Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Cancer occurs more frequently among older adults with advancing age and can impact the overall physical well-being and quality of life after diagnosis. The risks of adverse, long-term effects of cancer treatment can influence physical functioning and quality of life and more so for older adults who have multiple medical problems. Effects of cancer treatment can result in functional disability, increased pain, and an overall increase in physical and emotional strain, leading to premature mortality. Given the prevalence of cancer among older adults and the need for social work interventions as functioning declines, it is imperative that we understand cancer survivorship in later life in relation to perceptions of health of this potentially vulnerable population. This paper examines how health perceptions among older cancer survivors are predicted by additional chronic health conditions, disability and length of survivorship after controlling for socio-demographic factors.

Data for this study stems from a cross-sectional design of the 2003 California Health Interview Survey (CHIS). Designed to examine health behaviors and health status, this survey captures information on older cancer survivors' perceptions of health. Variables included in this study identify co-morbid health conditions other than cancer, experience of disability (measured by activities of daily living ADL and instrumental activities of daily living IADL), length of surviving with cancer, and socio-demographic factors to consider in the analysis. The sub-sample of 610 subjects was selected from 3874 older adults reporting a history of cancer with 134 Latinos, 95 Asian, 131 African Americans, and 250 Whites. Ordered probit analysis was used to analyze the predictive relationships and report marginal effects on self-rated health.

Findings demonstrate, after controlling for socio-demographic factors, the probability of additional chronic health conditions, disability (ADL and IADL), and length of survivorship show a significant effect on self-rated health among older cancer survivors. Chronic diseases and disability increased the probability of reporting fair/poor self-rated health by 12% for chronic conditions, 19% for experiencing problems with ADLs and 27% for problems with IADLs. For length of survivorship, the probability was decreased in reporting fair/poor self-rated health by 1% for every 3-year increase in length of time living with cancer. Being a minority (for Latinos, Asian, and African American) also had a significant influence on reporting fair/poor self-rated health as the probability increased by 22% for Latinos, 19% for Asian, and 18% for African Americans per unit change on these dichotomous predictors.

These findings demonstrate that different factors affect self-perceived health among older cancer survivors in California. Those who have additional health problems are more likely to experience an added burden of illness and are at risk for poor health, functional decline, increased mortality, and can suffer greater hardship, which influences their global perceptions of health. Due to these increased risks, social workers need to know about older adults needs and perceptions of health that relate to poor outcomes as to better serve this population.