A mixed method study of second cancer risk among cancer survivors
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Recent research shows that cancer survivors are at greater risk of developing cancer than the general population. Knowledge of the magnitude of second cancer risk and cancer-specific deaths among cancer survivors, factors that influence their second cancer risk, cancer survivors’ perceptions of second cancer risk and current practices and existing gaps in follow-up care is urgently needed if we hope to prepare survivors and their healthcare providers as to how best to monitor their long-term health. An exploratory mixed method study, guided by Kaplan and colleagues (2000) multilevel approach to the health determinants, was conducted to provide a detailed understanding of second cancer risks among cancer survivors. Data collection methods included: (1) qualitative survey of current practices in the follow-up care offered for cancer survivors across Canada, (2) population-based health databases (cancer registry and health insurance databases), and (3) qualitative interviews on cancer survivors’ perceptions of second cancer risks. Coordinated follow-up services are not universally available across Canada. Yet, cancer survivors have a 4-7-fold increased risk of developing cancer compared to the general population in Nova Scotia and Manitoba. Second cancer risks varied by demographic and disease-related factors such as age at first cancer diagnosis, cancer type, treatment era, and time since diagnosis. Second cancer risk does not exist only as an epidemiological calculation. Second cancer risk, from the perspective of cancer survivors, is shaped by more intuitive conceptual models than statistical models of risk. The theme, Life After Cancer – Living with Risk, described survivors’ sense that second cancer risk is now a part of their everyday lives.