Path analysis of survivorship care needs, symptom experience, and quality of life among multiethnic cancer survivors

Abstract

Purpose

Cancer survivors continue to experience issues that persist across the survivorship trajectory. This study aims to explore the relationship among survivorship care need, symptom experience, and quality of life (QoL) of multiethnic cancer survivors by using path analytic methods.

Methods

Participants were recruited from an academic medical center in Singapore that provides inpatient and outpatient oncology and hematology service. The Cancer Survivor Unmet Needs measure, physical effects subscale of the Cancer Survivors’ Survey of Needs tool, and a Global QoL 10-point Likert scale were used to identify survivorship care needs, symptom experience, and QoL. Descriptive statistics were used to compute sociodemographic information, total survivorship needs, symptom experienced, and quality of life scores. The symptom experience model was used as the hypothetical model. The Analysis of Moment Structure was used to conduct the path analysis to evaluate the relationship between survivorship care needs, symptom experience, and quality of life.

Results

Older cancer survivors were more likely to have spent a longer duration having cancer. Males were unlikely to suffer from solid tumor malignancies. Survivors with solid tumor malignancies were less likely to require supportive care. Survivors who require more supportive care were more likely to have a greater symptom burden. Cancer survivors with more symptoms have poorer QoL. The findings from this study partially supported the symptom experience model.

Conclusions

Our findings reveal that cancer survivors continue to experience symptoms across the survivorship trajectory. The results provide information for nurses during the planning and execution of survivorship care.

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References

  1. 1.

    Simon S (2016) ACS report: number of US cancer survivors expected to exceed 20 million by 2026. American Cancer Society, Atlanta

    Google Scholar 

  2. 2.

    Office, N.R.o.D. (2017) Singapore Cancer Registry Annual Registry Report 2015, Health Promotion Board Singapore

  3. 3.

    Feuerstein M (2007) Defining cancer survivorship. J Cancer Surviv 1(1):5–7

    Article  Google Scholar 

  4. 4.

    Mullan F (1985) Seasons of survival: reflections of a physician with cancer, Mass Med Soc

  5. 5.

    den Bakker C et al (2018) Cancer survivors’ needs during various treatment phases after multimodal treatment for colon cancer-is there a role for eHealth? BMC Cancer 18(1):1207

    Article  Google Scholar 

  6. 6.

    Zhang M-f et al (2015) The influence of demographics, psychological factors and self-efficacy on symptom distress in colorectal cancer patients undergoing post-surgical adjuvant chemotherapy. Eur J Oncol Nurs 19(1):89–96

    Article  Google Scholar 

  7. 7.

    Hung HY, Wu LM, Chen KP (2018) Determinants of quality of life in lung cancer patients. J Nurs Scholarsh 50(3):257–264

    Article  Google Scholar 

  8. 8.

    Giuliani M, McQuestion M, Jones J, Papadakos J, le LW, Alkazaz N, Cheng T, Waldron J, Catton P, Ringash J (2016) Prevalence and nature of survivorship needs in patients with head and neck cancer. Head Neck 38(7):1097–1103

    Article  Google Scholar 

  9. 9.

    Horick NK, Muzikansky A, Gutierrez HL, Boyd KL, Finkelstein DM (2018) Physical symptoms in long-term survivors of rare cancer. J Cancer Surviv 12(6):835–842

    Article  Google Scholar 

  10. 10.

    Ness S, et al. (2013) Concerns across the survivorship trajectory: results from a survey of cancer survivors. in Oncol Nurs Forum

  11. 11.

    Mayer DK, Nasso SF, Earp JA (2017) Defining cancer survivors, their needs, and perspectives on survivorship health care in the USA. Lancet Oncol 18(1):e11–e18

    Article  Google Scholar 

  12. 12.

    Wu S-F, Tong HY, kan YY, Su SH, Lee MC, Kao CC, Lin YH (2017) The exploration of health-related quality of life: factors influencing quality of life in gynecologic cancer patients. Clin Nurs Res 26(1):114–131

    Article  Google Scholar 

  13. 13.

    Bernat JK, Wittman DA, Hawley ST, Hamstra DA, Helfand AM, Haggstrom DA, Darwish-Yassine M, Skolarus TA (2016) Symptom burden and information needs in prostate cancer survivors: a case for tailored long-term survivorship care. BJU Int 118(3):372–378

    Article  Google Scholar 

  14. 14.

    Reed SC, Bell JF, Whitney R, Lash R, Kim KK, Bold RJ, Joseph JG (2018) Psychosocial outcomes in active treatment through survivorship. Psycho-oncology 27(1):279–285

    Article  Google Scholar 

  15. 15.

    Taylor K, DipOnc G, Monterosso L (2015) Survivorship care plans and treatment summaries in adult patients with hematologic cancer: an integrative literature review. in Oncol Nurs Forum

  16. 16.

    Wieldraaijer T, Duineveld LAM, Bemelman WA, van Weert HCPM, Wind J (2019) Information needs and information seeking behaviour of patients during follow-up of colorectal cancer in the Netherlands. J Cancer Surviv 13(4):603–610

    CAS  Article  Google Scholar 

  17. 17.

    Armstrong TS (2003) Symptoms experience: a concept analysis. In Oncology Nursing Forum. Oncol Nurs Soc

  18. 18.

    Cohen J (1992) Quantitative methods in psychology: a power primer. Psychol Bull 112:1155–1159

    Google Scholar 

  19. 19.

    Hodgkinson K, Butow P, Hunt GE, Pendlebury S, Hobbs KM, Lo SK, Wain G (2007) The development and evaluation of a measure to assess cancer survivors’ unmet supportive care needs: the CaSUN (Cancer Survivors’ Unmet Needs measure). Psychooncology 16(9):796–804

    CAS  Article  Google Scholar 

  20. 20.

    Schlairet MC, Heddon MA, Martha Griffis R (2010) Piloting a needs assessment to guide development of a survivorship program for a community cancer center. In Oncology Nursing Forum. Oncol Nurs Soc

  21. 21.

    Pearce NJ, Sanson-Fisher R, Campbell HS (2008) Measuring quality of life in cancer survivors: a methodological review of existing scales. Psychooncology 17(7):629–640

    Article  Google Scholar 

  22. 22.

    Arbuckle JL (2017) IBM SPSS AMOS 25 User’s guide, United States: IBM Development Corporation

  23. 23.

    Byrne BM (2016) Structural Equation Modeling With AMOS: Basic Concepts, Applications, and Programming (Third Edition). Routledge, New York

    Google Scholar 

  24. 24.

    Kline RB (2015) Principles and practice of structural equation modeling (fourth edition). Guilford publication, New York

    Google Scholar 

  25. 25.

    Schermelleh-Engel K, Moosbrugger H, Müller H (2003) Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures. Methods Psychol Res Online 8(2):23–74

    Google Scholar 

  26. 26.

    Hu Lt, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model Multidiscip J 6(1):1–55

    Article  Google Scholar 

  27. 27.

    Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH (2011) Cancer survivors: a booming population. Cancer Epidemiol Prev Biomarkers 20(10):1996–2005

    Article  Google Scholar 

  28. 28.

    Mangoni AA et al. (2016) Chronic conditions and cancer in older adults, in Cancer and chronic conditions, Springer. p. 421–454

  29. 29.

    Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte S, Warner E, Lyman GH, Ganz PA (2016) American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline. CA Cancer J Clin 66(1):43–73

    Article  Google Scholar 

  30. 30.

    Fitzmaurice C et al (2017) Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol 3(4):524–548

    Article  Google Scholar 

  31. 31.

    Thompson CA, Stan DL, Solberg Nes L, Jenkins SM, Lackore KA, Pruthi S (2014) Breast cancer survivors’ self-reported needs and preferences of survivorship care. Breast J 20(1):107–109

    Article  Google Scholar 

  32. 32.

    Campo RA, Leniek KL, Gaylord-Scott N, Faurot KR, Smith S, Asher G, Porterfield D, Gaylord SA (2016) Weathering the seasons of cancer survivorship: mind-body therapy use and reported reasons and outcomes by stages of cancer survivorship. Support Care Cancer 24(9):3783–3791

    Article  Google Scholar 

  33. 33.

    Morrison V, Henderson BJ, Zinovieff F, Davies G, Cartmell R, Hall A, Gollins S (2012) Common, important, and unmet needs of cancer outpatients. Eur J Oncol Nurs 16(2):115–123

    CAS  Article  Google Scholar 

  34. 34.

    Ang WHD, Lang SP, Ang E, Lopez V (2016) Transition journey from hospital to home in patients with cancer and their caregivers: a qualitative study. Support Care Cancer 24(10):4319–4326

    Article  Google Scholar 

  35. 35.

    Gates P, Krishnasamy M (2009) Nurse-led survivorship care. In Cancer Forum. The Cancer Council Australia

  36. 36.

    Lipscomb J, Gotay CC, Snyder CF (2007) Patient-reported outcomes in cancer: a review of recent research and policy initiatives. CA Cancer J Clin 57(5):278–300

    Article  Google Scholar 

  37. 37.

    Hodgkinson K, Butow P, Hunt GE, Pendlebury S, Hobbs KM, Wain G (2007) Breast cancer survivors’ supportive care needs 2–10 years after diagnosis. Support Care Cancer 15(5):515–523

    Article  Google Scholar 

  38. 38.

    Mahendran R, Lim HA, Tan JYS, Ng HY, Chua J, Lim SE, Kua EH, Griva K (2017) Evaluation of a brief pilot psychoeducational support group intervention for family caregivers of cancer patients: a quasi-experimental mixed-methods study. Health Qual Life Outcomes 15(1):17

    Article  Google Scholar 

  39. 39.

    Lim J (2017) Sustainable health care financing: the Singapore experience. Glob Policy 8:103–109

    Article  Google Scholar 

  40. 40.

    Russell L, Gough K, Drosdowsky A, Schofield P, Aranda S, Butow PN, Westwood JA, Krishnasamy M, Young JM, Phipps-Nelson J, King D, Jefford M (2015) Psychological distress, quality of life, symptoms and unmet needs of colorectal cancer survivors near the end of treatment. J Cancer Surviv 9(3):462–470

    Article  Google Scholar 

  41. 41.

    Burris JL, Armeson K, Sterba KR (2015) A closer look at unmet needs at the end of primary treatment for breast cancer: a longitudinal pilot study. Behav Med 41(2):69–76

    Article  Google Scholar 

  42. 42.

    Zebrack BJ, Mills J, Weitzman TS (2007) Health and supportive care needs of young adult cancer patients and survivors. J Cancer Surviv 1(2):137–145

    Article  Google Scholar 

  43. 43.

    Bober SL, Fine E, Recklitis C (2019) Sexual health and rehabilitation after ovarian suppression treatment (SHARE-OS): a clinical intervention for young breast cancer survivors. J Cancer Surviv: p. 1–5

  44. 44.

    Beck SL, Towsley GL, Caserta MS, Lindau K, Dudley WN (2009) Symptom experiences and quality of life of rural and urban older adult cancer survivors. Cancer Nurs 32(5):359–369

    Article  Google Scholar 

  45. 45.

    Etikan I, Musa SA, Alkassim RS (2016) Comparison of convenience sampling and purposive sampling. Am J Theor Appl Stat 5(1):1–4

    Article  Google Scholar 

  46. 46.

    Van de Mortel TF (2008) Faking it: social desirability response bias in self-report research. Aust J Adv Nurs 25(4):40

    Google Scholar 

  47. 47.

    Teo MC, Soo KC (2013) Cancer trends and incidences in Singapore. Jpn J Clin Oncol 43(3):219–224

    Article  Google Scholar 

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Acknowledgments

The authors would like to thank all survivors for participating in this study. The authors would also like to thank Professor Alex Molasiotis of Hong Kong Polytechnic University and Professor Raymond Chan of Queensland University of Technology for their inclusion into the STEP study.

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Corresponding author

Correspondence to Ying Lau.

Ethics declarations

Ethical approval was obtained from the Singapore National Healthcare Group-Domain Specific Review Board (2016-01023). All participants received study information and provided verbal and written consent.

Conflict of interest

The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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Ang, W.H.D., Lau, Y., Ngo, L.P.E. et al. Path analysis of survivorship care needs, symptom experience, and quality of life among multiethnic cancer survivors. Support Care Cancer 29, 1433–1441 (2021). https://doi.org/10.1007/s00520-020-05631-6

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Keywords

  • Cancer survivorship
  • Survivorship care needs
  • Symptom experience
  • Quality of life
  • Path analysis
  • Oncology nursing