Abstract: The purpose of this article is to examine health needs as well as disparities in practice and research pertaining to aging women with cancer. Given the increasing number of aging women with cancer and the concomitant challenges in survivorship, caregivers need research and improved clinical care to identify needs and enhance cancer survivors' quality of life. The authors use inner strength as a theoretical framework to discuss examples of practice and strategies to improve health outcomes and assess health needs in aging women with cancer. Because researchers find it difficult to identify gender-specific and culturally appropriate instruments, the authors conducted a pilot test on an inner strength questionnaire to identify potential problems in instrumentation and data collection with aging women. Ultimately, a therapeutic partnership between patient and careprovider should be based on mutual goal setting and identifying all the dimensions of a women's health status with valid and reliable research instruments and practice strategies.
Key Words: health disparities, cancer, women with cancer, aging women with cancer, cancer survivorship
The primary author of this article became especially interested in health disparities when facilitating a breast cancer support group in which women gave very compelling accounts of their experiences. In the clinical work that this article documents, the authors developed a research program to enhance the quality of life of female cancer survivors. The article describes current demographic, gender and epidemiological issues that play a role in the lives of aging women with cancer. The authors also discuss strategies for more effective healthcare interventions based on women's biological, social, cultural, spiritual and behavioral issues.
WOMEN'S HEALTH: DEMOGRAPHIC AND GENDER ISSUES
Both demographic changes and the increasing incidence of cancer among the aging justify a research focus on health disparities and quality of life issues facing aging women with cancer. Based on recent demographic shifts, the number of people aged 65 and older is expected to double over the next 40 years (Administration on Aging, 2000), adding to an already overburdened health care system. For example, a disproportionate number of cancer cases afflict women aged 60 and older, and the mortality rate for breast cancer peaks in women aged 85 and older (National Cancer Institute, 2003). Although age is a well established risk factor for cancer, limited findings examine disparities, differences, health needs and interventions to maximize the quality of life among aging women living with cancer. Given the increasing number of aging women with cancer and the concomitant challenges in survivorship, caregivers need research and improved clinical care to identify needs and enhance cancer survivors' quality of life.
Understanding the importance of gender in aging and health care is very complex. Dr. Vivian Pinn (2003) of the Office of Research on Women's Health differentiates between sex and gender as follows: the term "sex" is used when differences are primarily biological or physiological, and "gender" when referring to social and cultural influences based on sex. Accordingly, access to care and the use of health resources would depend on gender-related social forces. Social structures that influence health status in both practice and research must be examined, or the result may be the implementation of sexism, ageism or other discriminatory practices. Understanding how biological factors (e.g., cellular metabolism, genetics and hormones) interact with social factors (e.g., stress, economics and social support) is crucial to understanding health outcomes for aging women with cancer.
AGING WOMEN WITH CANCER: EPIDEMIOLOGICAL ISSUES AND SURVIVORSHIP
As a result of improved diagnosis and treatment, more people are surviving cancer (National Cancer Institute, 2003). …