Journal of Cancer Survivorship

, Volume 5, Issue 1, pp 18–26 | Cite as

Do ongoing lifestyle disruptions differ across cancer types after the conclusion of cancer treatment?

  • Kenneth Mah
  • Andrea Bezjak
  • D. Andrew Loblaw
  • Andrew Gotowiec
  • Gerald M. Devins
Article

Abstract

Introduction

Cancer interferes with participation in valued lifestyle activities (illness intrusiveness) throughout post-treatment survivorship. We investigated whether illness intrusiveness differs across life domains among survivors with diverse cancers. Intrusiveness should be highest in activities requiring physical/cognitive functioning (instrumental domain). Intrusiveness into relationship/sexual functioning (intimacy domain) should be higher in prostate, breast, and gastrointestinal cancers than in others.

Methods

Cancer outpatients (N = 656; 51% men) completed the Illness Intrusiveness Ratings Scale (IIRS) during follow-up. We compared IIRS Instrumental, Intimacy, and Relationships and Personal Development [RPD] subscale and total scores across gastrointestinal, lung, lymphoma, head and neck, prostate (men), and breast cancers (women), comparing men and women separately.

Results

Instrumental subscale scores (Mmen = 3.05–3.80, Mwomen = 3.02–3.63) were highest for all groups, except prostate cancer. Men with prostate cancer scored higher on Intimacy (M = 3.40) than Instrumental (M = 2.48) or RPD (M = 1.59), p’s < .05; their Intimacy scores did not differ from men with gastrointestinal or lung cancer. Women collectively showed higher Instrumental (M = 3.39) than Intimacy (M = 2.49) or RPD scores (M = 2.27), p’s < .001, but not the hypothesized group difference in Intimacy.

Conclusions

Post-treatment survivors continue to experience some long-term interference with activities requiring physical and cognitive functioning. Sexual adjustment may be of special concern to men when treatments involve genitourinary functioning.

Implications for Cancer Survivors

Ongoing monitoring with the IIRS to detect lifestyle interference throughout survivorship may enhance quality of life. Screening and intervention should target particular life domains rather than global interference.

Keywords

Cancer diagnosis Cancer survivorship Illness intrusiveness Psychosocial factors Quality of life 

Notes

Acknowledgements

This research was supported by funding from the University Health Network (UHN) Quality Program, the Princess Margaret Hospital’s Department of Radiation Oncology, and the Princess Margaret Hospital’s Quality of Life Clinical Research Program. This research was also supported in part by the Canadian Institutes of Health Research (CIHR) through a post-doctoral fellowship to Kenneth Mah and a Senior Investigator Award to Gerald M. Devins. Thanks to Bev Devins and Wendy Maharaj for assistance in collecting the data. We extend our gratitude to the members of the UHN Psychosocial Oncology and Palliative Care Quality of Life Manuscript-Review Seminar for their invaluable feedback on earlier versions of this manuscript.

References

  1. 1.
    Lo C, Li M, Rodin G. The assessment and treatment of distress in cancer patients: overview and future directions. Minerva Psichiatr. 2008;49:129–43.Google Scholar
  2. 2.
    Lynch BM, Steginga SK, Hawkes AL, Pakenham KI, Dunn J. Describing and predicting psychological distress after colorectal cancer. Cancer. 2008;112:1363–70.CrossRefPubMedGoogle Scholar
  3. 3.
    Vahdaninia M, Omidvari S, Montazeri A. What do predict anxiety and depression in breast cancer patients? A follow-up study. Soc Psychiatr Psychiatr Epidemiol. 2010;45:355–61.CrossRefGoogle Scholar
  4. 4.
    Ahlberg K, Ekman T, Wallgren A, Gaston-Johansson F. Fatigue, psychological distress, coping and quality of life in patients with uterine cancer. J Adv Nurs. 2004;45:205–13.CrossRefPubMedGoogle Scholar
  5. 5.
    Burkett VS, Cleeland CS. Symptom burden in cancer survivorship. J Cancer Surviv. 2007;1:167–75.CrossRefPubMedGoogle Scholar
  6. 6.
    Chin D, Boyle GM, Porceddu S, Theile DR, Parsons PG, Coman WB. Head and neck cancer: past, present and future. Expert Rev Anticancer Ther. 2006;6:1111–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Delgado-Guay MO, Bruera E. Management of pain in the older person with cancer. Oncology. 2008;22:56–61.PubMedGoogle Scholar
  8. 8.
    Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;12 Suppl 1:4–10.CrossRefPubMedGoogle Scholar
  9. 9.
    Devins GM, Binik YM, Hutchinson TA, Hollomby DJ, Barre PE, Guttmann RD. The emotional impact of end-stage renal disease: importance of patients’ perceptions of intrusiveness and control. Int J Psychiatr Med. 1983;13:327–43.CrossRefGoogle Scholar
  10. 10.
    Devins GM. Illness intrusiveness and the psychosocial impact of lifestyle disruptions in chronic life-threatening disease. Adv Ren Repl Ther. 1994;1:251–63.Google Scholar
  11. 11.
    Ashing-Giwa KT, Kagawa-Singer M, Padilla GV, Tejero JS, Hsiao E, Chhabra R, et al. The impact of cervical cancer and dysplasia: a qualitative, multiethnic study. Psycho Oncol. 2004;13:709–28.CrossRefGoogle Scholar
  12. 12.
    Oberst K, Bradley CJ, Gardiner JC, Schenk M, Given CW. Work task disability in employed breast and prostate cancer patients. J Cancer Surviv. 2010;4:322–30.CrossRefPubMedGoogle Scholar
  13. 13.
    Rozmovits L, Ziebland S. Expressions of loss of adulthood in the narratives of people with colorectal cancer. Qual Health Res. 2004;14:187–203.CrossRefPubMedGoogle Scholar
  14. 14.
    Vironen JH, Kairaluoma M, Aalto AM, Kellokumpu IH. Impact of functional results on quality of life after rectal cancer surgery. Dis Colon Rectum. 2006;49:568–78.CrossRefPubMedGoogle Scholar
  15. 15.
    Heinonen H, Volin L, Zevon MA, Uutela A, Barrick C, Ruutu T. Stress among allogeneic bone marrow transplantation patients. Patient Educ Couns. 2005;56:62–71.CrossRefPubMedGoogle Scholar
  16. 16.
    Alder J, Zanetti R, Wight E, Urech C, Fink N, Bitzer J. Sexual dysfunction after premenopausal Stage I and II breast cancer: do androgens play a role? J Sex Med. 2008;5:1898–906.CrossRefPubMedGoogle Scholar
  17. 17.
    DeGroot JM, Mah K, Fyles A, Winton S, Greenwood S, DePetrillo AD, et al. The psychosocial impact of cervical cancer among affected women and their partners. Int J Gynecol Cancer. 2005;15:918–25.CrossRefGoogle Scholar
  18. 18.
    Neese LE, Schover LR, Klein EA, Zippe C, Kupelian PA. Finding help for sexual problems after prostate cancer treatment: a phone survey of men’s and women’s perspectives. Psycho Oncol. 2003;12:463–73.CrossRefGoogle Scholar
  19. 19.
    Feuerstein M, Todd BL, Moskowitz MC, Bruns GL, Stoler MR, Nassif T, et al. Work in cancer survivors: a model for practice and research. J Cancer Surviv. 2010;4:415–37.CrossRefPubMedGoogle Scholar
  20. 20.
    Rasmussen DM, Elverdam B. The meaning of work and working life after cancer: an interview study. Psycho Oncol. 2008;17:1232–8.CrossRefGoogle Scholar
  21. 21.
    Beanlands HJ, Lipton JH, McCay EA, Schimmer AD, Elliott ME, Messner HA, et al. Self-concept as a “BMT patient”, illness intrusiveness, and engulfment in allogeneic bone marrow transplant recipients. J Psychosom Res. 2003;55:419–25.CrossRefPubMedGoogle Scholar
  22. 22.
    Devins GM, Stam HJ, Koopmans JP. Psychosocial impact of laryngectomy mediated by perceived stigma and illness intrusiveness. Can J Psychiatr. 1994;39:608–16.Google Scholar
  23. 23.
    Muzzin LJ, Anderson NJ, Figueredo AT, Gudelis SO. The experience of cancer. Soc Sci Med. 1994;38:1201–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Gudbergsson SB, Fossa SD, Dahl AA. Is cancer survivorship associated with reduced work engagement? A NOCWO study. J Cancer Surviv. 2008;2:159–68.CrossRefGoogle Scholar
  25. 25.
    Richardson LC, Wingo PA, Zack MM, Zahran HS, King JB. Health-related quality of life in cancer survivors between ages 20 and 64 years: population-based estimates from the behavioral risk factor surveillance system. Cancer. 2008;112:1380–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Bloom JR, Stewart SL, Johnston M, Banks P. Intrusiveness of illness and quality of life in young women with breast cancer. Psycho Oncol. 1998;7:89–100.CrossRefGoogle Scholar
  27. 27.
    Schimmer AD, Elliott ME, Abbey SE, Raiz L, Keating A, Beanlands HJ, et al. Illness intrusiveness among survivors of autologous blood and marrow transplantation. Cancer. 2001;92:3147–54.CrossRefPubMedGoogle Scholar
  28. 28.
    Demark-Wahnefried W, Clipp EC, Morey MC, Pieper CF, Sloane R, Snyder DC, et al. Lifestyle intervention development study to improve physical function in older adults with cancer: outcomes from Project LEAD. J Clin Oncol. 2006;24:3465–73.CrossRefPubMedGoogle Scholar
  29. 29.
    Chang VT, Hwang SS, Feuerman M, Kasimis BS. Symptom and quality of life survey of medical oncology patients at a veterans affairs medical center—a role for symptom assessment. Cancer. 2000;88:1175–83.CrossRefPubMedGoogle Scholar
  30. 30.
    Devins GM, Bezjak A, Mah K, Loblaw DA, Gotowiec AP. Context moderates illness-induced lifestyle disruptions across life domains: a test of the illness intrusiveness theoretical framework in six common cancers. Psycho Oncol. 2006;15:221–33.CrossRefGoogle Scholar
  31. 31.
    Incrocci L. Radiotherapy for prostate cancer and sexual functioning. Hosp Med. 2004;65:605–8.PubMedGoogle Scholar
  32. 32.
    Lintz K, Moynihan C, Steginga S, Norman A, Eeles R, Huddart R, et al. Prostate cancer patients’ support and psychological care needs: survey from a non-surgical oncology clinic. Psycho Oncol. 2003;12:769–983.CrossRefGoogle Scholar
  33. 33.
    Schover LR, Fouladi RT, Warneke CL, Neese L, Klein EA, Zippe C, et al. Seeking help for erectile dysfunction after treatment for prostate cancer. Arch Sex Behav. 2004;33:443–54.CrossRefPubMedGoogle Scholar
  34. 34.
    Birgisson H, Pahlman L, Gunnarsson U, Glimelius B. Late adverse effects of radiation therapy for rectal cancer—a systematic overview. Acta Oncol. 2007;46:504–16.CrossRefPubMedGoogle Scholar
  35. 35.
    Moriya Y. Function preservation in rectal cancer surgery. Int J Clin Oncol. 2006;11:339–43.CrossRefPubMedGoogle Scholar
  36. 36.
    Karabulut N, Erci B. Sexual desire and satisfaction in sexual life affecting factors in breast cancer survivors after mastectomy. J Psychosoc Oncol. 2009;27:332–43.CrossRefPubMedGoogle Scholar
  37. 37.
    Melisko ME, Goldman M, Rugo HS. Amelioration of sexual adverse effects in the early breast cancer patient. J Cancer Surviv. 2010;4:247–55.CrossRefPubMedGoogle Scholar
  38. 38.
    Henson HK. Breast cancer and sexuality. Sex Disabil. 2002;20:261–75.CrossRefGoogle Scholar
  39. 39.
    Kornblith AB, Ligibel J. Psychosocial and sexual functioning of survivors of breast cancer. Semin Oncol. 2003;30:799–813.CrossRefPubMedGoogle Scholar
  40. 40.
    Petronis VM, Carver CS, Antoni MH, Weiss S. Investment in body image and psychosocial well-being among women treated for early stage breast cancer: partial replication and extension. Psychol Health. 2003;18:1–13.CrossRefGoogle Scholar
  41. 41.
    Conger RD, Lorenz FO, Elder GHJ, Simons RL, Ge X. Husband and wife differences in response to undesirable life events. J Health Soc Behav. 1993;34:71–88.CrossRefPubMedGoogle Scholar
  42. 42.
    Kornstein SG, Schatzberg AF, Thase ME, Yonkers KA, McCullough JP, Keitner GI, et al. Gender differences in chronic major and double depression. J Affect Disord. 2000;60:1–11.CrossRefPubMedGoogle Scholar
  43. 43.
    Devins GM, Dion R, Pelletier LG, Shapiro CM, Abbey SE, Raiz L, et al. The structure of lifestyle disruptions in chronic disease: a confirmatory factor analysis of the illness intrusiveness ratings scale. Med Care. 2001;39:1097–104.CrossRefPubMedGoogle Scholar
  44. 44.
    Loblaw DA, Bezjak A, Singh M, Gotowiec AP, Joubert D, Mah K, et al. Psychometric refinement of an outpatient, visit-specific satisfaction with doctor questionnaire. Psycho Oncol. 2004;13:223–34.CrossRefGoogle Scholar
  45. 45.
    Devins GM, Styra R, O’Connor P, Gray T, Seland TP, Klein GM, et al. Psychosocial impact of illness intrusiveness moderated by age in multiple sclerosis. Psychol Health Med. 1996;1:179–91.CrossRefGoogle Scholar
  46. 46.
    Devins GM, Edworthy SM, Lupus State Models Research Group ARAMIS. Illness intrusiveness explains race-related quality-of-life differences among women with systemic lupus erythematosus. Lupus. 2000;9:534–41.CrossRefPubMedGoogle Scholar
  47. 47.
    Devins GM, Beanlands H, Mandin H, Paul LC. Psychosocial impact of illness intrusiveness moderated by self-concept and age in end-stage renal disease. Health Psychol. 1997;16:529–38.CrossRefPubMedGoogle Scholar
  48. 48.
    Devins GM. Using the Illness Intrusiveness Ratings Scale to understand health-related quality of life in chronic disease. J Psychosom Res. 2010;68:591–602.CrossRefPubMedGoogle Scholar
  49. 49.
    Mah K, Bezjak A, Loblaw DA, Gotowiec A, Devins GM. Measurement invariance of the Illness Intrusiveness Ratings Scale’s 3-factor structure in men and women with cancer. Rehabil Psychol. 2010; accepted for publication.Google Scholar
  50. 50.
    Nunnally JC. Psychometric theory. 2nd ed. New York: McGraw-Hill; 1978.Google Scholar
  51. 51.
    Syse A, Tretli S, Kravdal Ø. Cancer’s impact on employment and earnings—a population-based study from Norway. J Cancer Surviv. 2008;2:149–58.CrossRefPubMedGoogle Scholar
  52. 52.
    Platou TF, Skjeldestad FE, Rannestad T. Socioeconomic conditions among long-term gynaecological cancer survivors—a population-based case-control study. Psycho Oncol. 2010;19:306–12.CrossRefGoogle Scholar
  53. 53.
    Hodgson NA, Given CW. Determinants of functional recovery in older adults surgically treated for cancer. Cancer Nurs. 2004;27:10–6.CrossRefPubMedGoogle Scholar
  54. 54.
    Clark JA, Bokhour BG, Inui TS, Silliman RA, Talcott JA. Measuring patients’ perceptions of the outcomes of treatment for early prostate cancer. Med Care. 2003;41:923–36.CrossRefPubMedGoogle Scholar
  55. 55.
    Monga U. Sexual functioning in cancer patients. Sex Disabil. 2002;20:277–95.CrossRefGoogle Scholar
  56. 56.
    Tan G, Waldman K, Bostick R. Psychosocial issues, sexuality, and cancer. Sex Disabil. 2002;20:297–318.CrossRefGoogle Scholar
  57. 57.
    Schwartz S, Plawecki HM. Consequences of chemotherapy on the sexuality of patients with lung cancer. Clin J Oncol Nurs. 2002;6:212–6.CrossRefPubMedGoogle Scholar
  58. 58.
    Shell JA, Carolan M, Zhang Y, Meneses KD. The longitudinal effects of cancer treatment on sexuality in individuals with lung cancer. Oncol Nurs Forum. 2008;35:73–9.CrossRefPubMedGoogle Scholar
  59. 59.
    Banthia R, Malcarne VL, Varni JW, Ko CM, Sadler GR, Greenbergs HL. The effects of dyadic strength and coping styles on psychological distress in couples faced with prostate cancer. J Behav Med. 2003;26:31–52.CrossRefPubMedGoogle Scholar
  60. 60.
    Ben-Zur H, Gilbar O, Lev S. Coping with breast cancer: patient, spouse, and dyad models. Psychosom Med. 2001;63:32–9.PubMedGoogle Scholar
  61. 61.
    Jenkins R, Schover LR, Fouladi RT, Warneke C, Neese L, Klein EA, et al. Sexuality and health-related quality of life after prostate cancer in African-American and white men treated for localized disease. J Sex Marital Ther. 2004;30:79–93.CrossRefPubMedGoogle Scholar
  62. 62.
    Ganz PA, Rowland JH, Meyerowitz BE, Desmond KA. Impact of different adjuvant therapy strategies on quality of life in breast cancer survivors. Recent Results Cancer Res. 1998;152:396–411.PubMedGoogle Scholar
  63. 63.
    Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE. Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol. 1998;16:501–14.PubMedGoogle Scholar
  64. 64.
    Breukink SO, Wouda JC, van der Werf-Eldering M, van de Wiel HBM, Bouma EMC, Pierie JP, et al. Psychophysiological assessment of sexual function in women after radiotherapy and total mesorectal excision for rectal cancer: a pilot study on four patients. J Sex Med. 2009;6:1045–53.CrossRefPubMedGoogle Scholar
  65. 65.
    van der Horst-Schrivers A, van Ieperen E, Wymenga ANM, Boezen HM, Weijmar-Schultz WCM, Kema IP, et al. Sexual function in patients with metatastic midgut carcinoid tumours. Neuroendocrinology. 2009;89:231–6.CrossRefPubMedGoogle Scholar
  66. 66.
    Rosenthal R, Rosnow RL. The volunteer subject. New York: Wiley; 1975.Google Scholar
  67. 67.
    Lavery JF, Clarke VA. Prostate cancer: patients’ and spouses’ coping and marital adjustment. Psychol Health Med. 1999;4:289–302.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Kenneth Mah
    • 1
  • Andrea Bezjak
    • 2
  • D. Andrew Loblaw
    • 3
  • Andrew Gotowiec
    • 4
  • Gerald M. Devins
    • 5
    • 6
  1. 1.Psychosocial Oncology and Palliative Care ProgramPrincess Margaret HospitalTorontoCanada
  2. 2.Department of Radiation OncologyPrincess Margaret Hospital, and University of TorontoTorontoCanada
  3. 3.Odette Cancer Cancer CentreSunnybrook Health Sciences Centre, and University of TorontoTorontoCanada
  4. 4.Department of PsychiatrySt. Joseph’s Health Centre, and University of TorontoTorontoCanada
  5. 5.Psychosocial Oncology and Palliative Care ProgramOntario Cancer Institute, Princess Margaret Hospital, and University of TorontoTorontoCanada
  6. 6.Toronto General HospitalTorontoCanada

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