The effects of partnered exercise on physical intimacy in couples coping with prostate cancer.

OBJECTIVE: The study examined whether couples coping with prostate cancer participating in a partnered exercise program-Exercising Together (ET)-experienced higher levels of physical intimacy (i.e., affectionate and sexual behavior) than couples in a usual care (UC) control group. METHOD: Men and their wives (n = 64 couples) were randomly assigned to either the ET or UC group. Couples in the ET group engaged in partnered strength-training twice weekly for 6 months. Multilevel modeling was used to explore the effects of ET on husband and wife engagement in both affectionate and sexual behaviors over time. RESULTS: Controlling for relationship quality, wives in ET showed significant increases in engagement in affectionate behaviors compared to wives in UC. No intervention effects were found for husbands. CONCLUSION: Couple-based approaches to physical intimacy, after a cancer diagnosis, that facilitate collaborative engagement in nonsexual physical activities for the couple have potential to be effective for wives. More research is needed in this area to determine couples most amenable to such exercise strategies, optimal timing in the cancer trajectory, and the benefits of combining partnered exercise with more traditional relationship-focused strategies.

Benefits of partnered strength training for prostate cancer survivors and spouses: results from a randomized controlled trial of the Exercising Together project.

BACKGROUND: Prostate cancer can negatively impact quality of life of the patient and his spouse caregiver, but interventions rarely target the health of both partners simultaneously. We tested the feasibility and preliminary efficacy of a partnered strength training program on the physical and mental health of prostate cancer survivors (PCS) and spouse caregivers. METHODS: Sixty-four couples were randomly assigned to 6 months of partnered strength training (Exercising Together, N = 32) or usual care (UC, N = 32). Objective measures included body composition (lean, fat and trunk fat mass (kg), and % body fat) by DXA, upper and lower body muscle strength by 1-repetition maximum, and physical function by the physical performance battery (PPB). Self-reported measures included the physical and mental health summary scales and physical function and fatigue subscales of the SF-36 and physical activity with the CHAMPS questionnaire. RESULTS: Couple retention rates were 100 % for Exercising Together and 84 % for UC. Median attendance of couples to Exercising Together sessions was 75 %. Men in Exercising Together became stronger in the upper body (p < 0.01) and more physically active (p < 0.01) than UC. Women in Exercising Together increased muscle mass (p = 0.05) and improved upper (p < 0.01) and lower body (p < 0.01) strength and PPB scores (p = 0.01) more than UC. CONCLUSIONS: Exercising Together is a novel couples-based approach to exercise that was feasible and improved several health outcomes for both PCS and their spouses. IMPLICATIONS FOR CANCER SURVIVORS: A couples-based approach should be considered in cancer survivorship programs so that outcomes can mutually benefit both partners. TRIAL REGISTRATION: ClinicalTrials.gov NCT00954044.

Resistance Exercise Reduces Body Fat and Insulin During Androgen-Deprivation Therapy for Prostate Cancer.

PURPOSE/OBJECTIVES: To determine whether exercise could reduce biomarkers of cancer progression in prostate cancer survivors (PCSs) on androgen-deprivation therapy (ADT). DESIGN: Randomized, controlled trial. SETTING: Oregon Health and Science University School of Nursing. SAMPLE: 51 PCSs randomized to one year of resistance and impact training or a stretching control group. METHODS: The authors investigated changes in body composition and cancer-related biomarkers, and the influence of age and fat loss on changes in biomarkers. MAIN RESEARCH VARIABLES: Body composition (total fat, trunk fat, and lean mass), insulin, insulin-like growth factor-1, and sex hormone-binding globulin. FINDINGS: In the 36 PCSs with baseline and 12-month data, total fat (p = 0.02) and trunk fat (p = 0.06) mass decreased in the training group compared to gains in controls. Loss of total and trunk fat each mediated the relationship between groups and one-year change in insulin (p < 0.05). Age moderated the insulin response to exercise where insulin reductions were smaller with increasing age (p = 0.03). CONCLUSIONS: Resistance and impact exercise may reduce body fat among PCSs undergoing ADT, in turn exerting an insulin-lowering effect. IMPLICATIONS FOR NURSING: Nurses should counsel PCSs to exercise to reduce the risk of obesity and associated conditions, including cancer progression.

Incongruent perceptions of pain and physical function among families living with lung cancer.

PURPOSE: The purpose of the study was to examine the roles of concealment and communication in incongruence in perceptions of the lung cancer patient's physical function and pain severity. METHODS: Lung cancer patients and their family members (N = 108 family care dyads) rated the patient's physical function and pain severity. RESULTS: Multilevel modeling revealed that family members, on average, rated patient physical function significantly worse than patients; incongruence did not significantly differ from 0, on average, for pain severity. However, there was significant variability across family care dyads in how much incongruence existed within dyads. Controlling for depressive symptoms, family member role overload, family member physical function, the patients' cognitive impairment, relationship type, and stage of lung cancer, the patients' level of concealment was significantly associated with incongruence for both physical function and pain severity. Additionally, the family members' perceptions of communication problems in the dyad were significantly associated with incongruence for pain severity. Models accounted for 23 and 30 % of the incongruence in physical function and pain severity, respectively. CONCLUSIONS: Open communication and disclosure play important roles in the appraisal of symptoms within the lung cancer patient-family member dyad. These interpersonal factors may be promising targets for interventions to maximize patient and family member outcomes.

Resistance training reduces disability in prostate cancer survivors on androgen deprivation therapy: evidence from a randomized controlled trial.

OBJECTIVES: To investigate whether functionally based resistance exercise could improve strength, physical function, and disability among prostate cancer survivors (PCS) on androgen deprivation therapy (ADT); and to explore potential mediators of changes in outcomes from exercise. DESIGN: Randomized controlled trial. SETTING: Academic medical center. PARTICIPANTS: PCS (N=51; mean age, 70.2y) on ADT. INTERVENTION: PCS were randomized to moderate to vigorous intensity resistance training or stretching (placebo control) for 1 year. MAIN OUTCOME MEASURES: Maximal leg press and bench press strength, objective and self-reported physical function, and self-reported disability. Hierarchical linear modeling was used to test for significant group × time differences adjusting for covariates. RESULTS: Retention in the study was 84%, and median attendance to supervised classes was 84% in the resistance group. No study-related injuries occurred. Maximal leg strength (P=.032) and bench press strength (P=.027) were improved after 1 year of resistance training, whereas little change occurred from stretching. Self-reported physical function improved with resistance training, whereas decreases occurred from stretching (P=.016). Disability lessened more with resistance training than stretching (P=.018). One-year change in leg press strength mediated the relation between groups (resistance or stretching) and 1-year change in self-reported disability (P<.05). CONCLUSIONS: One year of resistance training improved muscle strength in androgen-deprived PCS. Strengthening muscles using functional movement patterns may be an important feature of exercise programs designed to improve perceptions of physical function and disability. Findings from this study contribute to the mounting evidence that exercise should become a routine part of clinical care in older men with advanced prostate cancer.

The role of patient pain and physical function on depressive symptoms in couples with lung cancer: a longitudinal dyadic analysis.

Drawing on the Developmental-Contextual Model (Berg & Upchurch, 2007), we examined the association between changes in patient physical health (pain severity and physical function) and changes in depressive symptoms in couples with lung cancer over a 12-month period. Patients and their spouses or partners (n = 77) were recruited using rapid case ascertainment and completed five waves of data collection (baseline, 3, 6, 9, and 12 months). Multilevel modeling was used to examine aggregate and time-varying effects of patient physical health on depressive symptoms. Results indicated that for patients and spouses, patient-rated mean pain severity was significantly positively associated with patient and spouse depressive symptoms and patient-rated mean physical function was significantly negatively associated with patient and spouse depressive symptoms. More importantly, increases in patient pain severity and declines in patient physical function were significantly associated with increases in patient depressive symptoms. However, only declines in patient physical function were significantly associated with increases in spouse depressive symptoms. These time-varying effects remained even when controlling for patient gender, patient age, patient stage of disease, spouse physical health, and relationship quality. Findings suggest the importance of examining the changing illness context on the couple as a unit and the complexity of interpersonal processes in the presence of a life-threatening illness.

Symptom incongruence trajectories in lung cancer dyads.

CONTEXT: There is little known about the pattern of change in patient-family member symptom incongruence across the lung cancer trajectory. OBJECTIVES: This study examined trajectories of patient-family member incongruence in perceptions of patient physical function, pain severity, fatigue, and dyspnea in lung cancer dyads and explored the association with family member grief after patient death. METHODS: Lung cancer patients and their family members providing care (n = 109 dyads) rated patient symptoms and physical function five times over 12 months. Symptom incongruence trajectories were analyzed using multilevel modeling. RESULTS: Patient-family member incongruence did not significantly change over time, on average, except in the case of patient physical function where incongruence significantly declined. There was significant variability around trajectories of incongruence for all symptoms except fatigue. Exploratory analysis on a subsample of 22 bereaved family members found that incongruence regarding patient fatigue was associated with family member grief two months after patient death. CONCLUSION: Findings suggest the importance of modeling symptom incongruence over time and taking a dyadic approach to the illness context to identify interventions that promote adjustment and quality of life for both patient and family member.

Measuring activity levels associated with rehabilitative care in hospitalized older adults.

Older adults often experience functional losses during hospitalization. Clinical care activities have been increasingly promoted as a way to help older hospitalized patients offset these losses and recover from acute illness. Little research exists to objectively measure clinical care activities. This study evaluated the utility and feasibility of using the Actiheart, a combined heart rate monitor and accelerometer, to measure heart rate and motion (activity counts) during five clinical care activities. Fifty-four adults, aged 65 and older, scheduled for surgery, participated in a simulation of activities. The Actiheart successfully measured motion and heart rate during each of the five activities. One-way repeated measures analyses of variance showed that the Actiheart discriminated significant differences within and across the five activities. This study supports the use of an activity monitor to quantify clinical care activities in research studies that can be translated into clinical care. However, the complexity associated with data collection and analysis using the Actiheart could limit its direct use in clinical research.

Skeletal response to resistance and impact training in prostate cancer survivors.

INTRODUCTION: Androgen deprivation therapy (ADT) is associated with significant bone loss and an increase in fracture risk among prostate cancer survivors (PCS). We investigated whether impact + resistance training could stop ADT-related declines in bone mineral density (BMD) among PCS on ADT. METHODS: We randomized 51 PCS (mean age, 70.2 yr) currently prescribed ADT to participate in 1 yr of impact + resistance training (Prevent Osteoporosis with Impact + Resistance (POWIR)) or in an exercise placebo program of stretching exercise (FLEX). Outcomes were proximal femur (total hip, femoral neck, and greater trochanter) and spine (L1-L4) BMD (g·cm) and bone turnover markers (serum osteocalcin (ng·mL) and urinary deoxypyrodinoline cross-links (nmol·mmol Cr)). RESULTS: Retention in the 1-yr study was 84% and median attendance to supervised classes was 84% in POWIR and 74% in FLEX. No study-related injuries were reported. There were no significant differences between groups for average L1-L4 BMD or for BMD at any hip site. When examining individual vertebrae, POWIR has a significant effect on preservation of BMD (-0.4%) at the L4 vertebrae compared with losses (-3.1%) in FLEX (P = 0.03). CONCLUSION: Impact + resistance training was a safe and acceptable form of exercise for older PCS on ADT. Among our limited sample, POWIR did not appear to have a clinically meaningful effect on hip or spine BMD, but some evidence of skeletal adaptation to resistance + impact training in an androgen-deprived state was apparent. Future studies need to be conducted on a larger sample of patients and should consider modifications to POWIR that could further enhance loading across the spine and at the hip to preserve BMD at these clinically relevant sites.

Musculoskeletal changes after 1 year of exercise in older breast cancer survivors.

INTRODUCTION: We have previously reported that 1 year of supervised resistance + impact training stopped bone loss and built muscle strength in older breast cancer survivors. The purpose of this study was to determine whether these benefits persisted 1 year after completion of the intervention. METHODS: Sixty-seven women from the original trial completed baseline and post-intervention body composition and muscle strength tests, and 44 women were available 1 year later for follow-up assessments. Bone mineral density (grams per square centimeter) of the hip and spine, muscle mass (kilograms), and fat mass (kilograms) were measured by dual-energy X-ray absorptiometry and maximal upper and lower body strength were measured by one-repetition maximum tests (kilograms). We compared between group changes across baseline (pre-intervention), 1 (post-intervention), and 2 years (1 year follow up) on study outcomes using repeated-measures analysis of covariance, adjusting for age. RESULTS: Significant group by time interactions were found for spine bone mineral density (BMD) (p < 0.01) and lower body muscle strength (p < 0.05), with a trend for upper body muscle strength (p = 0.05). Spine BMD remained stable across intervention and follow-up periods in exercisers compared with continuous losses in controls across 1- and 2-year periods. In contrast, lower body strength increased in exercisers across the intervention, but decreased to near-baseline levels during follow-up compared with no change over either time period in controls. CONCLUSIONS: Our data suggest that spine BMD can be preserved in older breast cancer survivors even after formal exercise training stops; however, muscle strength is not similarly maintained and may require continued participation in a supervised exercise program. IMPLICATIONS FOR CANCER SURVIVORS: Exercise programs aimed at improving musculoskeletal health should be considered in the long-term care plan for breast cancer survivors.

Patterns and predictors of symptom incongruence in older couples coping with prostate cancer.

PURPOSE: Prostate cancer survivors (PCSs) may experience persistent symptoms following treatment. If PCSs and spouses differ in their perceptions of symptoms, that incongruence may cause mismanagement of symptoms and reduced relationship quality. The purpose of this study was to examine symptom incongruence and identify the PCS and spouse characteristics associated with symptom incongruence in older couples coping with prostate cancer. METHODS: Participants in the study were older PCSs (>60 years) and their spouses (N=59 couples). Symptom incongruence was determined by comparing patient and spouse independent ratings of the severity of his cancer-related symptoms. Predictor variables included PCS age, time since diagnosis, PCS comorbidity, PCS and spouse depressive symptoms, and spouse caregiving strain. RESULTS: PCS and spouse ratings of his symptom severity and the amount of incongruence over his symptoms varied significantly across couples. Overall, couples rated a moderate level of PCS symptom severity, but PCSs and their spouses significantly differed in their perceptions of PCS symptom severity with spouses rating severity higher (t=-2.66, df=51, p<0.01). PCS younger age and high spouse caregiver strain accounted for 29 % of incongruence in perceptions of PCS symptom severity. CONCLUSIONS: This study is among the first to show that PCSs and spouses may perceive cancer-related persistent symptoms differently. Among this older sample, younger PCS age and spouse caregiver strain were associated with incongruence in symptoms perceptions in couples. These and other factors may inform future interventions aimed at preserving relationship quality in older couples who have experienced prostate cancer.

Frailty in older breast cancer survivors: age, prevalence, and associated factors.

PURPOSE/OBJECTIVES: To describe frailty and associated factors in breast cancer survivors (BCSs) and evaluate whether BCSs are frail at an earlier age than female participants from in two large epidemiological studies. DESIGN: Descriptive, cross-sectional. SETTING: School of Nursing at Oregon Health and Science University. SAMPLE: 216 BCSs aged 53-87 years who were a mean 5-7 years post-treatment and not currently participating in exercise. METHODS: Performance tests, clinical measures, and self-reported questionnaires provided baseline data on five criteria for frailty. MAIN RESEARCH VARIABLES: Frailty was defined as meeting three of the five criteria of the frailty phenotype: shrinking, exhaustion, low activity, slowness, and weakness. Data were compared to published data from women in the Cardiovascular Health Study (CHS) and Women's Health and Aging Study (WHAS). FINDINGS: Eighteen percent of BCSs aged 70-79 years were frail compared to 11% of women of the same age in the CHS and WHAS. Frailty was more common at a younger age in BCSs, and more BCSs were frail in all age groups compared to women in the CHS study until about age 80 years, when prevalence of frailty was similar in the two groups. Fifty percent of BCSs were classified as prefrail because they met one or two of the five frailty criteria. Higher body mass index increased the odds of frailty, and higher physical activity decreased the odds of frailty (odds ratio [OR] = 1.12, p = 0.003, and OR = 0.99, p = 0.000, respectively). CONCLUSIONS: Frailty and prefrailty may be common in BCSs and may occur at an earlier age than in adults without a history of breast cancer. IMPLICATIONS FOR NURSING: Nurses should be alert to prefrailty or frailty at a younger age in BCSs. Awareness and early intervention may delay or prevent frailty. KNOWLEDGE TRANSLATION: BCSs may be frail even when they are not yet considered older adults. Prefrailty in BCSs is important to recognize because it suggests impending frailty that could lead to reduced physical functioning or poor health. Prefrailty and frailty could be assessed in BCSs aged 50 years and older in a clinical setting using a few questions about weight, fatigue, and activity levels, in addition to simple tests of walking speed and grip strength, if warranted.

Comparison of tai chi vs. strength training for fall prevention among female cancer survivors: study protocol for the GET FIT trial.

BACKGROUND: Women with cancer are significantly more likely to fall than women without cancer placing them at higher risk of fall-related fractures, other injuries and disability. Currently, no evidence-based fall prevention strategies exist that specifically target female cancer survivors. The purpose of the GET FIT (Group Exercise Training for Functional Improvement after Treatment) trial is to compare the efficacy of two distinct types of exercise, tai chi versus strength training, to prevent falls in women who have completed treatment for cancer. The specific aims of this study are to: 1) Determine and compare the efficacy of both tai chi training and strength training to reduce falls in older female cancer survivors, 2) Determine the mechanism(s) by which tai chi and strength training each reduces falls and, 3) Determine whether or not the benefits of each intervention last after structured training stops. METHODS/DESIGN: We will conduct a three-group, single-blind, parallel design, randomized controlled trial in women, aged 50-75 years old, who have completed chemotherapy for cancer comparing 1) tai chi 2) strength training and 3) a placebo control group of seated stretching exercise. Women will participate in supervised study programs twice per week for six months and will be followed for an additional six months after formal training stops. The primary outcome in this study is falls, which will be prospectively tracked by monthly self-report. Secondary outcomes are maximal leg strength measured by isokinetic dynamometry, postural stability measured by computerized dynamic posturography and physical function measured by the Physical Performance Battery, all measured at baseline, 3, 6 and 12 months. The sample for this trial (N=429, assuming 25% attrition) will provide adequate statistical power to detect at least a 47% reduction in the fall rate over 1 year by being in either of the 2 exercise groups versus the control group. DISCUSSION: The GET FIT trial will provide important new knowledge about preventing falls using accessible and implementable exercise interventions for women following chemotherapy for cancer. ClinicalTrials.gov NCT01635413.

Theory-based predictors of follow-up exercise behavior after a supervised exercise intervention in older breast cancer survivors.

PURPOSE: Supervised exercise interventions can elicit numerous positive health outcomes in older breast cancer survivors. However, to maintain these benefits, regular exercise needs to be maintained long after the supervised program. This may be difficult, as in this transitional period (i.e., time period immediately following a supervised exercise program), breast cancer survivors are in the absence of on-site direct supervision from a trained exercise specialist. The purpose of the present study was to identify key determinants of regular exercise participation during a 6-month follow-up period after a 12-month supervised exercise program among women aged 65+ years who had completed adjuvant treatment for breast cancer. METHODS: At the conclusion of a supervised exercise program and 6 months later, 69 breast cancer survivors completed surveys examining their exercise behavior and key constructs from the Transtheoretical Model. RESULTS: After adjusting for weight status and physical activity at the transition point, breast cancer survivors with higher self-efficacy at the point of transition were more likely to be active 6 months after leaving the supervised exercise program (odds ratio [95% confidence interval, 1.10 [1.01-1.18]). Similarly, breast cancer survivors with higher behavioral processes of change use at the point of transition were more likely to be active (odds ratio [95% confidence interval], 1.13 [1.02-1.26]). CONCLUSION: These findings suggest that self-efficacy and the behavioral processes of change, in particular, play an important role in exercise participation during the transition from a supervised to a home-based program among older breast cancer survivors.

The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial.

INTRODUCTION: Older breast cancer survivors (BCS) report more falls and functional limitations than women with no cancer history. Exercise training could reduce risk factors for future falls and disability. METHODS: We conducted a randomized, controlled trial in 106 early-stage, postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment. Women were randomly assigned to a 1-year resistance + impact exercise program or a stretching placebo program. Endpoints were one repetition maximum bench press and leg press strength, timed five chair stands, 4 m usual walk speed, timed stance tests, handgrip strength, self-report physical function, and fatigue. We also examined the influence of age, adjuvant hormone therapy use, and exercise adherence on study outcomes. RESULTS: Women in the resistance + impact training program significantly improved maximal leg (p <0 .02) and bench (p <0 .02) press strength compared to the stretching group. Women who attended 50% or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women. CONCLUSIONS: Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement. IMPLICATIONS FOR CANCER SURVIVORS: Older BCS can safely engage in resistance exercise that improves lower and upper body strength, thereby reducing a risk factor for falls and future disability. However, the ability of resistance training to shift other indices of fall and disability risk, i.e., balance and function, is unclear. Strategies to promote adherence to resistance training could lead to greater improvements in strength.

Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial.

Targeted exercise training could reduce risk factors for fracture and obesity-related diseases that increase from breast cancer treatment, but has not been sufficiently tested. We hypothesized that progressive, moderate-intensity resistance + impact training would increase or maintain hip and spine bone mass, lean mass and fat mass and reduce bone turnover compared to controls who participated in a low-intensity, non-weight bearing stretching program. We conducted a randomized, controlled trial in 106 women with early stage breast cancer who were >1 year post-radiation and/or chemotherapy, ≥ 50 years of age at diagnosis and postmenopausal, free from osteoporosis and medications for bone loss, resistance and impact exercise naïve, and cleared to exercise by a physician. Women were randomly assigned to participate in 1 year of thrice-weekly progressive, moderate-intensity resistance + impact (jump) exercise or in a similar frequency and length control program of progressive, low-intensity stretching. Primary endpoints were bone mineral density (BMD; g/cm²) of the hip and spine and whole body bone-free lean and fat mass (kg) determined by DXA and biomarkers of bone turnover-serum osteocalcin (ng/ml) and urinary deoxypyrodiniline cross-links (nmol/mmolCr). Women in the resistance + impact training program preserved BMD at the lumbar spine (0.47 vs. -2.13%; P = 0.001) compared to controls. The resistance + impact group had a smaller increase in osteocalcin (7.0 vs. 27%, P = 0.03) and a larger decrease in deoxypyrodinoline (-49.9 vs. -32.6%, P = 0.06) than controls. Increases in lean mass from resistance + impact training were greatest among women currently taking aromatase inhibitors compared to controls not on this therapy (P = 0.01). Our combined program of resistance + impact exercise reduced risk factors for fracture among postmenopausal breast cancer survivors (BCS) and may be particularly relevant for BCS on aromatase inhibitors (AIs) because of the additional benefit of exercise on muscle mass that could reduce falls.

Scientific and statistical reviews of manuscripts submitted to Nursing Research: Comparison of completeness, quality, and usefulness.

Sound statistical analysis is fundamental to high-quality reporting of quantitative studies. Peer review are also important in determining whether statistical procedures in submitted manuscripts are appropriate and effectively reported. However, the quality of statistical reviews of manuscripts submitted to nursing journals has not been previously evaluated. The purpose of this project was to compare the content and quality of statistical and scientific (general) reviews of manuscripts submitted to Nursing Research. The General Assessment of Reviews of Nursing Research (GARNR) and the Statistical Assessment of Reviews of Nursing Research (SARNR) were used to evaluate 105 reviews of 35 manuscripts assigned to both scientific and statistical review between August 2007 and February 2009. Scientific reviews were rated as more comprehensive, but most did not evaluate statistical aspects of a manuscript. Statistical reviews were more likely to identify fatal flaws, were generally rated higher in overall usefulness to the editor in making a decision on whether to publish, and were rated as more useful to authors for improving a manuscript. Statistical and scientific reviews are complementary and both are necessary. More thorough integration of substantive and methodological content in reviews of quantitative studies has potential for even greater leverage of effort and improved quality of nursing research reports.

Time since diagnosis as a predictor of symptoms, depression, cognition, social concerns, perceived benefits, and overall health in cancer survivors.

PURPOSE/OBJECTIVES: To assess whether health and other factors are different in short-term cancer survivors (less than five years since diagnosis), long-term survivors (5-10 years), and very long-term survivors (more than 10 years). DESIGN: A cross-sectional survey. SETTING: New Zealand. SAMPLE: 836 survivors of adult-onset cancers (6 months to 43 years since diagnosis). METHODS: Survivors were recruited using community-based methods and answered a mailed questionnaire. MAIN RESEARCH VARIABLES: Physical and emotional health, depression, symptoms, cognitive difficulty, social concerns, and perceived benefits of cancer. FINDINGS: Physical and emotional health, depression, physical symptoms, and perceived benefits of cancer were not associated with time since diagnosis, but longer time since diagnosis was associated with decreases in cognitive difficulties and social concerns. The survivors in this study reported a mean of 8.4 physical symptoms, regardless of time since diagnosis, with the most frequent being fatigue (76%), aches and pain (75%), and trouble sleeping (68%). CONCLUSIONS: Most survivors enjoyed a moderately good level of health. However, some adverse effects, such as symptoms, were similar in short-, long-, and very long-term survivors, suggesting that interventions may be needed to prevent persistent issues as time progresses. IMPLICATIONS FOR NURSING: The findings suggest a need to reconsider the common attitude that survivors who finish treatment should be able to return to normal life. Assessment of symptoms, particularly fatigue, pain, and sleep issues, is important even in very long-term survivors.

Differences between older and younger cancer survivors in seeking cancer information and using complementary/alternative medicine.

OBJECTIVE: The purpose of this study was to describe the differences between younger and older cancer survivors in seeking cancer information, using complementary and alternative medical (CAM) services, and using conventional support services. DESIGN AND METHODS: Participants were 836 survivors of adult cancers (6 months-43 years since completion of primary cancer treatment) in New Zealand who answered a mailed questionnaire between April 2007 and January 2008. RESULTS: Younger survivors (aged <60 years at diagnosis) were more likely to seek information from sources beyond their physicians and used different sources for that information, compared to older survivors. Older and younger survivors used similar conventional support services, but different CAM services. In logistic regression analyses, information-seekers were 5.9 times more likely to use CAM than those who did not seek cancer information (p = 0.02), but the association between information-seeking and CAM use depended on age (p = 0.02). Older cancer survivors who did not seek information from sources beyond that provided by physicians were less likely to use CAM. IMPLICATIONS: Physicians should consider talking to older cancer survivors about their use of information sources or CAM therapies. A conversation between physician and patient may uncover inaccurate information or CAM use that has potential for adverse effects, while allowing the physician to encourage CAM that is potentially useful. Even a brief conversation may be sufficient to encourage older cancer survivors to take action themselves to find services that support their recovery from cancer and cancer treatment.