The relationship between the sense of community and health-related quality of life of female cancer survivors
Currently there are roughly 12 million individuals alive today with a history of cancer (USCS, 2010). Research has shown that cancer and its treatment exact significant psychosocial effects, and that further research on the relationship between the survivor’s association with their family, community and larger society and their HRQOL is an important question for study (ACS, 2010; Albrecht & Devlieger, 1999; IOM, 2005; NCI, 2010). Due to the nature of the disease and treatment modalities typically utilized, many cancer survivors report psychosocial and HRQOL effects (Aziz, 2002, 2007; Bloom, 2008). In the case of women who are diagnosed with cancer, research has shown that female survivors report more psychosocial and emotional distress than men (Langeveld, Grootenhuis, Voute, & de Haan, 2004; Taieb, Moro, Baubet, Revah-Levy, & Flament, 2003). Supported by the survivorship literature is the notion that regardless of the cancer type, virtually all individuals experience altered relationships to some extent (Zebrack, Yi, Petersen, & Ganz, 2008). Dependence and/or independence issues, altered and/or reduced support, isolation and loneliness as a result of the sequelae associated with diagnosis and treatment are often reported (Montazeri, 2008; Robb, et al., 2007; Zebrack et al., 2008). As cancer and its treatment often leave its victims highly vulnerable, the sense of community (SOC) one receives from others throughout the continuum of care has been suggested to positively influence their health-related quality of life (HRQOL) (Albrecht & Devlieger, 1999). As female survivors of cancer are embedded in multiple communities, often within a single day, there is a need to extend current research to better understand how these multiple senses of community may be related to their HRQOL. This has been clearly recognized as an important topic in need of further investigation as both the American Cancer Association [ACS] (2010), National Cancer Institute [NCI] (2005) and the Institute of Medicine [IOM] (2005) have all called for further investigation into the relationship between cancer survivors’ communities of support and their HRQOL. The purpose of this study was therefore to investigate the relationship that select multiple senses of community have on the health-related quality of life (HRQOL) of adult female cancer survivors. To address this purpose, this study explored adult female cancer survivors’ sense of community based on five mutually exclusive community types commonly investigated in the literature (Social Support, Neighborhood, Leisure, Faith, and Work-based community types) and how their sense of community with these community types is related to their HRQOL. More specifically, this study addressed three research questions that investigated the relationship between the SOC and HRQOL of adult female cancer survivors: Question 1: What is the relationship between SOC and its domains and the HRQOL of women who are cancer survivors? Question 2: How does the sense of community (Social Support, Neighborhood, Leisure, Faith, and Work-based community types) to which a female cancer survivor identifies relate to her HRQOL? Question 3: How does a female cancer survivor’s SOC differentially impact the various components of HRQOL? Female cancer survivors from a cancer support program based in the Southwestern United States participated in this study. A total of 98 responses from a population of 800 were obtained for data analysis. Multiple Analysis of Covariance (MANCOVA) was used to address the research questions of interest from this purposive sample of female cancer survivors. First, preliminary analyses revealed violations with normality and multicollinearity for the scales that measured respondents’ SOC. After attempting several transformation processes for the SOC data, it was determined that a median split would be the most appropriate transformation to correct for issues with assumptions for parametric data analyses. In addition, exploratory factor analysis revealed that SOC was comprised of a unidimensional solution. As two of the research questions relied on the existence of a multidimensional model of SOC, each of the research questions and associated hypotheses were changed accordingly. Regarding the relationship between SOC and HRQOL, for these respondents it was found that their Leisure and Work-based SOC was positively related to specific aspects of their HRQOL. With much of the literature finding links between Geographic / Neighborhood community types, this research extended current research and suggested that the relationship between respondents’ SOC and HRQOL are not dependent upon the SOC of just one community type, but rather on multiple community types. As this was a purposive biased sample of cancer survivors from a mid-sized Southwestern city in the United States, further research using other samples and methods may provide further insights into this relationship.
Cancer, Sense of Community (SOC), Community, Recreation, Lesiure, Health-Related Quality of Life (HRQOL), Women, Female
University of Illinois - Urbana-Champaign
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University of Illinois at Urbana-Champaign