Cancer survivors have evolving information needs

Cancer patient’s information needs appear to differ depending on the type of cancer they have and where they are in their survivorship. Clinicians caring for cancer survivors may need to understand these needs in order to better address survivor’s concerns about cancer recurrence, late effects, and family member’s risks.

A three-year study of over 2,000 cancer survivors by the University of Pennsylvania’s Annenberg School for Communication discovered that, across survivors, the most frequently sought information was about cancer recurrence. However, interest in other topics varied by cancer type: breast cancer survivors were more likely to seek information about topics related to late effects and family members’ risks than prostate and colon cancer survivors. The patterns of seeking for these topics also changed over time. For instance, breast cancer survivors were less likely to seek information about their risks of cancer recurrence in later years than during the first year after their diagnosis. These findings are reported in the journal Cancer Epidemiology, Biomarkers & Prevention (online first, 2015).

The findings from the study are important because understanding how people seek cancer information during their cancer survivorship is an important component as clinicians help to address the physical and emotional issues their patients may be experiencing. Clinicians may need to intervene at distinct points during the cancer survivorship period with timely information to address their patients’ concerns about cancer recurrence, late effects, and family members’ risks.

Researchers Andy Tan (Dana-Farber Cancer Institute), Rebekah H. Nagler (University of Minnesota), Robert C. Hornik (Annenberg School, University of Pennsylvania), and Angela DeMichele (Abramson Cancer Center, University of Pennsylvania) surveyed over 2,000 cancer survivors three times over a three-year period (2006 to 2008). The participants were survivors of colon cancer (males and females), breast cancer, and prostate cancer. They were, on average, in their early 60s, and the survey population was split evenly between men and women.

In this series of three surveys administered over three years, the researchers asked what type of information participants sought, including:

  • How to reduce the chance of their cancer coming back
  • How to reduce their chance of getting another cancer
  • How to reduce the risk of their children or family members getting breast/prostate/colon cancer or a different type of cancer
  • Whether they are at risk of having other health problems as a result of their cancer or treatment

Across all participants, reducing the chance of cancer coming back was the number one researched subject in all three surveys. Over 28 percent of cancer survivors expressed looking for information about their risk of cancer recurrence, compared with only 12 percent who said they had looked for information about the risks of their family members getting a different cancer from their diagnosis.

Cancer type was related to survivor’s information seeking patterns over time. Although breast cancer survivors were more likely to seek information about survivorship topics earlier in their trajectory, their seeking declined over time. In comparison, female colon cancer survivors were more likely to seek information about certain topics than female breast cancer survivors in later years. The researchers surmised this may be due to the ample amount of breast cancer information readily available and the existence of robust survivorship organizations to support breast cancer survivors.

Not surprisingly, information about reducing risks of recurrence was the most frequently sought after topic among cancer survivors and over all three years of the study,” says Dr. Tan, lead author of the study. He noted that the study points to several “teachable moments” for clinicians, as well as avenues for additional study.

Additionally, Dr. Tan said, “clinicians should consider the early survivorship timeframe as an opportunity to counsel patients on other positive health behaviors, from diet to smoking cessation, to help manage risks of cancer recurrence, since this window of opportunity may be when a patient is most open to receiving such information.

Tan et al. Evolving information needs among colon, breast, and prostate cancer survivors: Results from a longitudinal mixed-effects analysis. Cancer Epidemiol Biomarkers Prev. 2015; doi: 10.1158/1055-9965.EPI-15-0041 [Abstract]

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Physical activity seems to significantly extend lives of cancer survivors

Reduces mortality by up to 48 percent according to study

Physical activity significantly extends the lives of male cancer survivors, a new study of 1,021 men has found. During the period while the men were followed, those who expended more than 12,600 calories per week in physical activity were 48 percent less likely to die than those who burned fewer than 2,100 calories per week.

Kathleen Y. Wolin, PhD, of Loyola University Chicago Stritch School of Medicine, is co-author of the study, published in the Journal of Physical Activity & Health, the official journal of the International Society for Physical Activity and Health.

Many cancer survivors are living longer, due to earlier diagnosis and better treatment, and their numbers are increasing rapidly. “Thus physical activity should be actively promoted to such individuals to enhance longevity,” researchers concluded.

There has been extensive research showing that among generally healthy, cancer-free populations, physical activity extends longevity. But there has been relatively little such research on physical activity among cancer survivors.

Researchers examined data from the Harvard Alumni Health Study, an ongoing study of men who entered Harvard as undergraduates between 1916 and 1950. Researchers looked at 1,021 men (average age 71) who previously had been diagnosed with cancer. In questionnaires conducted in 1988, men reported their physical activities, including walking, stair-climbing and participation in sports and recreational activities. Their physical activities were updated in 1993, and the men were followed until 2008.

Compared with men who expended fewer than 2,100 calories per week in physical activity, men who expended more than 12,600 calories per week were 48 percent less likely to die of any cause during the follow-up period. This finding was adjusted for age, smoking, body mass index, early parental mortality and dietary variables. (By comparison, a 176-pound man who walks briskly for 30 minutes a day, five days a week burns 4,200 calories.)

There were similar findings for mortality from cancer and cardiovascular disease: the most physically active cancer survivors were 38 percent less likely to die of cancer and 49 percent less likely to die of cardiovascular disease during the follow-up period.

Lee et al., (2014). Physical activity and survival after cancer diagnosis in men. J. Phys. Act. Health.,11:85–90 [Abstract]

Racial disparities in health care among older male cancer survivors

Older African-American and Hispanic men who have survived cancer are less likely than their white counterparts to see a specialist or receive basic preventive care, such as vaccinations, according to new research from Wake Forest Baptist Medical Center.

Researchers examined racial/ethnic disparities in health care receipt among a nationally representative sample of male cancer survivors. They found that disparities are evident among older, but not younger, cancer survivors, despite their access to Medicare.

Lead author Nynikka Palmer, Dr.P.H., a postdoctoral fellow at Wake Forest Baptist, said they identified 2,714 men 18 and older from the 2006-2010 National Health Interview Survey who reported a history of cancer. The researchers looked at health care receipt in four self-reported measures: primary care visit, specialist visit, flu vaccination and pneumonia vaccination.

“Overall, our results suggest that older minority male cancer survivors may need specific support to ensure they receive necessary post-treatment care,” Palmer said.

The study was recently published online ahead of print in the American Journal of Public Health.

Even when the researchers adjusted for factors that contribute to disparities, such as education and health insurance, they found that African American and Hispanic male cancer survivors 65 years and older may not be receiving appropriate follow-up care and preventive care. Palmer said this is a concern “because regular follow-up care is important to monitor for recurrence, new cancers, and late and long-term effects of cancer and its treatment, particularly for those with more co-morbidities.”

Overall, among older survivors, approximately 39 percent of African-Americans and 42 percent of Hispanics did not see a specialist, compared with 26 percent of older non-Hispanic whites. Likewise, about 40 percent of African-American and Hispanic cancer survivors did not receive the flu vaccination, compared with 22 percent of non-Hispanic white cancer survivors.

Similarly, 51 percent of African-Americans and 59 percent of Hispanic cancer survivors did not report receiving the pneumonia vaccine, compared with 29 percent of non-Hispanic whites.

“These findings are consistent with other reports of health care use among cancer survivors and suggest there may be differences in types of Medicare health plans, supplemental insurance and out-of-pocket costs among older survivors that could be contributing to this disparity,” Palmer said.

Palmer said further study is needed to identify other factors that may influence racial/ethnic disparities among male survivors, such as patients’ beliefs about care after cancer and patient-provider communication.

Palmer et al., (2013). Racial/Ethnic Disparities in Health Care Receipt Among Male Cancer Survivors. Am. J. Public Health103: 1306-1313 [Abstract]