Cancer, Comorbidities, and Psychosocial Quality of Life of Married Couples
Aloen L. Townsend, Ph.D. (Principal Investigator), Mandel School of Applied Social Sciences
Karen F. Bowman, Ph.D. (Co-Investigator), Department of Sociology
Julia Hannum Rose, Ph.D. (Co-Investigator), School of Medicine
Funded by the Aging and Cancer Research Program (P20 CA103736),
Case Comprehensive Cancer Center, 03/2005-02/2007
Research investigating psychosocial quality of life in adults with cancer is increasing
rapidly. Yet a number of gaps have been identified in existing research: most notably,
limited research on older adults, underrepresentation of minorities, limited attention to the
effects of comorbid conditions, few longitudinal designs, and sparse research on the psychosocial
and physical health status of family caregivers of older adults with cancer (NIH, 2001). The
proposed pilot is designed to address these gaps. The study design is a secondary analysis of
longitudinal data from married couples drawn from two large, nationally-representative surveys (the
Health and Retirement Survey [HRS] and the Asset and Health Dynamics Among the Oldest-Old Survey
[AHEAD]). HRS targeted adults aged 51-61 at baseline, whereas AHEAD targeted adults age 70 or
older at baseline. For inclusion in the pilot, baseline data must be available from both
spouses. The pilot's first goal is to examine the short-term and long-term effects of cancer and
comorbid conditions on the psychosocial quality of life of married adults and their spouses.
The second goal is to investigate whether effects vary by age (or cohort), race and ethnicity,
and/or socioeconomic status. The third goal, when cancer does occur, is to examine the
longitudinal effects of cancer-related characteristics (e.g., cancer site, type of treatment) on
the psychosocial quality of life of married adults and their spouses. The study is grounded in
social contextual theories, which argue that health and quality of life are interdependent across
partners in social systems such as married couples, and social structural theories, which posit
that health and quality of life vary across sociological statuses such as age, cohort, race,
ethnicity, socioeconomic status, and gender. The study examines three dimensions of
psychosocial quality of life: psychological (depressive symptomatology, emotional health, life
satisfaction), social (marital satisfaction and enjoyment), and physical (global health,
satisfaction with health, ADL impairment). Hierarchical linear modeling and structural
equation modeling will be used for analyses, reflecting the nested study design (longitudinal data
nested within individuals nested within households). Innovative features of the proposed
pilot are inclusion of adults with cancer in middle age (HRS) and old age (AHEAD), in order to
examine age/cohort differences; inclusion of a comparison group consisting of couples where neither
spouse reports having cancer during the study; use of a dyadic design including both married cancer
patients and their spouses; a multidimensional conceptualization of psychosocial quality of life;
and large, nationally-representative, community-dwelling samples that include substantial numbers
of minorities. At baseline, there are 5,833 couples with interviews from both the husband and
the wife. Fourteen percent of those couples (n = 809 couples) include at least one spouse
with cancer at baseline. Newly-incident cases of cancer will be accrued during the
study.
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