Abstract
Objective
To assess prevalence and frequency of use of self-management strategies among female cancer survivors and to empirically identify categories of self-management.
Methods
Female cancer survivors (N=673, mean age 51 years; >90% with breast cancer; M=5 years since diagnosis) completed an Internet survey indicating the frequency (never to very often) with which they had employed each strategy since diagnosis. The survey included commonly assessed self-management strategies, such as complementary and alternative medicine (CAM), religious practices, and exercise. Additionally we assessed the use of further strategies identified from recommendations of cancer survivors shared in Internet forums.
Results
A principal component analysis yielded five categories: More Conscious Living, Turning to Family/Friends, CAM, Religious/Spiritual Practices, and Exercise. Prevalence rates of commonly measured strategies like CAM, Religious Practices, and Exercise were similar to previous studies. Considering frequency of use, however, revealed that only few participants reported frequent use of these strategies (<10%). In contrast, about half of the women (>50%) reported Turning to Family/Friends and engaging in More Conscious Living strategies (very) often.
Conclusions
Relying on prevalence assessments of commonly investigated behaviors such as CAM or exercise may overestimate their use among cancer survivors. Cancer survivors engage in a wide range of self-management strategies. Encouraging living more consciously and cultivating social relations might be of greater relevance compared with CAM use or exercise.
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Data availability
The authors have full control of all primary data and agree to allow the journal to review their data if requested.
References
Brearley SG, Stamataki Z, Addington-Hall J, Foster C, Hodges L, Jarrett N, Richardson A, Scott I, Sharpe M, Stark D, Siller C, Ziegler L, Amir Z (2011) The physical and practical problems experienced by cancer survivors: a rapid review and synthesis of the literature. Eur J Oncol Nurs 15(3):204–212. https://doi.org/10.1016/j.ejon.2011.02.005
Stein KD, Syrjala KL, Andrykowski MA (2008) Physical and psychological long-term and late effects of cancer. Cancer. 112:2577–2592. https://doi.org/10.1002/cncr.23448
Vickberg SMJ (2003) The Concerns About Recurrence Scale (CARS): a systematic measure of women’s fears about the possibility of breast cancer recurrence. Ann Behav Med 25:16–24. https://doi.org/10.1207/S15324796ABM2501_03
Janz NK, Mujahid M, Chung LK, Lantz PM, Hawley ST, Morrow M, Schwartz K, Katz SJ (2007) Symptom experience and quality of life of women following breast cancer treatment. J Women's Health 16(9):1348–1361. https://doi.org/10.1089/jwh.2006.0255
Arndt V, Merx H, Stegmaier C, Ziegler H, Brenner H (2005) Persistence of restrictions in quality of life from the first to the third year after diagnosis in women with breast cancer. J Clin Oncol 23(22):4945–4953. https://doi.org/10.1200/jco.2005.03.475
U.S. Cancer Statistics Working Group (2017) United States cancer statistics: 1999–2014 incidence and mortality web-based report. Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute, Atlanta (GA) Available at: http://www.cdc.gov/uscs
Robert Koch-Institut (2015) Gesellschaft der epidemiologischen Krebsregister. In Deutschland EV (Eds.) Krebs in Deutschland 2011/2012 Berlin [cited 2017 November 29th]. Available from: http://www.krebsdaten.de/Krebs/DE/Content/Publikationen/Krebs_in_Deutschland/krebs_in_deutschland_node.html.
Shneerson C, Taskila T, Holder R, Greenfield S, Tolosa I, Damery S, Gale N (2015) Patterns of self-management practices undertaken by cancer survivors: variations in demographic factors. Eur J Cancer Care 24(5):683–694. https://doi.org/10.1111/ecc.12252
Holmes MM, Bishop FL, Calman L (2017) “I just googled and read everything”: exploring breast cancer survivors’ use of the internet to find information on complementary medicine. Complement Ther Med 33:78–84. https://doi.org/10.1016/j.ctim.2017.06.007.
McCorkle R, Ercolano E, Lazenby M, Schulman-Green D, Schilling LS, Lorig K, Wagner EH (2011) Self-management: enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin 61(1):50–62. https://doi.org/10.3322/caac.20093
Coffey L, Mooney O, Dunne S, Sharp L, Timmons A, Desmond D, O’Sullivan E, Timon C, Gooberman-Hill R, Gallagher P (2016) Cancer survivors’ perspectives on adjustment-focused self-management interventions: a qualitative meta-synthesis. J Cancer Surviv 10(6):1012–1034. https://doi.org/10.1007/s11764-016-0546-3
Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J (2002) Self-management approaches for people with chronic conditions: a review. Patient Educ Couns 48(2):177–187. https://doi.org/10.1016/s0738-3991(02)00032-0
National Center for Complementary and Integrative Health. Our Mission [cited 2018 January, 31]. Available from: https://nccih.nih.gov/about/plans/2011/introduction.htm.
Horneber M, Bueschel G, Dennert G, Less D, Ritter E, Zwahlen M (2012) How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Integr Cancer Ther 11:187–203. https://doi.org/10.1177/1534735411423920
Fox P, Butler M, Coughlan B, Murray M, Boland N, Hanan T, Murphy H, Forrester P, O' Brien M, O' Sullivan N (2013) Using a mixed methods research design to investigate complementary alternative medicine (CAM) use among women with breast cancer in Ireland. Eur J Oncol Nurs 17(4):490–497. https://doi.org/10.1016/j.ejon.2012.10.008
Matsuno RK, Pagano IS, Maskarinec G, Issell BF, Gotay CC (2012) Complementary and alternative medicine use and breast cancer prognosis: a pooled analysis of four population-based studies of breast cancer survivors. J Womens Health 21(12):1252–1258. https://doi.org/10.1089/jwh.2012.3698
Wanchai A, Arrner JM, Stewart BR (2010) Complementary and alternative medicine use among women with breast cancer: a systematic review. Clin J Oncol Nurs 14(4):431. https://doi.org/10.1188/10.cjon.e45-e55
Greenlee H, Kwan ML, Ergas IJ, Sherman KJ, Krathwohl SE, Bonnell C, Lee MM, Kushi LH (2009) Complementary and alternative therapy use before and after breast cancer diagnosis: the Pathways Study. Breast Cancer Res Treat 117(3):653–665. https://doi.org/10.1007/s10549-009-0315-3
Rausch SM, Winegardner F, Kruk KM, Phatak V, Wahner-Roedler DL, Bauer B, Vincent A (2011) Complementary and alternative medicine: use and disclosure in radiation oncology community practice. Support Care Cancer 19:521–529. https://doi.org/10.1007/s00520-010-0846-5
Templeton AJ, Thürlimann B, Baumann M, Mark M, Stoll S, Schwizer M, Dietrich D, Ruhstaller T (2013) Cross-sectional study of self-reported physical activity, eating habits and use of complementary medicine in breast cancer survivors. BMC Cancer 13:1–8. https://doi.org/10.1186/1471-2407-13-153
Sohl S, Weaver K, Birdee G, Kent E, Danhauer S, Hamilton A (2014) Characteristics associated with the use of complementary health approaches among long-term cancer survivors. Support Care Cancer 22:927–936. https://doi.org/10.1007/s00520-013-2040-z
Gansler T, Kaw C, Crammer C, Smith T (2008) A population-based study of prevalence of complementary methods use by cancer survivors: a report from the American Cancer Society’s studies of cancer survivors. Cancer (0008543X) 113(5):1048–1057. https://doi.org/10.1002/cncr.23659
Hawkins NA, Smith T, Zhao L, Rodriguez J, Berkowitz Z, Stein KD (2010) Health-related behavior change after cancer: results of the American Cancer Society’s studies of cancer survivors (SCS). J Cancer Surviv 4(1):20–32. https://doi.org/10.1007/s11764-009-0104-3 First Author & Affiliation: Hawkins, Nikki A
Andrykowski MA, Beacham AO, Schmidt JE, Harper FWK (2006) Application of the theory of planned behavior to understand intentions to engage in physical and psychosocial health behaviors after cancer diagnosis. Psycho-Oncology. 15:759–771. https://doi.org/10.1002/pon.1007 First Author & Affiliation: Andrykowski, Michael A
Mao JJ, Palmer CS, Healy KE, Desai K, Amsterdam J (2011) Complementary and alternative medicine use among cancer survivors: a population-based study. J Cancer Surviv 5:8–17. https://doi.org/10.1007/s11764-010-0153-7
Dunne S, Mooney O, Coffey L, Sharp L, Timmons A, Desmond D, Gooberman-Hill R, O'Sullivan E, Keogh I, Timon C, Gallagher P (2017) Self-management strategies used by head and neck cancer survivors following completion of primary treatment: a directed content analysis. Psycho-Oncology. 26(12):2194–2200. https://doi.org/10.1002/pon.4447
Foster C, Fenlon D (2011) Recovery and self-management support following primary cancer treatment. Br J Cancer 105:21–S8. https://doi.org/10.1038/bjc.2011.419
Foster C, Roffe L (2009) An exploration of the internet as a self-management resource. J Res Nurs 14(1):13–24. https://doi.org/10.1177/1744987108099237
Goldstein MS, Lee JH, Ballard-Barbash R, Brown ER (2008) The use and perceived benefit of complementary and alternative medicine among Californians with cancer. Psycho-Oncology. 17(1):19–25. https://doi.org/10.1002/pon.1193
Yun YH, Jung JY, Sim JA, Choi H, Lee JM, Noh DY, Han W, Park KJ, Jeong SY, Park JW, Wu HG, Chie EK, Kim HJ, Lee JH, Zo ZI, Kim S, Lee JE, Nam SJ, Lee ES, Oh JH, Kim YW, Kim YT, Shim YM (2015) Patient-reported assessment of self-management strategies of health in cancer patients: development and validation of the Smart Management Strategy for Health Assessment Tool (SAT). Psycho-Oncology. 24(12):1723–1730. https://doi.org/10.1002/pon.3839
Fabrigar LR, Wegener DT, MacCallum RC, Strahan EJ (1999) Evaluating the use of exploratory factor analysis in psychological research. Psychol Methods 4(3):272–299. https://doi.org/10.1037//1082-989x.4.3.272
Dziuban CD, Shirkey EC (1974) When is a correlation matrix appropriate for factor analysis? Some decision rules. Psychol Bull 81(6):358–361. https://doi.org/10.1037/h0036316
Moosbrugger H, Schermelleh-Engel K (2012) Exploratorische (EFA) und Konfirmatorische Faktorenanalyse (CFA). In: Moosbrugger H, Kelava A (eds) Testtheorie und Fragebogenkonstruktion [test theory and questionnaire construction]. Springer, Berlin, pp 325–343
Cattell RB (1966) The scree test for the number of factors. Multivar Behav Res 1:245–276. https://doi.org/10.1207/s15327906mbr0102_10
Ford JK, MacCallum RC, Tait M (1986) The application of exploratory factor analysis in applied psychology: a critical review and analysis. Pers Psychol 39(2):291–314. https://doi.org/10.1111/j.1744-6570.1986.tb00583.x
Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM (2005) Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 23:5814–5830. https://doi.org/10.1200/jco.2005.01.230
Park CL, Blank TO (2012) Associations of positive and negative life changes with well-being in young and middle-aged adult cancer survivors. Psychol Health 27:412–429. https://doi.org/10.1080/08870446.2011.586033
Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay, CC, & Snyder C (2012) Exercise interventions on health-related quality of life for cancer survivors. Cochrane Libr, Art. No.: CD007566. https://doi.org/10.1002/14651858.CD007566.pub2
Cormie P, Zopf EM, Zhang X, Schmitz KH. The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiologic reviews. 2017;39(1):71-92. doi: 10.1093/epirev/mxx007.
De Bruijn G, Rhodes R (2011) Exploring exercise behavior, intention and habit strength relationships. Scand J Med Sci Sports 21(3):482–491. https://doi.org/10.1111/j.1600-0838.2009.01064.x
Gardner B, de Bruijn G-J, Lally P (2011) A systematic review and meta-analysis of applications of the self-report habit index to nutrition and physical activity behaviours. Ann Behav Med 42(2):174–187. https://doi.org/10.1007/s12160-011-9282-0
Acknowledgments
Preparation of this article was supported by grants from the German Research Foundation Excellence Initiative Guest Professor Program, Heidelberg University (G.W.), and the German Research Foundation Excellence Initiative International Mobility Program, Heidelberg University (M.S.).
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Sieverding, M., Ungar, N., Fleischmann, A. et al. Prevalence and frequency of self-management strategies among female cancer survivors: the neglected roles of social relations and conscious living. Support Care Cancer 28, 607–616 (2020). https://doi.org/10.1007/s00520-019-04790-5
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DOI: https://doi.org/10.1007/s00520-019-04790-5