Cancer survivors with pre-existing functional impairments due to disabling conditions such as polio, spinal cord injury or sensory impairments are the subject of a new $324,732 University of Texas at Austin School of Nursing study.
The two-year research project, funded by the National Cancer Institute, will look at health-promoting behaviors and quality of life among persons, who because of a pre-existing medical condition, may find cancer diagnosis and treatment exacerbate their ongoing challenges.
"While all cancer survivors may experience long-term effects, those with pre-existing functional limitations may have special concerns related to their diagnosis and treatment that could affect efforts to promote their heath," said Dr. Heather Becker, research scientist at the School of Nursing.
Becker wants to modify an existing wellness program intervention called Lifestyle Counts to help this special group of cancer survivors better their health-related quality of life. Lifestyle Counts was developed by Dr. Alexa Stuifbergen, associate dean of the School of Nursing, for her earlier studies on fibromyalgia and multiple sclerosis.
Becker will recruit from throughout the U.S. 150 individuals with functional limitations that existed before their cancer diagnosis, and who have moved beyond their active cancer treatment phase, to participate in the survey portion of the study. Factors identified in the survey will be combined with focus group feedback to adapt the Lifestyle Counts program to their needs.
"People with disabilities encounter many barriers to health-promoting behaviors, among them few programs tailored to their needs, inaccessible facilities and higher rates of smoking and depression," Becker said. "These patients, therefore, struggle to promote their health and prevent secondary disabling conditions, such as pain, fatigue and urinary tract infections. Cancer diagnosis and treatment may create additional challenges."
People who have multiple sclerosis, for example, already experience fatigue. They may find the increased fatigue following cancer treatment especially difficult to manage, she said. Or, lymphedema could seriously affect wheelchair users who engage in repetitive upper body motion to navigate in their environment.
"When individuals with functional limitation cannot access routine health services, they may have difficulty getting needed health care following active cancer treatment, thereby delaying the diagnosis of recurrence or late effects of cancer treatment," Becker said.
An estimated 64 percent of adults who were diagnosed with cancer between 1995 and 2000 are expected to survive at least five years after diagnosis, compared with 50 percent of those diagnosed between 1974 and 1976, Becker said.
"While the tremendous research investment in cancer diagnosis and treatment has successfully decreased cancer mortality," she said, "we are only now beginning to understand the challenges of long-term cancer survivorship."
Researchers do not know how many cancer survivors nationwide have other pre-existing disabling conditions and to what degree those conditions limit functioning and increase the challenges of survival, according to Becker. The U.S. Census Bureau estimated that in 2003, 36 million Americans over the age of 17 had limitations in usual activities.
"Since approximately one in two men and one in three women are expected to develop cancer in their lifetime, we might anticipate that at least one-third of these 36 million adults with functional limitations are likely to eventually become cancer survivors," Becker said.