The CSRP's primary aim is to determine the physiological, psychological, and sociological long-term effects of surviving cancer on older adults (age 60+). This study uses the general stress and coping paradigm and combines the perspectives of extreme stress theory and identity theory to examine the effects of cancer among this uniquely vulnerable group of older adult survivors. The physiological outcomes include indicators for assessing the quality of life (QOL) of older adults such as physical and cognitive functioning, and their appraisal of their physical health and symptoms. Psychological outcomes include a global indicator of well being/life satisfaction along with measures of psychological distress (e.g., anxiety and depression) and symptoms of post-traumatic stress disorder (PTSD). In addition, several cancer specific measures of psychological QOL will tap fear of recurrence and stigma. Social QOL outcomes include effects on survivor identity; relevant characteristics such as self esteem, body image, and development of the survivor identity; and indicators of survivor ability to maintain valued roles. Other core features of the model are personal dispositions such as coping style and health beliefs, along with proactive behaviors such as health promotion and marshalling support, and how these buffer cancer survivors from the chronic stressors associated with cancer survivorship.
Other buffers include social support (e.g., informal support received from family and friends and responsiveness of medical care). Central to the analysis are age-related stressors such as co-morbid health problems and other negative life events that may exacerbate the stress associated with cancer. Our 10-year study uses a longitudinal design to collect and analyze three waves of in-person interviews with 321 older adult (60 years of age and older) former patients of the Ireland Cancer Center (ICC) of University Hospitals (UH) of Cleveland. The interview data will be combined with the tumor registry file data for each survivor. The sample includes long-term survivors (5 years beyond primary treatment and currently in remission) and stratified samples on colorectal, prostate, and breast cancer, three of the four most common cancers among older adults and those in the ICC tumor registry. It over-samples African-Americans to provide maximum analytic power to identify racial differences. The ICC of UH is one of 12 National Institutes of Health (NIH) Clinical Cancer Centers and maintains data on 28,500 cancer patients diagnosed and/or treated at University Hospitals of Cleveland since 1975. Multivariate analyses such as regression, structural equation modeling, and growth curve analysis will be used to investigate the relationship between the variables in our conceptual model. Specific comparative analyses are planned with age, gender and racial subgroups.