Stagebased Conceptual Framework

Underlying future systematic attempts to improve cancer survivorship is the fundamental need for more comprehensive models or conceptualizations of factors that impact cancer survivorship over time. There are conceptualizations that have been used to guide some research in the area9 however future efforts that integrate the many factors in the trajectory of cancer survivorship should stimulate a comprehensive understanding of factors involved.

As a relative newcomer to cancer survivorship I took the liberty to generate a conceptual framework that highlights many of the factors that I have found in my assessment of the literature, my personal experience as a cancer survivor, and my clinical work. Figure 1 illustrates some major areas that impact outcomes in cancer survivorship. The overarching point is the dynamic nature of the interactions among variables and the stages or phases of survivorship. As many of the chapters in this book indicate the variables listed in the figure can impact symptom and functional outcomes across the various stages of cancer survivorship. This conceptualization identifies six stages of phases involved in cancer survivorship: diagnosis, treatment, acute, sub-acute, chronic, and end stage. These phases of survivorship can be influenced by medical, sociocultural, individual and environmental factors. It is also possible that transitions can occur among the six stages such that an individual can move back and forth between these phases. This framework proposes that a number of variables within the four categories of variables can impact various challenges or benefits across each of the phases. Any model of cancer survivorship must await well-designed studies for validation, however, this conceptual framework can help organize research and thinking in the area. I present this as an example of a broad-based multidimensional delineation of the critical variables we need to be concerned with and how these may interact with each other to impact the several

Biopsychosocial Model of Cancer Survivorship

Biopsychosocial Model of Cancer Survivorship

Figure 1. Example of Stage-Based Framework.

phases of cancer survivorship. Clearly, as mentioned natural history studies need to verify stages and risk factor research must identify which variables meet the criteria of a valid risk factor.

It is also important to remain cognizant of the interactive role between biological and psychological processes involved in cancer and its recovery, the reciprocal impact of functional and emotional recovery, and long-term health and quality of life. This framework highlights the dynamic interplay among multiple factors that impact the biology of cancer, the psychobiology of the person, and overall function. Lastly, with a focus on the temporal dimension of cancer survivorship in which research indicates that as the time from diagnosis, treatment, and or recurrence increases many aspects of adaptation or adjustment set in. This temporal dimension of survivorship seems important and as with many traumatic experiences several aspects of survivorship can perhaps best be considered within a temporal framework (i.e., time from some critical event- recurrence, recovery of health or functional outcome, advanced stage).

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