and physical functioning vary by individual and not by chronological age” (Yancik and Ries, 2000:17), older adults with cancer are more likely to present with a preexisting chronic disease and increased functional impairment and disability, which can compound the stresses imposed by cancer (Hewitt et al., 2003). Evidence also indicates that older adults are at greater risk than younger adults for difficulties with health-related decision making (Finucane et al., 2002). Taken together, older adults may have greater need for psychosocial services. At the other end of the age continuum, the great cognitive, emotional, and developmental (as well as physical) variations among children affect the extent to which they can fully understand the implications of their disease and be involved in treatment decision making, how they cope with the physical pain and distress accompanying cancer and its treatment, and the resources available to help them cope (Patenaude and Kupst, 2005).

CANCER-INDUCED PHYSICAL STRESSORS

Health Impairment, Disability, Fatigue, and Pain

As a result of advances in early detection and treatment, in the past two decades the 5-year survival rate for the 15 most common cancers has increased for all ages—from 43 to 64 percent for men and from 57 to 64 percent for women (Jemal et al., 2004). However, these improvements in survival are sometimes accompanied by permanent damage to patients’ physical health. In addition to the damage caused by the cancer itself, the side effects of chemotherapy, radiation, hormone therapy, surgery, and other cancer treatments often lead to substantial permanent impairment of several organ systems, with resultant disability (Aziz and Rowland, 2003; Oeffinger and Hudson, 2004).

Impairment and Disability

Compared with people without a history of cancer, adults with cancer (or with a history of cancer) more frequently report having fair or poor health (30 percent), other chronic medical conditions (42 percent), one or more limitations in the ability to perform activities of daily living (11 percent), other functional disabilities (58 percent), and (among those under age 65) an inability to work because of a health condition (17 percent) (Hewitt et al., 2003). These numbers may reflect in part the older age of individuals with a diagnosis of cancer; 61 percent of those with a history of cancer are more than 65 years of age (IOM and NRC, 2006). Yet one-third of those with a history of cancer who report limitations in activities of daily living or other functional areas identify cancer as the cause of their limitation,



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