Holly T. Renzhofer, M.A., Gary T. Deimling, Ph.D., Sherri P. Brown, M.S.

1. How Self-Reported Disability and Functional Limitations Influence Older, Adult Long-Term Cancer Survivors’ Body Satisfaction and Continuity of Self Holly T. Renzhofer, M.A., Gary T. Deimling, Ph.D., Sherri P. Brown, M.S. and Cory E. Cronin, M.H.A. Department of Sociology Case Western Reserve University Cancer Survivor’s Research Project Funded by the National Cancer Institute, R01-CA-78975 Presented at the 35th Annual Ohio Professional and Student Conference on Aging, Columbus, Ohio, April15, 2011

2. Goal of Study • To examine the association of cancer survivors’ reports of disability and functional limitations with body satisfaction, continuity of self and health-related stigma in older long-term adult cancer survivors.

3. Introduction • “The increased prevalence of limitations in long-term survivors was not linked to one cancer site or stage at diagnosis, but rather seemed to be a general phenomenon” (Sweeny et al 2006: 528). • Cancer is an important cause of disability (Hewitt et al. 2003). • “Disability among cancer survivors appears to be most pronounced in the area of physical functioning” (Hewitt et al. 2003: 86). • The accuracy of self-reported disability is the same for both men and women (Merrill et al. 1997).

4. Introduction • Some patients my feel “stigmatised, ashamed, depressed, anxious and angry” about their disease experience (Else-Quest et al. 2009: 962) • Body image dissatisfaction is a frequent side effect of both cancer and its treatment (DeFrank et al. 2007). • Self-continuity plays an important role, and alienation may result when survivors are unable to establish a sense of self continuity (Little et al. 2002).

5. Research Questions • If survivors have a greater number of functional limitations, are they more likely to have lower body satisfaction, lower continuity of self, and higher levels of stigma? • If survivors consider themselves disabled, are they more likely to have lower body satisfaction, lower continuity of self, and a higher level of stigma?

6. Sample • Longitudinal study (6 waves) • Sample of 321 cancer survivors • randomly selected from a tumor registry in Cleveland, OH • survivors of breast, colorectal, or prostate cancer • aged 60+ years • diagnosed a minimum of five years, at study enrollment • 59.2% female and 40.8% male • 37.7% African American and 62.3% Whites • 41.4% breast cancer, 29.9% colorectal cancer, and 28.7% prostate cancer

7. Measures • Functional Difficulty • Nagi (1976) Activities Scale • Range = 0-25 • Perceived Disability • Single-item, ECRC Burden of Disability Scale • Range = 0-4 • Stigma • Single-item, ECRC Burden of Disability Scale • Range = 0-4 • Body Satisfaction • Single-item • Range = 0-4 • Self-Continuity • 2-item scale (alpha = .64) • Range = 2-10

8. Functional Difficulties

9. Perceived Disability *The items much and very much were combined

10. Perceived Stigma

11. Body Satisfaction

12. Continuity of Self *Cancer survivors who reported neither agree or disagree were excluded in the above bar chart

13. Full Correlation Model STIGMA .18** FUNCTIONAL DIFFICULTY -.10 .11 BODY SATISFACTION -.26** -.02 .131* .59** .13* -.01 DISABILITY -.19** SELF-CONTINUITY -.06

14. Correlation Summary: Functional Difficulty & Disability STIGMA .18** FUNCTIONAL DIFFICULTY -.10 .11 BODY SATISFACTION -.26** -.02 .131* .59** .13* -.01 DISABILITY -.19** SELF-CONTINUITY -.06

15. Correlation Summary: Functional Difficulty & Stigma STIGMA .18** FUNCTIONAL DIFFICULTY -.10 .11 BODY SATISFACTION -.26** -.02 .131* .59** .13* -.01 DISABILITY -.19** SELF-CONTINUITY -.06

16. Correlation Summary: Functional Difficulty & Body Satisfaction STIGMA .18** FUNCTIONAL DIFFICULTY -.10 .11 BODY SATISFACTION -.26** -.02 .131* .59** .13* -.01 DISABILITY -.19** SELF-CONTINUITY -.06

17. Correlation Summary: Disability & Body Satisfaction STIGMA .18** FUNCTIONAL DIFFICULTY -.10 .11 BODY SATISFACTION -.26** -.02 .131* .59** .13* -.01 DISABILITY -.19** SELF-CONTINUITY -.06

18. Correlation Summary: Body Satisfaction & Self-Continuity STIGMA .18** FUNCTIONAL DIFFICULTY -.10 .11 BODY SATISFACTION -.26** -.02 .131* .59** .13* -.01 DISABILITY -.19** SELF-CONTINUITY -.06

19. Conclusion • Functional difficulties and perceived disability are strongly correlated. • Functional difficulty and stigma have a weak but significant correlation, but perceived disability and stigma are not significantly correlated. • Functional difficulty and perceived disability show a relatively weak but significant correlation to body satisfaction. • Neither functional difficulty or perceived disability show a correlation with self-continuity. • Identity factors are weakly correlated and generally not significant.

20. References • DeFrank, J.T., Mehta C.B.C., Stein, K.D., and Frank Baker. 2007. “Body Image Dissatisfaction in Cancer Survivors.” Oncology Nursing Forum. 34: E1-E6. • Else-Quest N.M., LoConte N.K., Schiller J.H. and Janet Shibley Hyde. 2009. Psychology and Health. 24(8): 949-964. • Hewitt, M., Rowland J.H., and Rosemary Yancik. 2003. “Cancer Survivors in the United States: Age, Health, and Disability.” Journal of Gerontology. 58(1): 82-91. • Little, M., Paul K., Jordens C.F.C., and Emma-Jane Sayers. 2002. “Survivorship and Discourses of Identity.” Psycho-Oncology. 11: 170- 178. • Merrill, S.S., Seeman T.E., Kasl S.V., and Lisa Berkman. 1997. “Gender Differences in the Comparison of Self-Reported Disability and Performance Measures.” The Journals of Gerontology. 52A(1):M19- M26.

21. References • Sweeney, C., Schmitz, K.H., Lazovich, D., Virnig, B.A., Wallace, R.B., and Aaron R. Folsom. 2006. “Functional Limitations in Elderly Female Cancer Survivors.” Journal of the National Cancer Institute. 98(8): 521-529.