Current Concepts and Management of Cancer Pain in Older Women

Pain is the most common symptom associated with cancer. Sixty to eighty-five percent of individuals with advanced cancer have pain either of a severe or a chronic nature. Despite the fact that appropriate pain management exists, cancer pain is often inadequately controlled. Management strategies for older cancer patients must address the physical, psychological, and social concerns of the individual. The special problems of drug management presented by older patients reinforces the importance of implementing nonpharmacologic therapies when possible.     

Area Deprivation and Liver Cancer Prevalence in Shenzhen,China: A Spatial Approach Based on Social Indicators

Cancer has become an alarming threat to human health and well-being worldwide. Examining the social determinants of cancer prevalence should effectively inform the practices and strategies on cancer treatment and prevention. However, rather few studies have conducted in this regard for developing countries. This paper attempts to characterize the association between area deprivation and liver cancer prevalence using a case of Shenzhen, China. Data from 2009 to 2011 provided by Shenzhen’s Health Information Center are used to calculate the incidence rate of liver cancer at district level. An area deprivation index (ADI) at district level is established by integrating 13 indicators of 5 domains (income, employment, education, housing and demography). The weight for each indicator is determined by two typical subjective methods (AHP and fuzzy AHP) and two common objective methods (Entropy and Coefficient Variation). Quantitative comparisons indicate that the four methods are highly consistent though they assign different weight to the indicators. Spatial lag regression identifies significantly positive linear relationships between ADIs and liver cancer incidence rate from 2009 and 2010. It suggests that greater possibility of liver cancer prevalence would be expected in districts of higher social deprivation. The results also denote that the obtained relationships are insensitive to weight determination method and temporal dimension. Our study demonstrates that spatial autocorrelation should be incorporated for better understanding the association between area deprivation and liver cancer prevalence at district level. This paper provides some new insights into social indicators research.     

Perceived Stress and Sexual Orientation Among Breast Cancer Survivors

Little is known about the cancer survivorship experiences of sexual minority women (SMW). SMW breast cancer survivors are hypothesized to experience more stress compared to heterosexual breast cancer survivors. A convenience sample of 211 breast cancer survivors (68 SMW, 143 heterosexual women) participated in this cross-sectional online investigation of perceived stress. Regression analyses indicated significant differences in reported stress between heterosexual and SMW breast cancer survivors (β= -.15, p = .03). Our findings may reflect unique experiences had by sexual minority breast cancer survivors. Future research should explore the factors that contribute to elevated perceived stress in this group.     

Treatment decision-making among older women with breast cancer

This study examined breast cancer treatment decision-making among older adults, including professional and lay involvement. Thirty respondents were interviewed for this study; cancer survivors (70%) and newly diagnosed (30%) women with breast cancer. Respondents reported making treatment decisions in consultation with their oncologists. However, women differed on the extent to which they perceived their participation in the treatment process. Respondents' oncologists appear to be the primary factor associated with older women's breast cancer surveillance decision-making and adherence. The influence of women's support systems on their treatment decisions and surveillance activities appears to be minimal. Informal support systems, however, likely enhance women's ability to be active participants in their care. The growing need for interventions which target older women has been indicated. Interventions, however, cannot be adequately developed without first identifying the physical and psychosocial phenomena which affect decision-making.     

The social costs of cancer

The annual social costs of cancer, exclusive of economic costs such as medical costs and loss of earnings while incapacitated, are systematically developed. The social costs of cancer are believed significant because they may exceed the economic costs, and resource allocation on the basis of the economic costs alone distorts the socially optimal allocations of such resources. Some twenty-five separate social costs are identified qualitatively from a review of the oncology literature. Included are social costs to the victims of cancer, to the immediate family and colleagues of the victims, and to care-givers. These qualitative social costs are then translated into equaivalent money costs on the basis of market costs or shadow prices of imputed costs. The total social costs are computed by multiplying the average individual total social costs times the number of such individuals affected. The present value of future cost streams is also considered. The social costs of cancer apparently exceed the simple economic costs by over an order of magnitude. There are also indications that some forms of cancer incur much higher social costs than others, as well as much higher social costs than economic costs, suggesting that a more optimal allocation of public resources for reducing the total costs of the disease would shift resources to alleviation of social costs, where investment in medical therapies approaches saturation.     

What predicts breast cancer rates? Testing hypotheses of the demographic and nutrition transitions

Modern demographic and nutritional transitions have been implicated in global epidemiological transitions intensifying over the last 60 years. These transitions include steadily declining fertility rates, improving nutritional indicators, and increasing incidence rates of chronic diseases such as breast cancer. This research draws on the well established pathways linking individual reproductive and nutritional profiles to breast cancer risk, in order to test the links among demographic, nutritional, and epidemiological transitions on a global scale. We propose two hypotheses that test the reproductive and nutritional pathways that are suggested to increase breast cancer risk at the population level. We use total fertility rate (TFR) to test the reproductive behaviour hypothesis, and we use average height and the percentage of the population that is overweight for the nutritional hypothesis; these indicators are compared to breast cancer incidence rates for 2008. Accounting for national wealth and expenditures on healthcare, we found that both hypotheses were significantly associated with breast cancer incidence, although TFR appears to have a more consistent association with incidence. Drawing on our regression model, we explain trends in breast cancer incidence in selected countries, as well as making predictions about shifting breast cancer incidence rates over the next several decades. These data suggest that greater attention should be paid to the unintended health consequences of transitions that are largely considered to bring improvements in quality of life. Our findings suggest that greater investments in screening and treatment are particularly needed in regions undergoing transitions in fertility rates, particularly those areas experiencing super-low fertility.     

From the Editor

ABSTRACT

Data from focus groups held in Montréal (Canada) with 13 women born in Cameroon, Colombia, and Democratic Republic of Congo were used to explore cancer knowledge among immigrant grandmothers and mothers-in-law and their influence over family cancer-preventative practices. Thematic analysis identified the following leading themes: cancer literacy and influence over family cancer preventative and early detection practices, cancer literacy in relation to family health behaviors, and barriers to accessing health services. Perceived external causes of cancer and its prevention are countered by healthy eating and exercises. Cancer literacy was contextualized by the development of women’s ways of being and doing.     

Stochastic Modelling of Multiple Random Genetic Mutations Under the Cancer Stem Cell Hypothesis

The probability distribution for the size of each of the various cancer cell subpopulations created by random genetic mutations is expressed in the case of non-exponential growth of cancer and in the case of a heterogeneous tumor cell population.     

Visibility of the ovaries and breasts: an analysis of Angelina Jolie’s medical announcements

Advanced epithelial ovarian cancer is the deadliest gynecologic cancer; yet public knowledge about the disease is limited. This essay critically examines the limited visibility of ovarian cancer using Angelina Jolie’s medical announcements in 2013 and 2015 as examples. The essay also examines how Jolie’s case reinforces and also challenges hegemonic notions of femininity, the woman’s body and health, and how it explicates limitations in discourses of choice and risk. I argue that normative views about the female body play significant roles in shaping how and what we know about women’s health.     

Tobacco-related cancers in Poland in 1963-1989

"In this paper we are presenting an epidemiological analysis of tobacco-related cancer risk in Poland in 1963-1989 and, in addition, etiological characteristics of the cancers." Data are from official sources. The results indicate that "standardized mortality rates had significantly increased for all tobacco-related cancer sites in 1963-1989."     

The impact of early-life economic conditionson cause-specific mortality during adulthood

The aim of this study is to assess the effects of economic conditions in early life on cause-specific mortality during adulthood. The analyses are performed on a unique historical sample of 14,520 Dutch individuals born in 1880–1918, who are followed throughout life. The economic conditions in early life are characterized using cyclical variations in annual real per capital gross domestic product during pregnancy and the first year of life. Exposure to recessions in early life appears to significantly increase cancer mortality risks of older males and females. It also significantly increases other mortality risks especially for older females. The residual life expectancies are up to about 8 and 6 % lower for male and female cancer mortality, respectively, and up to about 5 % lower for female cardiovascular mortality. Our analyses show that cardiovascular and cancer mortality risks are related and that not taking this association into account leads to biased inference.     

Women,Aging, and Cancer

Women over 65 bear high risk for developing cancer. The risk for developing most cancers grows'with increasing age. Of the 1.13 million people estimated to develop cancer in 1992,362,000 (32 percent) will be women over 65 years old (American Cancer Society, 1992). The few early detection and prevention programs that have focused on this age group have found that the women often have problems with utilization, misconceptions, and plain lack of correct information. Treatment for women over 65 with cancer may differ from that for younger women because of age bias, comorbidity, stage of disease at time of diagnosis, and a lack of research on women of this age. Even quality of life and survivorship for the woman over 65 become issues due to the lack of knowledge about how women over 65 view these concepts. The Healthy People 2000 Report has developed goals for a healthier society by the year 2000. The priority areas in relation to cancer include reduction in cigarette smoking, dietary changes, greater utilization of early detection mechanisms, and decreasing exposure to occupational and environmental carcinogens. Implementation of these goals should affect future generations in terms of healthy aging: however, specific programs do need to focus on the woman over 65 and her present needs which will impact current and future health status.     

Breast Cancer:

Cancer is a major problem for elderly individuals. Overall, it is the second leading cause of death after heart disease and 50% of all documented cases occur in 12% of the population over the age 65. About 50,000 women in the United States age 65 and older are diagnosed annually with breast cancer, making it one of the most serious health oroblems for women in this age ~ O U D I. t is the second leading causk of cancer deaths after lung cancer in women. While breast cancer is not preventable, the survival rate is near 100% if detected earlv. However. late staEe of diamosis remains a concern in this age groip. ~ ~ ~ r o x & n ai0t%e lo~f women with breast cancer present with metastases as the first indication of a malignancy. Early detection and screening offer the only solution to this dreaded situation. Society must find ways to make these practices available to the elderly.     

Searching for therapies,seeking for hope: transnational cancer care in Asia

ABSTRACT

This paper is about transnational cancer care in Asia. People with terminal diseases such as cancer increasingly escape devastating prognosis of their local regimes of clinical diagnostic truth by traveling to destinations where medicine is more advanced, yet affordable for them, and hence offers a broader scope for hope. The paper suggests that transnational cancer care provides an instructive case of the enormous geographical disparities in the availability of therapies and how this, combined with economies of hope and the marketization of health care, affects patients and their family caregivers. The primary contribution of the paper is the introduction of the concept of relational subjectivities to the health mobilities literature. The findings presented proof that the concept provides a fruitful analytical lens, yielding not only fresh empirical insights but prompting re-conceptualizations of medical travel itself as hopeful, yet risky transnational acts of family care.     

Quality Assessment of the Oncology Health Service in a Public Hospital

Quality assessment is a crucial issue in the strategic management of the public health sector. The objective of this study is to investigate the patients’ perception of the health system quality and explore the relationships between doctors and long-term cancer patients. The data under study have been collected during a survey conducted with long-term cancer patients who follow an oncological therapy in a Public Hospital. In the study, exploratory factorial analysis is developed and two structural equation models are proposed. The first model describes the service quality as perceived by the patients, which is influenced by four important factors, namely tangible aspects, reliability, empathy (doctor–patient human relations) and hospital organization. The second model describes the relationship between doctors and long-term cancer patients, which is influenced by three factors, that is reliability, empathy and hospital organization. The discussion highlights the contribution that the results of the study may make to the investigation of the possible strategies for improving health care service quality.

     

Disease-related stigma: comparing predictors of AIDS and cancer stigma

This study explores the prevalence of AIDS and cancer stigma as influenced by attitude toward homosexuality, religiosity, authoritarianism, and androgyny. This study used a quasi-experimental survey design (N = 485) to examine attitude toward people with AIDS and cancer, and interaction with people with AIDS and cancer. Negative attitudes toward homosexuality, high religious intensity and ideology, high authoritarianism, and low expressive emerged as factors related to more negative attitudes toward people with AIDS and unwillingness to interact with people with AIDS. Attitudes toward people with cancer were generally not related to the variables. Findings explore how to campaign efforts to reduce existing negative attitudes toward AIDS and homosexuality, given that gay men with AIDS are especially stigmatized. Implications and directions for future research are discussed, especially for interventions.     

An age–period–cohort analysis of cancer incidence among the oldest old,Utah 1973–2002

We used age–period–cohort (APC) analyses to describe the simultaneous effects of age, period, and cohort on cancer incidence rates in an attempt to understand the population dynamics underlying their patterns among those aged 85+. Data from the Utah Cancer Registry (UCR), the US Census, the National Center for Health Statistics (NCHS), and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) programme were used to generate age-specific estimates of cancer incidence at ages 65–99 from 1973 to 2002 for Utah. Our results showed increasing cancer incidence rates up to the 85–89 age group followed by declines at ages 90–99 when not confounded by the separate influences of period and cohort effects. We found significant period and cohort effects, suggesting the role of environmental mechanisms in cancer incidence trends between the ages of 85 and 100.     

Mental health and breast cancer screening utilization among older Hispanic women

Considerable racial and ethnic differences exist in the way the burden of cancer is experienced in the United States for older Hispanic women. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the mental health factors associated with older Hispanic women’s participation in breast cancer screening services. Logistic regression models were used. Findings indicated that anxiety and positive affect were associated with a greater likelihood of participating in breast cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.     

Coping with loneliness among the terminally ill

Loneliness is a universal phenomenon, and its pain is intensified by a diagnosis of a terminal illness. The present study is an investigation of the strategies used by patients with Multiple sclerosis (MS), by individuals diagnosed with cancer, and by the general population to cope with loneliness. Three hundred and twenty nine MS patients, 315 cancer patients, and 391 participants from the general population answered a 34-item questionnaire. Results indicated that with the exception of Reflection and acceptance, Distancing and denial, and Increased activity, the three groups cope with loneliness significantly differently.