Date of Award

6-1-2013

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Lisa Kennedy Sheldon

Second Advisor

Jacqueline Fawcett

Third Advisor

Jerry Cromwell

Abstract

Background: African Americans suffer from lung cancer more often than other populations. Surgical resection is the best available treatment to enhance long-term survival for non-small cell lung cancer (NSCLC), but it can negatively impact health-related quality of life (HRQOL). Assessment of HRQOL in adults is an important field in clinical health care and research. The Conceptual Model for Nursing and Health Policy and the Contextual Model of HRQOL guided this study.

Objective: To examine the relations of race, age, gender, marital status, education, income, insurance, social support, smoking status, surgeon's practice volume, comorbidities, disease stage, type of surgery, adjuvant chemotherapy, and time since surgery to HRQOL for patients who underwent surgical resection for NSCLC.

Data Source: Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium.

Methods: Descriptive statistics, correlation analysis and multivariate regression analyses were computed. Structural equation modeling was used to test the hypothesized causal relations among study variables. The HRQOL outcome measures were physical component summary (PCS) and mental component summary (MCS) scores measured by the Short-Form 12 at two time points after lung cancer surgery. The mean time between surgery and baseline data was 4.3 (SD 2.4) months, mean time between surgery and follow-up data was 13.5 (SD 4.7) months.

Results: Of 1126 participants undergoing lung cancer surgery, 77.0% were White, and 10.8% were African American; 56.7% were male; 62.4% were married or living with a partner. African Americans had significantly less improvement (β=-2.73, p=.04) in MCS score than Whites. No significant difference was found in PCS score between African Americans and Whites. Comorbidity was associated with less improvement in PCS score. Use of adjuvant chemotherapy within 6 months of surgery was associated with more improvement in MCS score.

Conclusion: These results add to the increasing knowledge of cancer disparities. African Americans experience significantly less improvement in mental health following lung cancer surgery than Whites. Results highlight the need for providing psychosocial interventions after lung cancer surgery to improve mental health. More research is needed to better understand racial difference in mental health in order to develop effective, culturally appropriate interventions to enhance HRQOL after lung cancer surgery.

Comments

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