The aim of this study is to describe breast cancer survivors' experiences and the associated meanings participating in their important activities during and after breast cancer treatment and the relationship among the survivor, environment, occupation, and performance, using a concurrent mixed method design. Ten survivors between the ages of 45 and 64 with Stage I, II, or III breast cancer who had been treated consecutively with surgery, chemotherapy, and radiation therapy were recruited for the study. Each survivor completed the Activity Card Sort-modified scoring system (ACSm) during the first and last week of radiation therapy and 3 and 6 months post radiation therapy. Additionally, each survivor participated in a semi-structured interview at the end of radiation therapy and 6 months afterwards. Qualitative data was analyzed using interpretative phenomenological analysis (IPA) to understand the survivors' experiences participating in their most important activities. The means and standard deviations of the proportion of activities resumed for the participants' global and category activities were calculated at each time point. A desire to resume participation in meaningful activities emerged from the data and demonstrated the interrelationship between environment, person, and occupation. Themes from the last week of radiation were (a) individual outlook influences how activities are approached, (b) social support reduces the stress of life, (c) side effects influence how activities are completed, and (d) personal and treatment stresses and struggles influenced their perspectives on life. At 6 months post radiation therapy, the themes were (a) emotional effect on activities, (b) life after cancer has changed due to cancer diagnosis and treatment, and (c) side effects continue to influence daily activities. Using the seven stages of analyzing mixed method data developed by Onwuegbuzie and Teddlie (2003), the qualitative and quantitative data were integrated. The results illustrated that the participants resumed a greater proportion of instrumental activities, which were reported consistently as one of their five most important activities. Additionally, supportive extrinsic factors appeared to be more influential in resuming participation important activities than intrinsic factors. Findings from this study support using the Person-Environment-Occupational-Performance (PEOP) model to develop treatment plans for women undergoing or recovering from breast cancer treatment.

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The objective of this thesis is to assess the prevalence of low quality of life in adult cancer survivors and predictors for these low scores, separately for physical and mental quality of life. Possible predictors can include sociodemographic, clinical, and behavioral factors. The data source for this thesis is the National Health and Nutrition Examination Survey (NHANES) 2005-2012. The sample population included 1244 cancer survivors 20 years or older that answered “yes” to the question “have you ever been told by a doctor or other health professional that had cancer or malignancy of any kind?” Mental and physical health scores were determined based on the number of days physical and mental health was not good and dichotomized according to mean value. The four groups identified were low mental health and low physical health (n=148, 11.9%), low mental health and high physical health (n=239, 19.2%), high mental health and low physical health (n=143, 11.5%), and high mental health and high physical health (n=714, 57.4%). The diet quality was calculated using the Healthy Eating Index 2015, which measures adherence to the Dietary Guidelines for Americans 2015-2020. The SAS Survey Analysis Procedures was used to account for the random multi-stage sampling of NHANES. Also, ANOVA and chi-square tests were used to determine the possible predictors of low quality of life while multivariable logistic regression analysis was performed to examine the independent predictors of low physical and mental health. Statistical significance was set at a two-sided p-value of

Indiana University-Purdue University Indianapolis (IUPUI) / Adolescents and young adults with cancer have poorer treatment and survivorship outcomes than either younger or older cancer patients. These individuals also have psychosocial late effects and engage in lifestyle behaviors that increase their risk of subsequent cancer and other chronic illnesses. Thus, there is a need to identify protective factors during the diagnosis and treatment period to foster healthy lifestyle behaviors. Connectedness with healthcare providers is a potential protective factor that may diminish risk-taking behaviors and foster healthcare self-management in adolescents with cancer. However, little is known about connectedness with healthcare providers from adolescents with cancer perspectives. The purpose of this study was to describe young adult cancer survivors' experiences of connectedness with their healthcare providers as they negotiated the experience across the cancer continuum from diagnosis to survivorship during adolescence. A qualitative, empirical phenomenological method guided this research. The sample consisted of 9 young adult cancer survivors who had cancer as adolescents. A broad, data generating question was constructed to elicit rich, narrative descriptions of participants' experiences of connectedness with healthcare providers, which were audio-taped and transcribed. The narrative data were analyzed using Colaizzi's method, which involved a systematic process of extracting and analyzing significant statements for formulated meanings and themes. Seven theme categories were identified and then used to develop a narrative of the essential structure of the experience of connectedness. Connectedness with healthcare providers is a multi-faceted experience that encompasses instances of not only connectedness, but also unconnectedness and disconnectedness. Effective strategies that foster connectedness with adolescents were identified. Behaviors that foster disconnectedness relate to a lack of respect for the adolescent's personhood. Findings indicate that connectedness with healthcare providers may make adolescents more likely to engage in care partnerships and effective self-management during treatment and into survivorship. When there is no connectedness or a disconnection with healthcare providers, a door shuts: there are feelings of helplessness and vulnerability, anger and resentment, and reluctance to connect with healthcare providers for cancer prevention. Clinical implications for healthcare providers are discussed. Future research should focus on connectedness theory development, measures, and interventions that foster adolescent-provider connectedness.

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Physical activity (PA) has numerous benefits for cancer survivors, but limited research exists on PA interventions in young adult cancer survivors. Outdoor adventure therapy is a potential method of increasing PA in this demographic. The primary purpose of this non-randomized parallel group study was to determine whether the outdoor adventure camp experience (vs. wait list control) would increase participants’ PA levels immediately following the 7-day camp, as well as three months later. Secondary aims examined correlates of greater PA, including pre-post camp changes in sedentary behavior, exercise self-efficacy, environmental change self-efficacy, perceived barriers to exercise, physical activity enjoyment, and physical activity variety. Sixty-six control and 50 intervention participants were given validated quantitative questionnaires at baseline, 1 week (end of camp) and at the 3-month follow-up. Repeated measures multivariate analysis of variance (RMANOVA) was used to compare group changes over time. Using intent to treat analysis, adjusting for age, gender, age at diagnosis, and baseline minutes of PA per week, there was a significant difference (p=.0001) in minutes of PA per week between groups at both 1 week and 3 months. Bonferroni adjusted post-hoc analysis indicated that, relative to baseline, the intervention group had significantly (p=.0001) greater increases in PA at both 1 week (577 minutes vs. 9 minute increases) and 3 month follow-ups (133 minute increases vs. 75 minute decreases; p=.001) respectively. Significant intervention-related improvements were also observed in TV viewing hours/week (p=.001), hours sitting/week (p=.001), “Excuses” score of the Perceived Barriers to PA questionnaire (p=.04), Enjoyment of Structured Activities (p=.04), and PA Variety (p=.0001) at 1 week but not at the 3 month follow-up. No significant effects were observed for changes in exercise self-efficacy, environmental change self-efficacy, or the other subscales scores. In conclusion, outdoor adventure therapy has the potential to increase PA levels in cancer survivors both immediately following camp, as well as long-term. However, effects tend to wane after camp termination. Future research should explore the relationship between correlates of PA and PA levels in outdoor adventure therapy camp participants and methods to promote sustained PA after camp termination.