Esme Fuller-Thomson

Background: Ovarian cancer (OC) is among the most lethal gynecological malignancies and a leading cause of cancer-related deaths in women. Significant attention has been given to the experiences of OC patients; however, the experiences of their family caregivers have been largely overlooked. Objectives: The objectives of this scoping review is to characterize the scope, nature and focus of the existing literature describing the experiences of caregivers’ of individuals with OC during the caregiving process and after the care recipient’s death, and to identify gaps in the literature. Methods: This scoping review was guided by Arksey and O’Malley’s (2005) framework. Comprehensive searches were conducted in MEDLINE, EMBASE, CINAHL, PsycINFO, and Social Work Abstracts to identify literature on caregivers of individuals living with OC. A total of 739 titles and abstracts were screened by two reviewers, 123 full-text articles were assessed, and 32 met inclusion criteria for data extraction. Themes were extracted after the reviewers carefully read through the selected articles. Results: Main themes included (1) the well-being and mental health of caregivers, with two sub-themes (a) emotional well-being and mental health, (b) grief, bereavement and post-traumatic stress disorder; (2) challenges facing caregivers, with seven sub-themes (a) escalating patients needs and patient experiences, (b) interactions with doctors and medical system, (c) social isolation, (d) family responsibilities, (e) work stressors and financial burdens, (f) health behaviours and inadequate self-care, and (g) intrapersonal stressors; and (3) positive coping strategies with sub-themes (a) spirituality and (b) social support. Conclusion: This scoping review highlights an urgent need for tailored support for OC caregivers and may provide valuable insights for clinical practice in the field of caregiver wellbeing. Future research and greater awareness of the lived experience of OC caregivers may inform policymakers to develop policy initiatives promoting more family-centered care.

Childhood adversities, including physical abuse, sexual abuse, and exposure to parental domestic violence (PDV), have been linked to negative health outcomes in adulthood, yet their specific association with cancer in older Canadians remains understudied. The current study investigated the associations between these specific childhood adversities and cancer in Canadian older adults. We conducted a secondary analysis of the nationally representative cross-sectional 2022 Canadian Mental Health and Access to Care Survey (MHACS). The sample size was 2,636 Canadians aged 65 and older. Bivariate and logistic regression models assessed the relationship between self-reported cancer diagnoses and self-reported childhood adversities – childhood sexual abuse (CSA) (including unwanted touch/fondling and Childhood Sexual Violence with Coercion (CSVC)), childhood physical abuse (CPA), and PDV. Logistic regression analyses controlled for demographic characteristics, socioeconomic status, health behaviors, chronic pain, mental health conditions, and psychosocial factors. In the bivariate analyses, those who had experienced childhood adversities had a significantly (p < 0.05) higher prevalence of cancer than those who had not (CPA 28% vs. 20.7%; PDV 26.5% vs. 20.6%; CSVC 35.5%; unwanted touch/fondling 25.5%, no CSA 20%). After comprehensive adjustment for demographic, socioeconomic, behavioral, and psychosocial factors, CSVC was associated with double the odds of cancer diagnosis (odds ratio = 2.05; 95% confidence interval 1.41–2.98), but the other forms of childhood adversity no longer reached statistical significance. Childhood adversities are associated with an elevated prevalence of cancer in later life, and the association between CSVC and cancer remained significant even after adjustments for most of the known risk factors for cancer. Further longitudinal research exploring stress-induced biological changes and immune dysregulation is needed among those with a history of childhood adversities. These findings lend support to the integration of trauma-informed care into oncology services.

This study identified the factors associated with the absence of psychiatric disorder (APD) in the past year and complete mental health (CMH), among a nationally representative sample of Canadian adults aged 65 and older. APD is defined as the absence of suicidality, mental illness, and substance use disorder in the past year. CMH is defined as a combination of the following three characteristics: (1) APD; (2) life satisfaction or happiness almost every day in the past month and (3) social and psychological well-being almost every day in the past month. Data on 2,024 older respondents were obtained from the 2022 Mental Health and Access to Care Survey. The sample was analyzed using bivariate analyses and multivariate logistic regression models. Factors associated with ADP and CMH among older adults included being male, married, having social support, reporting religious or spiritual beliefs to be important, and having excellent self-reported health. Respondents without chronic pain, who had no difficulties in instrumental activities of daily living, had no sleep problems, and no history of depression, anxiety, or substance use disorder also had increased odds of both ADP and CMH. Findings from this study identify key factors associated with APD and CMH in older adults, which could inform the development of targeted public health interventions aimed at enhancing CMH within this population.

Background: This study examines characteristics of older adults who have regained optimal well-being at the end of the three-year study. The definition of optimal well-being used in this study refers to having adequate social support, high levels of older adults’ subjective perception of their aging process, physical health, mental health, happiness and life satisfaction and being free of limitations in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), disabling pain or discomfort, severe mental illness or cognitive decline in the preceding year. Methods: A secondary data analysis was conducted using the first two waves of data from the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA), a large, national, longitudinal study on aging. The sample included 8332 older adults who were not in optimal well-being at baseline and aged 60+ at time 2. Bivariate and multivariable binary logistic regression analyses were used to examine which baseline characteristics were associated with achieving optimal well-being approximately three years later. Results: The prevalence of optimal well-being at time 2 was higher among respondents who, at baseline, were younger, married, physically active, not obese, non-smokers, had higher income, without sleeping problems, diabetes, arthritis, osteoporosis, and achieved at least two of the four wellness domains (i.e., physical, psychological and emotional, social, and self-rated wellness) were more likely to be in optimal well-being at time 2 than their counterparts. Conclusions: Old age does not necessarily result in poor physical health, nor is a decline in well-being inevitable. Almost one in four respondents who were in less than optimal well-being at baseline regained well-being over the ensuing approximately 3 years. Further research could investigate the association between policies and programs and their support for older adults in regaining optimal well-being in later life after a period of suboptimal well-being.