title: Patterns of adaptation in patients living long term with advanced cancer.
abstract: BACKGROUND
  With improved treatment, increasing proportions of patients with advanced cancer are surviving longer with their disease: into a second year after diagnosis and beyond. These longer term survivors face continuing challenges in selecting and shifting personal life goals and goals of care over years (rather than months) of life with incurable cancer. Studies are needed to explore adaptation over time in patients who are living longer term with late-stage cancer, including anxiety, depression, and spiritual well being, which are conceptualized as indicators of psychospiritual well being in patients with advanced cancer.
  
  
  METHODS
  Psychospiritual well being and adaptation were explored in a study of middle-aged and older patients with advanced cancer (N=142) who survived into a second year after diagnosis and were assessed in interviews across 4 time points. Examining patterns of adaptation over time called for in depth analytical techniques to identify variation in key outcome trajectories. General growth mixture modeling was used to explore heterogeneity in adaptation using a multivariate parallel model of anxiety, depression. and spiritual well being.
  
  
  RESULTS
  Modeling revealed 3 distinct group trajectories of psychospiritual well being and adaptation (low-worsening, moderate-improving, and high-stable). Age and education were correlated with group membership. Advanced cancer survivors who were older and had more years of education were more likely to be members of the high-stable group in psychospiritual adaptation throughout the study.
  
  
  CONCLUSIONS
  The current findings suggested that psychospiritual adaptation, as measured in this study, is not uniform but is characterized by heterogeneous trajectories. The results contribute to the development of better hypotheses regarding the processes of adaptation in longer term survivors with advanced cancer and to the identification of potential subgroups at greatest risk for poor outcomes.
authors.affiliation: Department of Medicine, Geriatrics and Palliative Care, Case Western Reserve University School of Medicine, Cleveland, Ohio 44109, USA. julia.rose@case.edu
authors.forename: Julia Hannum
authors.initials: JH
authors.lastname: Rose
authors.forename: George
authors.initials: G
authors.lastname: Kypriotakis
authors.forename: Karen F
authors.initials: KF
authors.lastname: Bowman
authors.forename: Douglas
authors.initials: D
authors.lastname: Einstadter
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: O'Toole
authors.forename: Rhoderick
authors.initials: R
authors.lastname: Mechekano
authors.forename: Neal V
authors.initials: NV
authors.lastname: Dawson
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009369:Neoplasms / Q000523:psychology*; D011788:Quality of Life; D029181:Spirituality; D017741:Survivors / Q000523:psychology*