potential side effects with a health professional. Poorer symptom management was associated with younger age, having more comorbid conditions, and lower preparedness, social support, and spirituality. CONCLUSION: Survivors who feel unprepared for the transition to post-treatment care report poorer cancer-related symptom management. Identification of factors associated with low perceived preparedness and poor cancer-related symptom management will assist in risk stratification and development of tailored interventions to meet the needs of cancer survivors during re-entry.

Racial/ethnic differences in spiritual well-being among cancer survivors.

This study examined racial/ethnic differences in spiritual well-being (SWB) among survivors of cancer. We hypothesized higher levels of Peace and Faith, but not Meaning, among Black and Hispanic survivors compared to White survivors, differences that would be reduced but remain significant after controlling for sociodemographic and medical factors. Hypotheses were tested with data from the American Cancer Society's Study of Cancer Survivors-II. The FACIT-Sp subscale scores, Meaning, Peace, and Faith assessed SWB, and the SF-36 Physical Component Summary measured functional status. In general, bivariate models supported our initial hypotheses. After adjustment for sociodemographic and medical factors, however, Blacks had higher scores on both Meaning and Peace compared to Hispanics and Whites, and Hispanics' scores on Peace were higher than Whites' scores. In contrast, sociodemographic and medical factors had weak associations with Faith scores. The pattern with Faith in bivariate models persisted in the fully adjusted models. Racial/ethnic differences in Meaning and in Peace, important dimensions of SWB, were even stronger after controlling for sociodemographic and medical factors. However, racial/ethnic differences in Faith appeared to remain stable. Further research is needed to determine if racial/ethnic differences in SWB are related to variations in quality of life in survivors of cancer.

An examination of the 3-factor model and structural invariance across racial/ethnic groups for the FACIT-Sp: a report from the American Cancer Society's Study of Cancer Survivors-II (SCS-II).

OBJECTIVES: Recent confirmatory factor analysis (CFA) of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) Scale in a sample of predominantly white women demonstrated that three factors, Meaning, Peace, and Faith, represented a psychometric improvement over the original 2-factor model. The present study tested these findings in a more diverse sample, assessed the stability of the model across racial/ethnic groups, and tested the contribution of a new item. METHODS: In a study by the American Cancer Society, 8805 cancer survivors provided responses on the FACIT-Sp, which we tested using CFA. RESULTS: A 3-factor model provided a better fit to the data than the 2-factor model in the sample as a whole and in the racial/ethnic subgroups (Deltachi(2), p<0.001, for all comparisons), but was not invariant across the groups. The model with equal parameters for racial/ethnic groups was a poorer fit to the data than a model that allowed these parameters to vary (Deltachi(2)(81)=2440.54, p<0.001), suggesting that items and their associated constructs might be understood differently across racial/ethnic groups. The new item improved the model fit and loaded on the Faith factor. CONCLUSIONS: The 3-factor model is likely to provide more specific information for studies in the field. In the construction of scales for use with diverse samples, researchers need to pay greater attention to racial/ethnic differences in interpretation of items.

Nitrogen removal and nitrate leaching for two perennial, sod-based forage systems receiving dairy effluent.

In northern Florida, year-round forage systems are used in dairy effluent sprayfields to reduce nitrate leaching. Our purpose was to quantify forage N removal and monitor nitrate N (NO3(-)-N) concentration below the rooting zone for two perennial, sod-based, triple-cropping systems over four 12-mo cycles (1996-2000). The soil is an excessively drained Kershaw sand (thermic, uncoated Typic Quartzip-samment). Effluent N rates were 500, 690, and 910 kg ha(-1) per cycle. Differences in N removal between a corn (Zea mays L.)-bermudagrass (Cynodon spp.)-rye (Secale cereale L.) system (CBR) and corn-perennial peanut (Arachis glabrata Benth.)-rye system (CPR) were primarily related to the performance of the perennial forages. Nitrogen removal of corn (125-170 kg ha(-1)) and rye (62-90 kg ha(-1)) was relatively stable between systems and among cycles. The greatest N removal was measured for CBR in the first cycle (408 kg ha(-1)), with the bermudagrass removing an average of 191 kg N ha(-1). In later cycles, N removal for bermudagrass declined because dry matter (DM) yield declined. Yield and N removal of perennial peanut increased over the four cycles. Nitrate N concentrations below the rooting zone were lower for CBR than CPR in the first two cycles, but differences were inconsistent in the latter two. The CBR system maintained low NO3(-)-N leaching in the first cycle when the bermudagrass was the most productive; however, it was not a sustainable system for long-term prevention of NO3(-)-N leaching due to declining bermudagrass yield in subsequent cycles. For CPR, effluent N rates > or = 500 kg ha(-1) yr(-1) have the potential to negatively affect ground water quality.