title: Determinants of altered life perspectives among older-adult long-term cancer survivors.
abstract: BACKGROUND
  In the recent literature on cancer survivorship, positive changes are emphasized in the aftermath of trauma. However, there is insufficient research on older-adult survivors and more complex transformations.
  
  
  OBJECTIVE
  Consistent with nursing researchers' views about the duality of cancer survivor experiences, this research examined both positive and negative posttraumatic transformations (PTTs) among long-term survivors. Demographic, stress, and appraisal-related predictors of transformations were considered.
  
  
  METHODS
  Using cross-sectional survey design, interviews were conducted with 288 survivors of breast, colorectal, and prostate cancer. The sample, obtained from a hospital tumor registry, was 58% female, 33% African American, and 67% white (mean age, 72.5 [SD, 7.6] years). Demographic characteristics, cumulative stress exposure, appraisals of stress, and self-reported PTTs were measured.
  
  
  RESULTS
  Most respondents reported diverse transformations attributed to their illness experience. Demographic characteristics and stress appraisals were more strongly associated with PTT outcomes than was cumulative stress exposure. Appraisals of the cancer experience as stressful, as generating worry, and as stigmatizing were significantly associated with diverse PTT outcomes.
  
  
  CONCLUSIONS
  Many long-term older cancer survivors report PTT reflecting altered perspectives on life. Posttraumatic transformations are related to the view that cancer is a continuing worrisome and stigmatizing experience.
  
  
  CONCLUSIONS
  Nurses have a unique opportunity to discuss with patients the potentially life-changing nature of the cancer experience in a manner that allows for understanding and acceptance of complex changes, incorporating benefit finding along with acknowledgement of loss and suffering. This type of discussion can enhance cancer survivors' mental health.
authors.affiliation: Department of Psychology, Cleveland State University, Chester Avenue, E. 23rd Street, Cleveland, OH 44115, USA. b.kahana@csuohio.edu
authors.forename: Boaz
authors.initials: B
authors.lastname: Kahana
authors.forename: Eva
authors.initials: E
authors.lastname: Kahana
authors.forename: Gary
authors.initials: G
authors.lastname: Deimling
authors.forename: Samantha
authors.initials: S
authors.lastname: Sterns
authors.forename: Madeline
authors.initials: M
authors.lastname: VanGunten
mesh_terms: D000223:Adaptation, Psychological; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D008016:Life Change Events; D016014:Linear Models; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D011594:Psychometrics; D012042:Registries; D012720:Severity of Illness Index; D013315:Stress, Psychological; D017741:Survivors / Q000523:psychology*; D013997:Time Factors