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Examining cancer survivorship trajectories: Exploring the intersection between qualitative illness narratives and quantitative screening instruments

Published online by Cambridge University Press:  28 December 2017

Chelsea Ratcliff ,
Aanand D. Naik ,
Lindsey Ann Martin  and
Jennifer Moye
Chelsea Ratcliff
Affiliation:
South Central Mental Illness Research, Education and Clinical Center, Houston, Texas Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas Baylor College of Medicine, Houston, Texas
Aanand D. Naik
Affiliation:
Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas Baylor College of Medicine, Houston, Texas
Lindsey Ann Martin
Affiliation:
South Central Mental Illness Research, Education and Clinical Center, Houston, Texas Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas Baylor College of Medicine, Houston, Texas
Jennifer Moye*
Affiliation:
VA Boston Healthcare System, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts New England Geriatric Research, Education and Clinical Center, Boston and Bedford, Massachusetts
*
Author correspondence: Jennifer Moye, VA Boston Healthcare System, 150 South Huntington Avenue, Jamaica Plain, MA 02130. E-mail: [email protected]
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Abstract

Objective

This article examines the associations of quantitatively refined trajectories of adjustment to cancer survivorship determined by previously published qualitative narrative analysis.

Method

Patients completed measures of cancer-related worry (Cancer Related Worries Scale), depression (Patient Health Questionnaire-9), posttraumatic growth (Benefit Finding Scale), and open-ended survey questions 6, 12, and 18 months postdiagnosis of head and neck, esophageal, gastric, or colorectal cancer. Previously published narrative analysis revealed five distinct survivorship “paths,” which were combined into four paths in the present article: Moving On, Seeing the World Differently, Taking One Day at a Time, and Never the Same. To determine the association of qualitatively determined paths with quantitatively assessed adjustment (i.e., Cancer Related Worries Scale, Patient Health Questionnaire-9, Benefit Finding Scale), we used linear multilevel modeling to regress the adjustment variables on time, path, the time-by-path interaction, and relevant covariates (age, stage, cancer site, ethnicity, and Deyo score).

Results

There was a significant main effect of path on cancer worry, depression, and posttraumatic growth (p < 0.02 for all). Patients in the Moving On group reported consistently low worry, depression, and growth compared to the other groups. Patients in the Seeing the World Differently and Taking One Day at a Time paths both reported moderate worry and depression; but those in the Seeing the World Differently path reported the highest posttraumatic growth, whereas patients in the Taking One Day at a Time path reported little growth. Finally, patients in the Never the Same path reported the highest worry and depression but lowest posttraumatic growth.

Significance of results

This longitudinal study reinforces the notion that cancer survivorship is not a one-size-fits-all experience nor a dichotomized experience of “distress” or “no distress.” Additionally, this hypothesis-generating study suggests future directions for potential self-report measures to help clinicians identify cancer survivors’ trajectory to develop a more patient-centered survivorship care plan.

Keywords

Cancer survivorshipillness narrativeposttraumatic growthcancer worrydepression
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 6 , December 2018 , pp. 712 - 718
Copyright
Copyright © Cambridge University Press 2017 

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