Indiana University-Purdue University Indianapolis (IUPUI) / Current evidence shows that sleep-wake disturbances are a persistent problem in women surviving breast cancer. The purpose of this study was to refine the knowledge regarding the incidence, prevalence, and predictive factors of sleep-wake disturbances in breast cancer survivors (BCS) compared to age-matched women without breast cancer (WWBC). The cross-sectional, convenience-sample consisted of secondary data from BCS and WWBC who were recruited by two parent quality of life studies. Subjects were matched within +/- 5 years of age. The sample consisted of 246 BCS and 246 WWBC who were a mean age of 48 years old (SD=8.50), Caucasian (70%), employed (69%), married or partnered (76%), postmenopausal (59%), with a college education (56%), and with at least one concurrent medical problem (95%). Results showed that BCS had more prevalent sleep-wake disturbances (65%) compared to WWBC (55%). The poorest sleepers were BCS, women with hot flashes, poor physical functioning, depressive symptoms, or with moderate or high levels of distress related to a life event. BCS had higher PSQI scores indicating poorer sleep quality and higher sleep disturbances compared to WWBC. Predictors of the severity of poor sleep quality and sleep disturbances were BCS, women with higher number of co-morbidities, women with hot flashes, lower levels of physical functioning, higher depressive symptoms, and greater impact of a life event. Disease and treatment related factors did not predict poor sleep or sleep quality in BCS. Sleep disturbances are a problem in long-term BCS. Knowledge of contributing factors provides useful information during clinical evaluations and treatment of BCS reporting poor sleep. Additional research is needed to determine the impact of poor sleep on quality of life and develop/test effective interventions for long-term BCS.

Cancer-related fatigue (CRF) is a persistent and debilitating problem for many breast cancer survivors. Although many CRF measurement tools are available, no consensus exists on the most appropriate tool to use for breast cancer survivors. The purpose of this project was to identify the best method of assessing CRF in breast cancer survivors. The practice-focused question inquired about the most appropriate way to assess fatigue in breast cancer survivors. The central concepts of the project were CRF and cancer survivorship. This project was informed by the theory of health as expanding consciousness and Mishel's theory of uncertainty in illness. The sources of evidence included multi-database searches and literature from professional organizations. Results were tracked using preferred reporting items for systematic reviews and metasystems and a literature review matrix. The search identified 14 sources, which were assessed for quality using the grading of recommendations, assessment, development, and evaluation process. The results of this systematic review did not support the use of any particular assessment tool; however, 2 clinical practice guidelines recommended screening using a numerical severity scale followed by detailed assessment of clinically significant fatigue using available assessment tools. Screening can be implemented into the survivorship clinic, allowing nurses to identify potentially clinically significant fatigue so that further workup is done and interventions are implemented. Identifying, assessing, and intervening for clinically significant fatigue can improve the quality of life for breast cancer survivors, contributing to positive social change.

Purpose: A majority of childhood and adolescent cancer survivors face life-long cancer- and treatment-related sequelae. Long-term follow-up is necessary to facilitate timely diagnosis and management of these health conditions. As part of strategic long-term follow-up, provider continuity of care (PCOC) may improve outcomes through appropriate use of surveillance, screening, and coordination of services. The purpose of this thesis was to assess physician services utilization and PCOC among survivors of childhood cancer compared with general population subjects, and to examine factors associated with survivors' use of physician services and PCOC scores. Methods: Physician services utilization and PCOC were assessed in a population-based cohort of 1322 five-year cancer survivors diagnosed between 1981 and 1995 under age 20 in British Columbia, and a group of 13,220 age- and gender-frequency matched, randomly selected population-based subjects, whose records were linked to individual-level administrative healthcare datasets. Effects of clinical and sociodemographic modifiers on utilization and PCOC were examined using generalized linear modeling. Changes in utilization and PCOC by age were estimated using a longitudinal, repeated measures modeling approach. Results: Survivors incurred an average of 8.94 medical visits per year: 4.82 to primary care physicians, 2.69 to specialists, and 1.43 to non-physician providers. Survivors had more visits than comparators in all visit categories (p<0.0001 for all). As they age, survivors' use of primary care services increases significantly, while their use of specialist services declines, trends that are not mirrored by the comparison population. The average PCOC score for survivors was 0.54 ± 0.22, indicating survivors saw the same primary care provider for only 50% of their primary care visits. Mean score did not differ between survivors and comparators; however, in the population sample scores improved with age (p=0.02), while among survivors, scores worsened (p=0.05). Conclusions: The dramatic age-related increase in primary care visits observed in the survivor group suggests that primary care physicians play a key role in ensuring quality long-term follow-up care. Survivors are at heightened risk for poor PCOC as they age and transition into adult-oriented community care, raising concerns about whether they are receiving the appropriate follow-up care encompassing screening, surveillance and psychosocial support.

Purpose: A majority of childhood and adolescent cancer survivors face life-long cancer- and treatment-related sequelae. Long-term follow-up is necessary to facilitate timely diagnosis and management of these health conditions. As part of strategic long-term follow-up, provider continuity of care (PCOC) may improve outcomes through appropriate use of surveillance, screening, and coordination of services. The purpose of this thesis was to assess physician services utilization and PCOC among survivors of childhood cancer compared with general population subjects, and to examine factors associated with survivors' use of physician services and PCOC scores. Methods: Physician services utilization and PCOC were assessed in a population-based cohort of 1322 five-year cancer survivors diagnosed between 1981 and 1995 under age 20 in British Columbia, and a group of 13,220 age- and gender-frequency matched, randomly selected population-based subjects, whose records were linked to individual-level administrative healthcare datasets. Effects of clinical and sociodemographic modifiers on utilization and PCOC were examined using generalized linear modeling. Changes in utilization and PCOC by age were estimated using a longitudinal, repeated measures modeling approach. Results: Survivors incurred an average of 8.94 medical visits per year: 4.82 to primary care physicians, 2.69 to specialists, and 1.43 to non-physician providers. Survivors had more visits than comparators in all visit categories (p<0.0001 for all). As they age, survivors' use of primary care services increases significantly, while their use of specialist services declines, trends that are not mirrored by the comparison population. The average PCOC score for survivors was 0.54 ± 0.22, indicating survivors saw the same primary care provider for only 50% of their primary care visits. Mean score did not differ between survivors and comparators; however, in the population sample scores improved with age (p=0.02), while among survivors, scores worsened (p=0.05). Conclusions: The dramatic age-related increase in primary care visits observed in the survivor group suggests that primary care physicians play a key role in ensuring quality long-term follow-up care. Survivors are at heightened risk for poor PCOC as they age and transition into adult-oriented community care, raising concerns about whether they are receiving the appropriate follow-up care encompassing screening, surveillance and psychosocial support.

Thesis (Ph.D.)--Indiana University, 2008. / Title from screen (viewed on June 1, 2009). School of Nursing, Indiana University-Purdue University Indianapolis (IUPUI). ADVISOR(S): Janet S. Carpenter. Includes vita. Includes bibliographical references (leaves 227-243).

Purpose: A majority of childhood and adolescent cancer survivors face life-long cancer- and treatment-related sequelae. Long-term follow-up is necessary to facilitate timely diagnosis and management of these health conditions. As part of strategic long-term follow-up, provider continuity of care (PCOC) may improve outcomes through appropriate use of surveillance, screening, and coordination of services. The purpose of this thesis was to assess physician services utilization and PCOC among survivors of childhood cancer compared with general population subjects, and to examine factors associated with survivors' use of physician services and PCOC scores. Methods: Physician services utilization and PCOC were assessed in a population-based cohort of 1322 five-year cancer survivors diagnosed between 1981 and 1995 under age 20 in British Columbia, and a group of 13,220 age- and gender-frequency matched, randomly selected population-based subjects, whose records were linked to individual-level administrative healthcare datasets. Effects of clinical and sociodemographic modifiers on utilization and PCOC were examined using generalized linear modeling. Changes in utilization and PCOC by age were estimated using a longitudinal, repeated measures modeling approach. Results: Survivors incurred an average of 8.94 medical visits per year: 4.82 to primary care physicians, 2.69 to specialists, and 1.43 to non-physician providers. Survivors had more visits than comparators in all visit categories (p<0.0001 for all). As they age, survivors' use of primary care services increases significantly, while their use of specialist services declines, trends that are not mirrored by the comparison population. The average PCOC score for survivors was 0.54 ± 0.22, indicating survivors saw the same primary care provider for only 50% of their primary care visits. Mean score did not differ between survivors and comparators; however, in the population sample scores improved with age (p=0.02), while among survivors, scores worsened (p=0.05). Conclusions: The dramatic age-related increase in primary care visits observed in the survivor group suggests that primary care physicians play a key role in ensuring quality long-term follow-up care. Survivors are at heightened risk for poor PCOC as they age and transition into adult-oriented community care, raising concerns about whether they are receiving the appropriate follow-up care encompassing screening, surveillance and psychosocial support. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

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Alors que les survivants du cancer sont à risque plus élevé de second cancer, d’autres pathologies et de déclin fonctionnel ; les facteurs de mode de vie, comme une alimentation équilibrée, une pratique d’activité physique et le contrôle d’un poids sain, peuvent contribuer à prévenir ces risques et améliorer la qualité de vie des survivants du cancer. Dans ce contexte, les objectifs de cette thèse étaient, parmi les survivants du cancer de la cohorte française prospective NutriNet-Santé, 1) d’investiguer les variations du comportement nutritionnel entre avant et après diagnostic de cancer ainsi que la consommation de compléments alimentaires, et 2) d’évaluer les opinions vis-à-vis de certains facteurs nutritionnels, et de les mettre en regard de leurs pratiques alimentaires réelles d’une part, et de leurs sources d’information nutritionnelles d’autre part. Dans un premier temps, nous avons observé des tendances favorables à la santé comme une diminution de la consommation d’alcool et des boissons sucrées non alcoolisées, et d’autres moins favorables comme une diminution de la consommation de légumes et de plusieurs apports en vitamines et minéraux. Un déclin de l’activité physique globale et intense était observé. De manière cohérente, nous avons observé une augmentation des comportements sédentaires, particulièrement chez les femmes, les sujets plus âgés et les patients qui n’étaient pas actif professionnellement. Nous avons observé une perte de poids chez certains cas de cancers colorectaux, alors qu’une prise de poids était observée chez les cas de cancers du sein et de la peau. Les facteurs sociodémographiques et économiques semblaient influencer le risque de prise de poids, suggérant des inégalités sociales de santé (risque plus élevé chez les patients ayant des revenus et un niveau d’étude plus faible). Nos résultats suggéraient que la consommation de compléments alimentaires était largement répandue chez les survivants du cancer, en grande partie sans suivi médical, incluant une proportion non négligeable de patients ayant des pratiques de consommation de compléments alimentaires pouvant être considérées comme « à risque ».Dans un second temps, nous avons observé que les opinions des survivants du cancer concernant certains facteurs nutritionnels semblaient impacter leurs pratiques alimentaires et étaient eux-mêmes impactés par les sources d’informations auxquelles les survivants du cancer avaient eu accès depuis leur diagnostic de cancer. En particulier, les opinions concernant la consommation d’alcool étaient préoccupantes, avec une proportion importante de survivants du cancer qui pensaient que la consommation d’alcool (et plus encore concernant le vin rouge) avait un impact positif sur leur maladie. Les régimes restrictifs pour perdre du poids étaient pratiqués par une grande partie de notre échantillon ; le jeûne était moins pratiqué, mais était loin d’être un phénomène isolé. / While cancer survivors are at increased risk for negative conditions as second cancers, other comorbidities, and functional decline ; lifestyle factors, such as a healthy diet, regular exercise and weight control, may contribute to prevent these conditions and improve survivors' quality of life. In this context, aims of this thesis were, among cancer survivors from the French prospective NutriNet-Santé study, to 1) investigate nutritional variations between before and after cancer diagnosis as well as dietary supplements use, and 2) evaluate opinions relating to some diet factors and to weight-loss restrictive diets and fasting practices, and to link them on the one hand to their real practices, and, on the other hand, to their sources of nutritional information.In the first part, our results highlight some healthy behaviors such as a decrease in alcohol and sweetened drinks consumption, but also less favorable trends, such as a decrease in vegetable consumption and in many vitamin and mineral intakes. We also observed a decline in overall and vigorous physical activity after diagnosis, especially in prostate and skin cancers, in men and professionally inactive patients. Concomitantly, we observed an increase in sedentary behaviors, especially in women, older subjects and professionally inactive patients. We also observed that while weight loss was reported in many colorectal cancer patients, a substantial proportion of breast cancer patients gained weight. Sociodemographic and economic factors appeared as important determinants of weight gain, illustrating social inequalities in health (higher risk among patients with lower income and lower education). Our results suggest that dietary supplements use was widespread among cancer survivors, a large amount of which being used without any medical supervision, including a non-negligible proportion of patients having dietary supplement practices which can be considered as “at risk”. In a second part, we observed that opinions from cancer survivors regarding some nutritional factors seemed to impact their dietary practices and were themselves impacted by sources of nutritional information. In particular, opinions regarding alcohol consumption were concerning, with an important proportion of cancer survivors who thought that alcohol consumption (and even more regarding red wine) had a positive impact on their disease. Weight-loss restrictive diets were practiced by a large number of cancer survivors since their diagnosis, while fasting was less practiced, but was far from being an isolated phenomenon.

Cancer affects millions of people every year and survivorship has increased substantially recently. Two cancers that affect older adults is non-Hodgkin's lymphoma and breast cancer, yet very little research has focused on cancer and survivorship in late life. Emerging research has suggested that chemotherapy could have deleterious consequences on cognition, but few studies have considered the long-term neurocognitive sequelae of chemotherapy. Furthermore, social support and optimism have been independently examined as predictors of quality of life in cancer patients, but little research has considered the effects of these variables on other outcomes, such as cognition. The aim of this study was to gain a better understanding of the relationship between social support and optimism on cognition, specifically in non-Hodgkin's lymphoma (NHLS) and breast cancer survivors (BCS). It was hypothesized that social support and optimism would be positively related to cognition, and that social support would mediate the optimism-cognition relationship. Twenty-seven BCS (M age = 71.96), twenty-five female (M age = 69.76) and twenty-five male (M age = 65.28) NHLS groups were recruited. Each participant completed a three-hour standardized neuropsychological battery designed to evaluate a range of cognitive abilities involving attention, premorbid and current intellect, memory, language, visuospatial skills, and executive functioning, as well as self-report measures of mood, social support, and optimism. Performances on cognitive tests were within normal limits, but differences were found in aspects of executive functioning (p < .01) with the men outperforming women in the NHLS group. Women in the NHLS group performed better on a measure of executive functioning (p < .05) and visuospatial functioning (p < .01) than women in the BCS group. Women from both groups performed better than the male NHLS group on verbal learning and memory measures (all p's < .05). The groups did not differ on psychosocial variables. Correlations between psychosocial variables (i.e., social support and optimism) were variably related to cognitive measures in both groups. Social support did not mediate the optimism-cognition relationship. This is the first study to consider the relationship between social support, optimism, and cognition and early interventions to improve cognition in cancer survivors is discussed.