Survivorship Issues And Hrql

Cancer survivors report numerous positive and negative outcomes related to their cancer. The prevailing model of multidimensional health status, originally put forth by the charter of the WHO, defines health as "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity."19(p100) The late effects of cancer can also be classified under these three dimensions, with definable subsets of measurable concepts, or latent traits, found within each dimension (Figure 1). From our review of the literature12,20-27 and empirical work over the past 15 years24,27-46 we have built upon this fundamental framework of self-reported health, preserving the original.

To understand the magnitude of HRQL issues among cancer survivors, we have classified these concepts into discrete domains, however it is understood that they represent a highly interrelated and dynamic system. Adhering to this model of self-reported health, the late effects of cancer can have wide spread ramifications. For example, many of the late physical effects (e.g., pain, fatigue, urinary incontinence, infertility) can also have significant emotional and social consequences. Since those with increasing age also represent a large segment of cancer survivors, it is sometimes difficult to determine whether physical changes are predominantly age or cancer related (e.g., fatigue, decreased libido, weakness). Apart from the observed physical changes, the psychosocial and existential issues acknowledged by survivors

Figure 1. Conceptual Framework of Health-Related Quality of Life and Cancer Survivors.

E3 CfQ

Figure 1. Conceptual Framework of Health-Related Quality of Life and Cancer Survivors.

appear to be directly linked to the experience of cancer. Survivors frequently describe apprehension, unease, and heightened vulnerability related to the possibility of a recurrence or that their bodies are somehow defective and have failed them.

Depending on myriad internal and external factors (e.g., personality style, environmental facilitators or inhibitors) being a cancer survivor can have advantageous or obstructive consequences, such as inspiring one to appreciate life to the fullest or become immobilized with fear of the future. Because of the numerous mental, physical, and social changes many cancer survivors experience years following their treatment, ongoing HRQL assessment becomes critical. Such assessment can serve as a useful gauge of treatment success, assist in the identification of long-term complications that should continue to be monitored by medical personnel, or identify potential teaching and learning moments where health promotion interventions could be implemented.6 The following section provides an overview of measures commonly used to assess HRQL in cancer survivors.

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