Background
Methods
Participants
Materials
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Demographics and medical information. Data were collected on age, sex, educational level and civil status at baseline. Medical information, such as the site, kind (initial or recurrent), stage of cancer and number of comorbidities were obtained through medical records at baseline. Additional information (treatment or death) was obtained during follow-ups.
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Cognitive level was assessed only at the baseline with the French version of the Mini Mental State Examination (MMSE) [23]. This test measures orientation, learning, attention, memory, language and constructive praxis.
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SPA was measured with the Attitudes to Aging Questionnaire (AAQ) [24], translated and validated in French [25]. Measurements were taken at each testing time point (T0, T3, T6 and T12). This scale was specifically developed to flexibly and comprehensively assess attitudes toward the aging process as a personal experience from the perspective of older adults. For each of the 24 items of the scale (α = .78), participants respond on a five-point Likert-type scale ranging from 1 (strongly disagree/not at all true) to 5 (strongly agree/extremely true). This scale can be divided into three subscales: Psychosocial loss, Physical change and Psychological growth. In the present study, we only used the total score (range: 24–120). A higher total score reflects more positive SPA.
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View of cancer was assessed using the Social Impact Scale (SIS) [26] translated into French. This scale was also administered at each testing time point. It measures the individual’s perception of being stigmatized because of cancer. Some items were slightly modified in order to adapt them to older people. More specifically, two items related to the work place (“My employer/co-workers have discriminated against me” and “My job security has been affected by my illness”) were rephrased in order to refer to “useful activities (voluntary work, baby-sitting…)” rather than paid activities. This scale comprises 24 items (α = .87) that are answered using a 4-point Likert-type scale ranging from 1 (strongly disagree) to 4 (strongly agree). Items can be divided into four subscales: Social rejection, Financial Insecurity, Internalized shame and Social isolation. As for the AAQ, we only used the total score (range: 24–96). Originally, a high score indicates a strong feeling of stigmatization. However, in order to simplify the reading of stigma results, the score was reversed: a higher score indicated a lower level of cancer stigma, similarly to the SPA (i.e. AAQ) scale. In other words, a higher SIS score meant a more positive view of cancer.
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European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). This 30-item instrument [27] was administered during the four time points. In agreement with Giesinger et al. [28], we excluded from data analyses one item measuring financial difficulties and two items measuring the quality of life. Based on the 27 remaining items, the questionnaire includes 5 functioning scales: (1) physical, (2) role, (3) emotional, (4) cognitive and (5) social. It also measures symptomatology with three scales (Nausea and Vomiting, Fatigue, Pain) as well as with 5 separate items (Dyspnoea, Insomnia, Appetite Loss, Constipation and Diarrhoea). All scores are transformed into a 0–100 scale. On this basis, a summary score of global health was calculated (α = .9). A higher score indicated better health. For conceptual matters, we also have distinguished physical and mental health as we have done for the cross-sectional study [22]. For physical health (α = .89), we have included the following parameters (19 items): (1) the physical and role functioning scales; (2) symptoms scales and single items. For mental health (α = .78), we have included the emotional, social and cognitive functioning scale (8 items).
Data analyses
Results
Sample characteristics
Characteristics | One-year follow-up group (n = 58)a
M (SD) or % | Lost group (n = 43) M (SD) or N % | Baseline comparison between the lost group and patients who completed the study
t (p) or χ2 (p) | |
---|---|---|---|---|
Women | 54 (93.1%) | 12 (27.9%) | 8.18 (.004) | |
Age | 71.77 (5.53) | 75.06 (6.32) | −2.8 (.006) | |
Primary cancer site | Breast | 31 (53.4%) | 16 (37.2%) | 7.55 (.056) |
Gynecology | 16 (27.6%) | 9 (21%) | ||
Lung | 8 (13.8%) | 16 (37.2%) | ||
Hematology | 3 (5.2%) | 2 (4.6%) | ||
Cancer staging | Non-metastatic | 53 (91.4%) | 28 (65.1%) | 10.72 (.001) |
Metastatic | 5 (8.6%) | 15 (34.9%) | ||
Kind of cancer | Initial cancer | 48 (82.8%) | 40 (93%) | 2.32 (.12) |
Recurrence or progressive | 10 (17.2%) | 3 (7%) | ||
Charlson Comorbidity Index | 1.79 (1.33) | 2.56 (2.14) | −2.2 (.03) | |
Cognitive functioning | 27.84 (1.96) | 26.83 (2.32) | 2.35 (.02) | |
Global health | Baseline | 79.68 (15.97) | 73.8 (17.38) | 1.75 (.08) |
After 3 months | 75.26 (15.17) | |||
After 6 months | 76.66 (17.53) | |||
After one year | 80.36 (14.2) | |||
Mental health | Baseline | 82.35 (17.7) | 78.68 (19.72) | .956 (.34) |
After 3 months | 79.66 (19.98) | |||
After 6 months | 82.17 (18.97) | |||
After one year | 83.24 (18.5) | |||
Physical health | Baseline | 78.89 (17.46) | 72.33 (18.43) | 1.81 (.073) |
After 3 months | 73.41 (16.9) | |||
After 6 months | 74.98 (18.28) | |||
After one year | 79.5 (15.04) | |||
SPA | Baseline | 87.52 (12.79) | 81.56 (13.36) | 2.19 (.03) |
After 3 months | 84.5 (12.64) | |||
After 6 months | 86.05 (13) | |||
After one year | 84.4 (14.26) | |||
Cancer view | Baseline | 83.31 (9.55) | 80.05 (11.17) | 1.36 (.17) |
After 3 months | 81.1 (10.89) | |||
After 6 months | 84.53 (10.38) | |||
After one year | 84.5 (12.04) |
Mixed linear models
Characteristics | Global health | Physical health | Mental health | ||||||||||
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Coeff. |
SE
|
t
|
p
| Coeff. |
SE
|
t
|
p
| Coeff. |
SE
|
t
|
p
| ||
SPA (baseline) | .38 | .099 | 3.808 | < .001 | .37 | .1 | 3.587 | < .001 | .53 | .11 | 4.887 | < .001 | |
View of cancer (baseline) | .359 | .13 | 2.735 | < .001 | .3 | .14 | 2.204 | .03 | .49 | .14 | 3.463 | < .001 | |
Carcinoma staginga
| −7.37 | 3.34 | −2.21 | .03 | - | - | - | - | - | - | - | - | |
Chemotherapyb
| −7.31 | 1.57 | −4.66 | < .001 | −7.49 | 1.74 | −4.33 | < .0001 | −7.6 | 2.04 | −3.718 | < .001 | |
Genderc
| 8.13 | 3.74 | 2.17 | .03 | 13.08 | 5.05 | 2.591 | .01 | - | - | - | - | |
Cancer sited
| Lung (vs breast) | - | - | - | - | −6.63 | 4.35 | −1.525 | .13 | 5 | 3.45 | 1.451 | .15 |
Gynecological (vs breast) | - | - | - | - | −4.54 | 3.16 | −1.439 | .15 | −10.09 | 3.33 | −3.03 | .003 | |
Hematological (vs breast) | - | - | - | - | −17.68 | 6.3 | −2.806 | .006 | .41 | 6.3 | 0.06 | .95 | |
Kind of cancere
| - | - | - | - | 7.7 | 3.81 | 2.023 | .046 | - | - | - | - | |
Comorbidities | - | - | - | - | −1.69 | .082 | −4.33 | < .001 | - | - | - | - | |
REML criterion at convergence | 2349.1 | 2375 | 2472 |
Characteristics | Global health | Physical health | Mental health | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Coeff. |
SE
|
t
|
p
| Coeff. |
SE
|
t
|
p
| Coeff. |
SE
|
T
|
p
| ||
SPA | .41 | .07 | 5.92 | < .001 | .4 | .07 | 5.46 | < .001 | .53 | .07 | 6.785 | < .001 | |
Cancer view | .17 | .07 | 2.318 | .02 | - | - | - | - | .53 | .09 | 5.98 | < .001 | |
Carcinoma staginga
| −6.86 | 3.08 | −2.23 | .03 | −7.78 | 3.44 | −2.263 | .02 | −8.89 | 3.68 | −2.41 | .02 | |
Chemotherapyb
| −6.4 | 1.54 | −4.142 | < .001 | −6.89 | 1.7 | −4.05 | < .0001 | −5.73 | 1.91 | −3.005 | .003 | |
Cancer sitec
| Lung (vs breast) | - | - | - | - | - | - | - | - | 8.31 | 3.66 | 2.274 | .03 |
Gynecological (vs breast) | - | - | - | - | - | - | - | - | −7.39 | 3.03 | −2.44 | .02 | |
Hematological (vs breast) | - | - | - | - | - | - | - | - | 7 | 5.7 | 1.227 | .22 | |
REML criterion at convergence | 2344.5 | 2403.1 | 2425.7 |