SMOKING CESSATION IN CANCER SURVIVORS: EXPLORING PSYCHOSOCIAL WELLBEING, BELIEFS ABOUT SMOKING, AND E-CIGARETTE USE

Smoking after a cancer diagnosis is associated with various negative health outcomes and existing smoking cessation interventions for cancer survivors have not been effective in influencing cessation rates. The purpose of this dissertation is to better understand smoking-related factors uniquely influenced by receiving a cancer diagnosis that could be used to create more successful cessation interventions for cancer survivors. Manuscript 1 used time-to-event analysis to assess whether psychosocial factors—distress, health-related quality of life (HRQOL), and perceived social support—at one year after diagnosis predicted whether survivors successfully quit smoking and the amount of time it took to quit in a longitudinal nationally representative sample of long-term cancer survivors from the American Cancer Society Study of Cancer Survivors (SCS-I; n = 341). Manuscript 2 assessed whether survivors of tobacco-related cancers reported higher perceived severity of health problems from smoking compared to survivors of non-tobacco-related cancers and explored whether this relationship was stronger for recently-diagnosed versus long-term survivors in a cross-sectional national sample from the Population Assessment of Tobacco Health—PATH—study (n = 433). Manuscript 3 identified e-cigarette use prevalence and reasons for use among cancer survivors who smoke (n = 433) and compared to smokers without a prior cancer diagnosis (n = 10,872) in the PATH study. In Manuscript 1, survivors with low physical HRQOL were significantly less likely to quit smoking and took several more years to quit than survivors with high physical HRQOL. In Manuscript 2, survivors of tobacco-related cancer reported higher perceived severity of smoking than survivors of non-tobacco-related cancer and this relationship was the same for recently-diagnosed and for long-term survivors. In Manuscript 3, nearly 6 in 10 cancer survivors who smoke had used e-cigarettes, and nearly one quarter of survivors were currently doing so; rates were similar in those never diagnosed. The majority of both groups (>71%) reported using e-cigarettes for perceived health-related reasons—including smoking reduction. Clinicians may want to assess physical HRQOL, perceived severity of smoking, and discuss the research on the efficacy of e-cigarettes as a quitting strategy with their patients who smoke to identify patients at particularly high risk of continued smoking and potential means for interventions.Doctor of Philosoph

I Keep my Problems to Myself: Negative Social Network Orientation, Social Resources, and Health-Related Quality of Life in Cancer Survivors

Cancer survivors treated with hematopoietic stem cell transplant rely on their social network for successful recovery. However, some survivors have negative attitudes about using social resources (negative social network orientation) that are critical for their recovery

Promoting physical activity among cancer survivors: meta-analysis and meta-cart analysis of randomized controlled trials

Objective: We conducted a meta-analysis of physical activity interventions among cancer survivors in order to (a) quantify the magnitude of intervention effects on physical activity, and (b) determine what combination of intervention strategies maximizes behavior change. Methods: Out of 32,626 records that were located using computerized searches, 138 independent tests (N = 13,050) met the inclusion criteria for the review. We developed a bespoke taxonomy of 34 categories of techniques designed to promote psychological change, and categorized sample, intervention, and methodological characteristics. Random effects meta-analysis and meta-regressions were conducted; effect size data were also submitted to Meta-CART analysis. Results: The sample-weighted average effect size for physical activity interventions was d+ = .35, equivalent to an increase of 1,149 steps per day. Effect sizes exhibited both publication bias and small sample bias but remained significantly different from zero, albeit of smaller magnitude (d+ ≥ .20), after correction for bias. Meta-CART analysis indicated that the major difference in effectiveness was attributable to supervised versus unsupervised programs (d+ = .49 vs. .26). Greater contact time was associated with larger effects in supervised programs. For unsupervised programs, establishing outcome expectations, greater contact time, and targeting overweight or sedentary participants each predicted greater program effectiveness, whereas prompting barrier identification and providing workbooks were associated with smaller effect sizes. Conclusion: The present review indicates that interventions have a small but significant effect on physical activity among cancer survivors, and offers insights into how the effectiveness of future interventions might be improved

Involvement in Decision Making and Satisfaction With Treatment Among Partners of Patients With Newly Diagnosed Localized Prostate Cancer

To examine partner involvement in treatment decision making for localized prostate cancer, congruence between partner involvement and patient preference, reasons for partner noninvolvement, and partner satisfaction with patient treatment

Involvement in Decision Making and Satisfaction With Treatment Among Partners of Patients With Newly Diagnosed Localized Prostate Cancer

PURPOSE/OBJECTIVES: To examine partner involvement in treatment decision making for localized prostate cancer, congruence between partner involvement and patient preference, reasons for partner noninvolvement, and partner satisfaction with patient treatment. DESIGN: Cross-sectional exploratory study. SETTING: 100 counties in North Carolina. SAMPLE: 281 partners of men with newly diagnosed localized prostate cancer. METHODS: Participants completed a phone survey. Logistic regression analyses were used. MAIN RESEARCH VARIABLES: Partners’ involvement in treatment decision making, partner satisfaction with treatment, activities of partner involvement, and reasons for noninvolvement. FINDINGS: Two hundred twenty-eight partners (81%) related to decision making, 205 (73%) were very satisfied with the treatment the patients received, and partner involvement was congruent with patient preference in 242 partners (86%). Partners reported several reasons for noninvolvement: agreeing with whatever the patient decides, trusting the doctor’s decisions, believing that the patient should make the decision, respecting the patient’s decision, and being concerned with the impact on their relationship if they chose the wrong treatment. CONCLUSIONS: Most partners engaged in multiple activities during treatment decision making for localized prostate cancer and were satisfied with the patient’s treatment. Partner involvement was mostly congruent with patient preference. IMPLICATIONS FOR NURSING: Partners’ active involvement in treatment decision making for localized prostate cancer (e.g., being involved in patients’ conversations with doctors) should be encouraged and facilitated for those who prefer this type of decision making

I Keep my Problems to Myself: Negative Social Network Orientation, Social Resources, and Health-Related Quality of Life in Cancer Survivors

BACKGROUND: Cancer survivors treated with hematopoietic stem cell transplant rely on their social network for successful recovery. However, some survivors have negative attitudes about using social resources (negative social network orientation) that are critical for their recovery. PURPOSE: We examined the association between survivors’ social network orientation and health-related quality of life (HRQoL) and whether it was mediated by social resources (network size, perceived support, and negative and positive support-related social exchanges). METHODS: In a longitudinal study, 255 survivors completed validated measures of social network orientation, HRQoL, and social resources. Hypotheses were tested using path analysis. RESULTS: More negative social network orientation predicted worse HRQoL (p < .001). This association was partially mediated by lower perceived support and more negative social exchanges. CONCLUSIONS: Survivors with negative social network orientation may have poorer HRQoL in part due to deficits in several key social resources. Findings highlight a subgroup at risk for poor transplant outcomes and can guide intervention development