Can We Achieve Equity in Cancer Survivorship?
Annette L. Stanton, Ph.D.UCLA
Professor of Psychology and Psychiatry/Biobehavioral Sciences;
Member, Jonsson Comprehensive Cancer Center [email protected]
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Supported by the National Cancer Institute, Breast Cancer Research Foundation, Jonsson Comprehensive Cancer Center,
Hirshberg Foundation for Pancreatic Cancer Research
Commonalities in Survivorship
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Definition of Survivor
An individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life. Family members, friends, and caregivers are also impacted by the survivorship experience and are therefore included in this definition.- National Cancer Institute
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Institute of Medicine (2005) Findings:Survivorship Care
Survivorship care is a neglected phase of the cancer care trajectory
Survivors are concerned with cancer recurrence and treatment late effects
Few guidelines on follow-up care, and providers lack education and training
Interventions needed for physical and psychological consequences of cancer and treatment
Overall Depressive Symptom Trajectory in 460 Women Recently Diagnosed with Breast Cancer (Stanton et al., 2015, BCRT)
What Areas of Your Life Are Significantly Affected by Metastatic Cancer? (N = 353)
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Areas of Impact (N = 353)“Had to give up a rewarding job” Employment/Achievement Concerns
“Loss of financial stability” Financial Concerns
“High copays and denial of coverage for tests and treatment” Insurance
“Every day is a roller coaster” Uncertainty/Mortality
“Not being able to do activities with my husband and kids” Activity Disruption
“Sadness because loss of independence” Self-Concept Disruption
“I worry about [my] children.” Concern for Others
“Isolation from former friends” Social Isolation/Withdrawal
“I experience a strong sense of gratitude.” Finding Benefit
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Majority Find Benefit
◦ Enhanced relationships
◦ Deepened appreciation for life
◦ Increased personal strength
◦ Valued change in life priorities
◦ Greater spirituality
◦ Attention to health-promoting
behaviors
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Islands of Disruption
◦Diagnosis
◦Treatment
◦Re-Entry
◦Early Survivorship
◦Extended Survivorship
◦Recurrence
◦Advanced Disease
10Stanton, Rowland, & Ganz, 2015
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Coping CommonalitiesHazards of Cancer-Related Avoidance
At Biopsy
At Diagnosis
Prior to and after Surgery
During Re-Entry
Three Years Later
(Stanton & Snider, 1993; Stanton et al., 2000, 2002; Hack & Degner, 2004)
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Coping CommonalitiesUseful Approach-Oriented Coping Strategies
Expressing Emotions
Finding Benefit
Seeking Social Support
Actively Accepting Cancer Diagnosis
Using Spiritual Coping (Finding Meaning, Purpose, and Peace)
Engaging in Problem-Focused Coping
Distinctions in Survivorship
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Definition of Survivor
Most adults diagnosed with cancer consider themselves survivors, but not all like the word (Deimling et al., 2007; Kelly et al., 2009)
Areas of Impact (N = 353)“Had to give up a rewarding job” Employment/Achievement Concerns
“Loss of financial stability” Financial Concerns
“High copays and denial of coverage for tests and treatment” Insurance
“Every day is a roller coaster” Uncertainty/Mortality
“Not being able to do activities with my husband and kids” Activity Disruption
“Sadness because loss of independence” Self-Concept Disruption
“I worry about [my] children.” Concern for Others
“Isolation from former friends” Social Isolation/Withdrawal
“I experience a strong sense of gratitude.” Finding Benefit
More Negative Impact in Survivors < Age 50 and Lower Financial Status
Depressive Symptom Trajectory Classes in 460 Women Recently Diagnosed with Breast Cancer(Stanton et al., 2015, BCRT)
Coping Distinctions• Cancer Survivors at Risk for Depression Need Elevated Level of Care
• Avoidance Hazardous in Latinas Recently Diagnosed with Breast Cancer, but Expressing Emotions Not Useful (Moreno et al., 2016)
• Strong Black Woman Schema Avoidance Depression?
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Take-Home Points Commonalities Aspects of Survivorship Care Can Be
Effective across GroupsAssuming Equal Access
Distinctions Distinct Approaches Needed
Community-Researcher Partnerships to Promote Equity
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Many thanks to:Ph.D. Students
Collaborators
Funding Agencies
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