Bridging Disciplinary Boundaries (January 11 - 14, 2007)

A large body of evidence suggests that the experience of being diagnosed with and treated for cancer exerts adverse effects on patients' quality of life (QOL). However, much less is known about the longer-term effects (i.e., two years post-diagnosis and beyond) of cancer on survivors' functioning and QOL. Consequently, and since the number of cancer survivors in the US is rapidly increasing, health care teams would benefit from evidence regarding the needs of long-term survivors so that interventions can be designed to improve their overall functioning and QOL. This presentation will report on the reported QOL of long-term survivors of adult non-Hodgkin's lymphoma (NHL), with particular emphasis on psychological distress as defined by post-traumatic stress disorder (PTSD); it also will report the risk and protective factors associated with QOL and PTSD in adult survivors, with a focus on factors amenable for screening (e.g., risk associated with multiple types of treatment) and that are potentially modifiable (e.g., social support). Potential study subjects were identified through two tumor registries (the University of North Carolina Lineberger Comprehensive Cancer Center and the Duke Comprehensive Cancer Center). Approval for contact was obtained from each patient's physician. Participants completed the mailed survey, which contained several standardized measures, including the PTSD Checklist (PCL-C), Functional Assessment of Cancer Therapy (FACT-LYM), MOS Short Form (SF-36), Impact of Cancer instrument (IOC) and Post-traumatic Growth Inventory (PTGI). Of the 1195 eligible survivors, 884 (74%) participated. Participants ranged from 25 to 92 years of age (mean = 63, sd = 13.4) and were from 2 to 44 years post-diagnosis (mean = 10, sd=7.1). Thus, the data are unique in addressing QOL among a broad range of NHL patients, most of whom are older, long-term survivors. While the majority (69%) reported good QOL (i.e., with mean FACT-G scores >= the general population norm), 6-8% of the sample reported symptomatology consistent with a full PTSD diagnosis, and 16% reported two or more PTSD symptoms that were moderately to extremely bothersome. Factors associated with increased PTSD symptomatology and poorer QOL included having received multiple types of treatment, lower levels of social support and income, and more negative appraisals of treatment intensity and life threat. Survivors age 65 and older reported lower levels of PTSD than younger persons [25.6(8.7) vs. 28.2(10.6), p<.001]. In addition, no gender differences on PTSD and QOL measures were observed. Results of this study have important implications for the treatment of long-term survivors of NHL. Findings will be useful to inform providers from multiple disciplines about the survivorship experience of individuals with NHL and to design interventions aimed at reducing risk factors and enhancing QOL among members of this expanding population.