Quality Of Life In Older Breast Cancer Survivors

Quality of life (QoL) in cancer survivors is an important area of research. While data are available about QoL and breast cancer, there is a paucity of research regarding older breast cancer survivors. The purpose of this research was to examine QoL in older women with early stage breast cancer, within the first year of post-treatment survivorship. The specific aims of this study were to: 1) Describe the changes in overall QoL and the four QoL domains of Physical, Psychological, Social, and Spiritual well-being; 2) Examine the effects of a psychoeducational support intervention on QoL outcomes in older women; and 3) Describe nurses\u27 perceptions of their interactions with older breast cancer survivors. A descriptive, longitudinal design was used to answer the research questions. Data for this study were drawn from the Breast Cancer Education Intervention (BCEI), a longitudinal psychoeducational support intervention for women with early stage breast cancer. Fifty women from the BCEI who were 65 years of age and older were included in this sample, of whom 24 were assigned to the Experimental (EX) Group and 26 were assigned to the Wait Control (WC) Group. Data were collected at three time points: baseline, three months, and six months after study entry. Measurement tools included the BCEI Demographics Form, the Quality of Life-Breast Cancer Survey (QoL-BC), and field notes of the BCEI Research Nurses. The QoL-BC survey is a 50-item scale that measures QoL in women with breast cancer. Descriptive statistics, Generalized Estimating Equation (GEE) methods and t-tests were used to answer research questions #1 and #2. Content analysis was used to answer research question #3. Subjects reported good overall QoL at baseline, but QoL declined over six months. Physical and Psychological well-being declined from baseline to six months later. Social well-being initially improved from baseline to three months but declined at six months. Spiritual well-being initially declined at three months and improved at six months. There was insufficient power to detect a difference in the effects of the BCEI Intervention between the two groups. However, the decline in overall QoL was less in the EX Group. Field notes focusing on nurses\u27 perception of their interactions with older women revealed four themes. These themes include: continuing breast-related health, personal health issues, family health issues, and potential stressors. Results from this study suggest that: 1) changes in overall QoL and within the four QoL domains occur over time; 2) decline in overall QoL was lessened by the BCEI Intervention; and 3) concerns after treatment are both breast cancer and non-breast cancer related. Study findings can direct future research in the following areas: 1) identification of specific concerns within each QoL domain that could lead to an increase or decrease in well-being in older breast cancer survivors; 2) interventions tailored to the needs of older breast cancer survivors to maintain, improve, or lessen decline in QoL after treatment; and 3) reconceptualizing QoL in older breast cancer survivors to include non-cancer related factors

Older women, breast cancer, and social support

One in ten women over the age of 65 will develop breast cancer. Despite this high incidence of breast cancer among older women, social support for them is often inadequate. This paper describes a qualitative study of the impact of a breast cancer diagnosis on older women from racially/ethnically diverse populations and their subsequent need for social support. Forty-seven older African American, Asian American, Caucasian and Latina women between the ages of 65 to 83 participated in a larger study examining the impact of breast cancer on women from racially/ethnically diverse populations and the meaning and nature of social support. The women completed an in-depth qualitative interview on the psychosocial impact of breast cancer and the meaning and nature of social support. The results indicate that there are variations in reactions to a breast cancer diagnosis among older women, and that these reactions impact their experiences with seeking social support at diagnosis and during treatment. Respondents were concerned about their aging bodies, potential dependency on others, and loss of autonomy. At the same time, the severity of cancer treatment and existing co-morbidities often meant they needed to learn to receive support, and to reach out if they had no support. The implications of these findings underscore the older cancer patient’s need to strengthen her supportive networks at the time of diagnosis, during treatment, and post-treatment

The Role of Trust in Public Attitudes toward Invasive Species Management on Guam: A Case Study

Public attitudes toward invasive alien species management and trust in managers’ ability to effectively manage non-native species can determine public support for conservation action. Guam has experienced widespread species loss and ecosystem transformation due to invasive species. Despite Guam’s long history with invasives and efforts to eradicate them, we know little about the sociological context of invasive species. Using focused group discussions, we explore public attitudes toward invasive species management. Respondents expressed support for management activities and a desire to participate directly in conservation actions. Participants also expressed frustration with government institutions and lack of confidence in managers’ abilities to control invasive species. Perceptions of managers’ trustworthiness, communication with managers, and positive personal experiences with managers were related to positive attitudes about management and support for existing initiatives

Risk, Resilience, and Characteristics of Fatal or Near-Fatal Intimate Partner Violence with Native Americans

Thesis (Ph.D.)--University of Washington, 2023Native American people are at a higher risk of experiencing lifetime violence and are twice as likely to be murdered than non-Native American individuals. This project analyzed data from medical examiner reports in Pima, Maricopa, and Coconino in Arizona from 2016-2019, containing information on intimate partner-related homicides and intimate partner homicides of Native Americans. The Medical Examiner’s Offices investigated 151 Native American cases in the three counties. 12 cases were classified as intimate partner violence (IPV), and 11 were related to IPV. For both groups, the majority of victim age was between 18-35, the cause of death for IPV homicide victims was by knife, and IPV-related was firearms. Analyzed data from a more extensive study (n=229), The Ourcicle study, examines factors related to adverse childhood trauma, IPV risk, types of abuse experienced, resiliency, and how reservation residences may impact help and safety-seeking. The ACES score indicated an increased risk of experiencing IPV, and the DA scoring for participants also indicated an increased risk of IPV homicide. Cultural practices and safety planning were a source of strength for survivors. Another deductive analysis from secondary qualitative data from this study explores the connection between Indigenous feminism and colonial settler theory with interviews with 13 Native American survivors of IPV living in the Southwest. The themes identified within interviews were how colonization had impacted families, and communities, abuse experienced, resiliency factors and sources of strengths, and normalization of violence. Insights into risk and resiliency factors and survivors' experiences can help inform intervention, prevention, and reporting tools for social workers and advocates who work with Native American IPV survivors and Native communities impacted by fatal IPV

Symptom Experience In Older Adults Undergoing Treatment For Cancer

Purpose/Objectives: To explore the symptom experience of older adults receiving cancer chemotherapy in an outpatient treatment setting. Design: Exploratory, descriptive, cross-sectional study. Setting: A community cancer center in the southeastern United States. Sample: 100 adults aged 65 years or older undergoing treatment for cancer. Methods: Data were collected from participants at a chemotherapy treatment visit using structured questionnaires. Descriptive statistics were used to examine data. T tests and analysis of variance were used to compare symptoms among groups, and Pearson correlations were used to examine relationships among variables. Main Research Variables: Cancer treatment-related symptoms, comorbid illnesses, mental health function, and physical function. Findings: Older adults experience a high number of cancer treatment-related symptoms with moderate severity. The most common symptoms included fatigue, bowel disturbances, lack of appetite, hair loss, and drowsiness. Numbness and tingling were the most severe symptoms experienced. The presence of comorbid illness and poor mental functioning affects the number of symptoms experienced. Conclusions: Opportunities exist for clinicians to take steps to assess and manage symptoms common to older adults before serious complications and negative outcomes occur. Future research is needed. Implications for Nursing: Nurses should consider comorbidities and poor mental functioning in older adults when assessing treatment-related symptoms. Being proactive and assessing and managing symptoms early during treatment may improve outcomes for older patients

Cognitive Representation Of Treatment-Related Symptoms In Older Adults With Cancer

Background: Adults, 65 years or older, are the most common age group diagnosed with cancer. However, little is known about their beliefs (representations) regarding treatment-related symptoms or how they make decisions to manage those symptoms at home. Objective: The aim of this study is to explore symptom representation of treatment-related symptoms in older adults with cancer. Methods: A total of 100 older adults in treatment for cancer completed a standardized measure of symptom representation. Demographic and other patient variables were also collected. Analysis of variance, t tests, and Pearson correlations were used for analysis. Results: Fatigue was both the most common and most noted symptom; however, several most noted symptoms were not common. Overall, older adults believed symptoms were caused by either their cancer or treatment and were unsure if symptoms would last a long time. They were able to recognize symptom consequences but were unsure about their ability to control symptoms. Adults who reported more comorbid illnesses and a higher number of symptoms believed that treatment-related symptoms had higher consequences. Conclusions: Findings suggest that older adults experience symptom-related consequences but question the impact that their actions will have on symptom severity. This may contribute to older adult\u27s lack of active symptom self-management. Implications for Practice: Patient education strategies need to address these representations and new interventions may need to be developed to reinforce symptom consequences and empower older adults to self-manage symptoms

Community based fisheries management on Guam

Guam, the largest and most populated island in Micronesia, is surrounded by a narrow fringing reef that supports important cultural, subsistence and economic activities. However, this reef system is under immense pressure from development, sedimentation, and overharvesting. Managers lack the necessary resources to effectively address these threats, and fisheries management in particular has proven to be exceedingly difficult. Fishers and managers, though they do not agree on causes or solutions, both recognize dramatic declines in many fish stocks and the need to take action to reverse this negative trend. Community based management models offer one promising approach. This study examines the current state of Guam’s community based management efforts and obstacles to expanding community approaches on island. Data collected through participant observation and key informant interviews were used to create a series of recommendations to improve current management and move toward more community involvement in fisheries. Recommendations include the creation of programs to reconnect residents with the marine environment, repair of relationships between local and federal government agencies and stakeholders, improved enforcement, and pilot projects for community management in small village sites

Symptom Self-Management: Strategies Used By Older Adults Receiving Treatment For Cancer

BACKGROUND: Older adults are at high risk for cancer treatment–related symptoms but often accept them as inevitable. This may have a negative impact on patient outcomes. OBJECTIVES: The purpose of this study is to examine symptom self-management strategies used by older adults receiving cancer treatment, determine the effectiveness of these strategies, and examine relationships between symptom self-management and demographic and treatment characteristics. METHODS: 100 adults aged 65 years or older from a community cancer center participated in this descriptive, exploratory study. Demographic, treatment, and self-management data were collected using an investigator-developed tool. Symptom presence was collected using part 1 of the Symptom Representation Questionnaire. FINDINGS: Participants reported an average of 7.15 symptoms and 3.36 self-management strategies used at home. Taste changes were managed most, followed by fatigue and bowel changes. On average, strategies used to manage symptoms were moderately effective