A Double Whammy: Health Promotion Among Cancer Survivors With Preexisting Functional Limitations

Deborah L. Volker

Heather Becker

Sook Jung Kang

Vicki Kullberg

Patient education, survivors
ONF 2012, 40(1), 64-71. DOI: 10.1188/13.ONF.64-71

Purpose/Objectives: To explore the experience of living with a preexisting functional disability and a cancer diagnosis and to identify strategies that promote health in the growing population of cancer survivors.

Research Approach: Qualitative, descriptive.

Setting: Four sites in the United States.

Participants: 19 female cancer survivors with preexisting disabling conditions.

Methodologic Approach: Four focus groups were conducted. The group discussions were audio recorded and transcribed and analyzed using content analysis techniques.

Findings: Analytic categories included living with a cancer diagnosis, health-promotion strategies, and wellness program development for survivors with preexisting functional limitations. Participants described many challenges associated with managing a cancer diagnosis on top of living with a chronic disabling functional limitation. They identified strategies to maintain health and topics in health-promotion programs tailored for this unique group of cancer survivors.

Conclusions: The "double whammy" of a cancer diagnosis for people with preexisting functional limitations requires modification of health-promotion strategies and programs to promote wellness in this group of cancer survivors.

Interpretation: Nurses and other healthcare providers must attend to patients' preexisting conditions as well as the challenges of the physical, emotional, social, and economic sequelae of a cancer diagnosis.

Knowledge Translation: Cancer survivors with preexisting functional disabilities had difficulties finding cancer care providers who could manage their unique needs. That may be because some cancer-care providers are inadequately prepared to care for patients with cancer who have complex preexisting conditions. Cancer survivors with preexisting conditions may benefit from health-promotion programs that emphasize self-advocacy strategies, management of the economic impact of multiple diagnoses, and wellness activities adapted to their unique functional limitations.

Jump to a section


    Alfano, C. M., Day, J. M., Katz, M. L., Herndon, J. E., Bittoni, M. A., Oliven, J. M., … Paskett, E. D. (2009). Exercise and dietary change after diagnosis and cancer-related symptoms in long-term survivors of breast cancer: CALGB 79804. Psycho-Oncology, 18, 128-133. doi:10.1002/pon.1378
    American Association of People With Disabilities. (2011). Health reform explained. Retrieved from
    Becker, H., Kang, S. J., & Stuifbergen, A. (2012). Predictors of quality of life for long-term cancer survivors with preexisting disabling conditions [Online exclusive]. Oncology Nursing Forum, 39, E122-E131. doi:10.1188/12.ONF.E122-E131
    Brault, M. (2008). Americans with disabilities: 2005. Retrieved from
    Brearley, S. G., Stamataki, Z., Addington-Hall, J., Foster, C., Hodges, L., Jarrett, N., … Amir, Z. (2011). The physical and practical problems experienced by cancer survivors: A rapid review and synthesis of the literature. European Journal of Oncology Nursing, 15, 204-212. doi:10.1016/j.ejon.2011.02.005
    Brown, J. C., Huedo-Medina, T. B., Pescatello, L. S., Pescatello, S. M., Ferrer, R. A., & Johnson, B. T. (2011). Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: A meta-analysis. Cancer Epidemiology, Biomarkers, and Prevention, 20, 123-133. doi:10.1158/1055-9965
    Centers for Disease Control and Prevention. (2005). Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta, GA: Author.
    Chirikos, T. N., Roetzheim, R. G., McCarthy, E. P., & Iezzoni, L. I. (2008). Cost disparities in lung cancer treatment by disability status, sex, and race. Disability and Health Journal, 1, 108-115. doi:10.1016/j.dhjo.2008.01.004
    Conn, V. S., Hafdahl, A. R., Porock, D. C., McDaniel, R., & Nielsen, P. J. (2006). A meta-analysis of exercise interventions among people treated for cancer. Supportive Care in Cancer, 14, 699-712. doi:10.1007/s00520-005-0905-5
    Drainoni, M., Lee-Hood, E., Tobias, C., Bachman, S. S., Andrew, J., & Maisels, L. (2006). Cross-disability experiences of barriers to health-care access: Consumer perspectives. Journal of Disability Policy Studies, 17, 101-115. doi:10.1177/10442073060170020101
    Edmonds, P., Vivat, B., Burman, R., Silber, E., & Higginson, I. J. (2007). "Fighting for everything": Service experiences of people severely affected by multiple sclerosis. Multiple Sclerosis Journal, 13, 660-667. doi:10.1177/1352458506071789
    Foster, C., Wright, D., Hill, H., Hopkinson, J., & Roffe, L. (2009). Psychosocial implications of living five years or more following a cancer diagnosis: A systematic review of the research evidence. European Journal of Cancer Care, 18, 223-247. doi:10.1111/j.1365-2354.2008.01001.x
    Ganz, P. A., Casillas, J., & Hahn, E. E. (2008). Ensuring quality care for cancer survivors: Implementing the survivorship care plan. Seminars in Oncology Nursing, 24, 208-217. doi:10.1016/j.soncn.2008.05.009
    Groff, D., Battaglini, C., Sipe, C., Peppercorn, J., Anderson, M., & Hackney, A. (2010). "Finding a new normal": Using recreation therapy to improve the well-being of women with breast cancer. Annual in Therapeutic Recreation, 18, 40-52.
    Harding, M. (2012). Health-promotion behaviors and psychological distress in cancer survivors [Online exclusive]. Oncology Nursing Forum, 39, E132-E140. doi:10.1188/12.ONF.E132-E140
    Harrison, S. E., Watson, E. K., Ward, A. M., Khan, N. F., Turner, D., Adams, E., … Rose, P. W. (2011). Primary health and supportive care needs of long-term cancer survivors: A questionnaire survey. Journal of Clinical Oncology, 29, 2091-2098. doi:10.1200/JCO.2010.32.5167
    Hewitt, M., & Ganz, P. (2006). From cancer patient to cancer survivor—Lost in transition. Washington, DC: National Academies Press.
    Hoffman, B., & Stovall, E. (2006). Survivorship perspectives and advocacy. Journal of Clinical Oncology, 24, 5154-5159. doi:10.1200/Jco.2006.06.5300
    Iezzoni, L., Kilbridge, K., & Park, E. R. (2010). Physical access barriers to care for diagnosis and treatment of breast cancer among women with mobility impairments. Oncology Nursing Forum, 37, 711-717. doi:10.1188/10.ONF.711-717
    Iezzoni, L. I. (2006). Make no assumptions: Communication between persons with disabilities and clinicians. Assistive Technology, 18, 212-219. doi:10.1080/10400435.2006.101
    Iezzoni, L. I., Ngo, L. H., Li, D., Roetzheim, R. G., Drews, R. E., & McCarthy, E. P. (2008a). Early stage breast cancer treatments for younger Medicare beneficiaries with different disabilities. Health Services Research, 43, 1752-1767. doi:10.1111/j.1475-6773.2008.00853.x
    Iezzoni, L. I., Ngo, L. H., Li, D., Roetzheim, R. G., Drews, R. E., & McCarthy, E. P. (2008b). Treatment disparities for disabled Medicare beneficiaries with stage I non-small cell lung cancer. Archives of Physical Medicine and Rehabilitation, 89, 595-601. doi:10.1016/j.apmr.2007.09.042
    Iezzoni, L. I., Park, E. R., & Kilbridge, K. L. (2011). Implications of mobility impairment on the diagnosis and treatment of breast cancer. Journal of Women's Health, 20, 45-52. doi:10.1089/jwh.2009.1831
    Larson, M., Carrothers, L., & Premo, B. (2002). Providing primary health care for people with physical disabilities: A survey of California physicians. Pomona, CA: Center for Disability Issues and the Health Professions.
    Lee, T., Ko, I., Lee, I., Kim, E., Shin, M., Roh, S., … Chang, H. (2011). Effects of nurse navigators on health outcomes of cancer patients. Cancer Nursing, 34, 376-384. doi:10.1097/NCC.0b013e3182025007
    Levit, L., Smith, A. P., Benz, E. J., & Ferrell, B. (2010). Ensuring quality cancer care through the oncology workforce. Journal of Oncology Practice, 6, 7-11. doi:10.1200/JOP.091067
    Liu, S. Y., & Clark, M. A. (2008). Breast and cervical cancer screening practices among disabled women aged 40-75: Does quality of the experience matter? Journal of Women's Health, 17, 1321-1329. doi:10.1089/jwh.2007.0591
    Martin, H. L., Rowell, M. M., Reid, S. M., Marks, M. K., & Reddihough, D. S. (2005). Cerebral palsy: What do medical students know and believe? Journal of Paediatrics and Child Health, 41, 43-47.
    McCabe, M. S., & Jacobs, L. (2008). Survivorship care: Models and programs. Seminars in Oncology Nursing, 24, 202-207. doi:10.1016/j.oncn.2008.05.008
    McCarthy, E. P., Ngo, L. H., Chirikos, T. N., Roetzheim, R. G., Li, D., Drews, R. E., & Iezzoni, L. I. (2007). Cancer stage at diagnosis and survival among persons with Social Security Disability Insurance on Medicare. Health Services Research, 42, 611-628. doi:10.1111/j.1475-6773.2006.00619.x
    Patton, M. Q. (2002). Qualitative research and evaluation methods. Thousand Oaks, CA: Sage.
    Pedersen, A., & Hack, T. F. (2010). Pilots of oncology care: A concept analysis of the patient navigator role. Oncology Nursing Forum, 37, 55-60. doi:10.1188/10.ONF.55-60
    Rosedale, M. (2009). Survivor loneliness of women following breast cancer. Oncology Nursing Forum, 36, 175-183. doi:10.1188/09.ONF.175-183
    Shakespeare, T., Iezzoni, L. I., & Groce, N. E. (2009). Disability and the training of health professionals. Lancet, 374, 1815-1816.
    Sharts-Hopko, N. C., Smeltzer, S., Ott, B. B., Zimmerman, V., & Duffin, J. (2010). Healthcare experiences of women with visual impairment. Clinical Nurse Specialist, 24, 149-153. doi:10.1097/NUR.0b013e3181d82b89
    Shi, Q., Smith, T. G., Michonski, J. D., Stein, K. D., Kaw, C., & Cleeland, C. S. (2011). Symptom burden in cancer survivors one year after diagnosis: A report from the American Cancer Society's Studies of Cancer Survivors. Cancer, 117, 2779-2790. doi:10.1002/cncr.26146
    Short, P. F., Vasey, J. J., & Belue, R. (2008). Work disability associated with cancer survivorship and other chronic conditions. Psycho-Oncology, 17, 91-97. doi:10.1002/pon.1194
    Smeltzer, S. C., Robinson-Smith, G., Dolen, M. A., Duffin, J. M., & Al-Maqbali, M. (2010). Disability-related content in nursing textbooks. Nursing Education Perspectives, 31, 148-155.
    Stuifbergen, A., Becker, H., Rogers, S., Timmerman, G., & Kullberg, V. (1999). Promoting wellness for women with multiple sclerosis. Journal of Neuroscience Nursing, 31, 73-79.
    Stuifbergen, A. K., Harrison, T. C., Becker, H., & Carter, P. (2004). Adaptation of a wellness intervention for women with chronic disabling conditions. Journal of Holistic Nursing, 22, 12-31.
    Stuifbergen, A. K., Morris, M., Jung, J. H., Pierini, D., & Morgan, S. (2010). Benefits of wellness interventions for persons with chronic and disabling conditions: A review of the evidence. Disability and Health Journal, 3, 133-145. doi:10.1016/j.dhjo.2009.10.007
    Stuifbergen, A. K., Seraphine, A., Harrison, T., & Adachi, E. (2005). An explanatory model of health promotion and quality of life for persons with post-polio syndrome. Social Science and Medicine, 60, 383-393. doi:10.1016/j.socscimed.2004.05.009
    U. S. Department of Health and Human Services. (2011). Disability and health. Retrieved from
    Virgo, K. S., Lerro, C. C., Klabunde, C. N., Earle, C., & Ganz, P. A. (2011). Barriers in providing breast and colorectal cancer survivorship care: Perceptions of U. S. primary care physicians (PCPs) and medical oncologists (MOs). Journal of Clinical Oncology, 29(Suppl. CRA9006).
    Weaver, K. E., Rowland, J. H., Bellizzi, K. M., & Aziz, N. M. (2010). Forgoing medical care because of cost: Assessing disparities in healthcare access among cancer survivors living in the United States. Cancer, 116, 3493-3504. doi:10.1002/cncr.25209