A $1.4 million grant from the National Cancer Institute and the National Institute on Aging will enable sociologists from Case Western Reserve University to examine the quality of life for cancer survivors of five to 20 years. NCI announced the grants Saturday.
Gary Deimling, associate professor in the Department of Sociology, will direct a research team for the five-year, longitudinal study of 360 long-term cancer survivors over age 60 to see how this population group copes with surviving cancer and how the survival skills employed during surgeries and treatment for cancer can affect the coping abilities of senior citizens as they face other medical crises or losses in aging.
Working with Deimling on the study will be a multi-disciplinary team that includes Boaz Kahana, professor of sociology from Cleveland State University; Eva Kahana, chair of the CWRU Department of Sociology; Julia Rose, CWRU assistant professor and director of the Geriatric Education Center; Kyle Kercher, CWRU associate professor of sociology; and Kurt Stange, CWRU associate professor of medicine.
Deimling noted that funding comes at a time when the NCI is concerned with the psychosocial consequences of the disease, as an increasing number of older adults are surviving cancer and living longer. The American Cancer Society predicts there will be more than 10 million cancer survivors over age 50 by the year 2000.
He added that the NCI is concerned with why some cancer survivors go on to live normal lives, while other survivors in remission from cancer have a diminished quality of life due to physical and psychosocial problems.
The NCI-funded project, "The Quality of Life of Older Adult Long-Term Cancer Survivors," will look at colorectal, breast, and prostrate cancer survivors who were treated at the Ireland Cancer Center at University Hospitals of Cleveland. Deimling plans to have 120 individuals with each cancer type participate in the study.
Deimling chose to focus on survivors of these cancers because colorectal is the leading cancer of both sexes, while the other two types of cancer are sex-specific.
The three cancers, along with lung cancer, represent 52 percent of all cancers on the NCI tumor registry. (Deimling did not include adults with lung cancer because of their low survival rates after five years.)
The study will also examine the differences in the impact that cancer has had, comparing strategies of whites and African-Americans in terms of coping responses and the availability and use of social and medical supports.
In the new study, researchers will interview each participant annually for three years, following up on changes in the individual's life and how they coped with the aftermath of cancer and other ongoing health concerns.
They will be asked about their quality of life as defined by their physical health, any related medical conditions associated with cancer, fear of recurrence, distress, stigmatization, coping, health beliefs, self-esteem, perception of body image, and support from friends, family, or cancer support groups.
The research team has chosen to focus on older adults because much can happen as they age, chronic health problems may worsen, new health problems emerge, and their response to these may be affected by prior cancer-related experiences.
"Health changes almost on a daily basis for older adults," said Deimling, who will question how current medical conditions and relationships with the medical community relate to the cancer experience.
"We're also going to look at their ability to marshal support from their physician, and how the cancer experience may have changed how they interact with their physician and other sources of medical care," added Deimling.
Older adults often experience other losses and changes in family circumstances that may increase their vulnerability.
The researchers will also look at traditional and non-traditional support systems for cancer survivors to see how the support of family, friends, and agencies acts as a buffer for life stresses and contributes to the quality of life.
"The impact of cancer on later life is relatively unknown," remarked Deimling. Finding out how cancer affects the aging adult will provide opportunities to develop appropriate interventions to help those with negative outcomes.
This study is based on a pilot study, funded by CWRU's Claude D. Pepper Older Americans Independence Center, which studied the process of developing the survivor identity in response to cancer.
He found that by the five-year check-up, most identified themselves as survivors. He also found that those who identified themselves as survivors had a more positive outcome and took a more proactive approach to their health care, while those still in the mindset of a patient or victim were more passive.
"The preliminary research leading up to the NCI-funded study suggests that most cancer survivors have adjusted remarkably well to their illness experience and have led stable, productive lives," said Deimling.
He added that they have acquired a number of positive attitudes and learned important health behaviors that they can now apply to the challenges of aging.
Findings from the pilot study were published in the September 1997 edition of the Journal of Aging and Identity, in the article "Life-Threatening Illness and Identity: The Transition from Victim to Survivor," written by Deimling, Boaz Kahana, and John Schumacher, a CWRU graduate student in sociology. The authors also have an article prepared to appear in an upcoming issue of the Journal of Psychosocial Oncology on medical skepticism and cancer survivorship.