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Original Research

The Comparison of Health Promotion Behavior, Post Traumatic Growth and Quality of Life according to Stages of Survivorship in Patients with Female Genital Neoplasm

Eun Sil Lee1, Jeong Sook Park2
Korean Journal of Adult Nursing 2013;25(3):312-321.
Published online: June 18, 2013

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Corresponding author: Park, Jeong Sook College of Nursing Keimyung University 2800 Dalgubeoldaero, Dalseo-gu, Daegu 704-701, Korea. Tel: +82-53-580-3907, Fax: +82-53-580-3949, E-mail: jsp544@kmu.ac.kr
• Received: November 22, 2012   • Accepted: June 23, 2013

© 2013 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to compare health promotion behavior, post-traumatic growth and quality of life according to the stages of survivorship in patients with female genital neoplasm.
  • Methods
    Data were collected from August 1st, 2011 to September 31st 2011 from 142 gynecologic cancer patients who completed treatment or were treated at an out-patient clinic. The instrument were HPLP developed by Walker, Sechrist & Pender, PTGI developed by Tedeschi & Calhoun, and Korean C-QOL.
  • Results
    Health promotion behavior scores were significantly higher in the acute survival stage than the extended survival stage. Post-traumatic growth score was higher in the acute survival stage than the extended survival stage. The quality of life scores were higher in the lasting survival stage than the extended survival stage.
  • Conclusion
    Gynecological cancer patients in the extended survival stage reported low scores of health promotion behavior, post-traumatic growth and quality of life. Intervention needed to be developed to improve health promotion behavior, post-traumatic growth and quality of life for patients with female genital neoplasm in the extended survival stage.
  • Key Words: Female genital neoplasm; Survivorship; Health promotion; Quality of life
Table 1.
General Characteristics according to Stages of Survivorship in Gynecologic Cancer Patients (N=142)
Characteristics Categories Acute SS (n=38) Extended SS (n=58) Lasting SS (n=46) Total (n=142) x2 p
n (%) n (%) n (%) n (%)
Age (year) 20~39 2 (5.3) 9 (15.5) 3 (6.5) 14 (9.9) 25.53 ＜.001
40~49 19 (50.0) 12 (20.7) 7 (15.3) 38 (26.8)
50~59 15 (39.4) 26 (44.8) 18 (39.1) 59 (41.6)
≥60 2 (5.3) 11 (19.0) 18 (39.1) 31 (21.8)
Education level ≤Elementary school 3 (7.9) 10 (17.2) 12 (26.1) 25 (17.6) 8.55 .200
Middle school 9 (23.7) 15 (25.9) 15 (32.7) 39 (27.5)
High school 17 (44.7) 24 (41.4) 11 (23.9) 52 (36.6)
≥University 9 (23.7) 9 (15.5) 8 (17.4) 26 (18.3)
Marital status Non married 5 (13.2) 6 (10.3) 6 (13.1) 17 (12.0) 4.21 .378
Married 29 (76.3) 45 (77.6) 29 (63.0) 103 (72.5)
Divorce and others 4 (10.5) 7 (12.1) 11 (23.9) 22 (15.5)
Job Yes 19 (50.0) 21 (36.2) 13 (28.3) 53 (37.3) 4.25 .119
No 19 (50.0) 37 (63.8) 33 (71.7) 89 (62.7)
Religion Yes 31 (81.6) 36 (62.1) 33 (71.7) 100 (70.4) 4.25 .119
No 7 (18.4) 22 (37.9) 13 (28.2) 42 (29.6)
Monthly income (10,000 won) ＜100 8 (21.1) 12 (20.7) 21 (45.7) 41 (28.9) 14.18 .028
100~199 9 (23.7) 21 (36.2) 12 (26.0) 42 (29.6)
200~299 10 (26.3) 16 (27.6) 5 (10.9) 31 (21.8)
≥300 11 (28.9) 9 (15.5) 8 (17.4) 28 (19.7)

SS=survival stage.

Table 2.
Disease Characteristics according to Stages of Survivorship in Gynecologic Cancer Patients (N=142)
Characteristics Categories Acute SS (n=38) Extended SS (n=58) Lasting SS (n=46) Total (n=142) x2 p
n (%) n (%) n (%) n (%)
Diagnosis Cervical cancer 13 (34.2) 25 (43.1) 23 (50.0) 61 (43.0) 13.82 .032
Endometrial cancer 12 (31.6) 12 (20.7) 13 (28.3) 37 (26.1)
Ovarian cancer 6 (15.8) 1 (1.7) 2 (4.3) 9 (6.3)
Others cancer 7 (18.4)) 20 (34.5) 8 (17.4) 35 (24.6)
Recurrence Yes 3 (7.9) 19 (32.8) 6 (13.0) 28 (19.7) 10.88 .004
No 35 (92.1) 39 (67.2) 40 (87.0) 114 (80.3)
Treatment method Surgery 9 (23.7) 21 (36.2) 10 (21.7) 40 (28.1) 13.44 .036
Chemotherapy 7 (18.4) - 6 (13.0) 13 (9.2)
Surgery+Chemotherapy+R adiation therapy 17 (44.7) 27 (46.6) 19 (41.4) 63 (44.4)
Other (hormone therapy, radiation therapy) 5 (13.2) 10 (17.2) 11 (23.9) 26 (18.3)
Disease stage Stage I 18 (47.4) 32 (55.2) 21 (45.7) 71 (50.1) 3.06 .801
Stage II 11 (28.8) 12 (20.7) 11 (23.9) 34 (23.9)
Stage III 8 (21.1) 13 (22.4) 11 (23.9) 32 (22.5)
Stage IV 1 (0.7) 1 (1.7) 3 (6.5) 5 (3.5)
Perceived health status activity Asymptomatic normal 17 (44.7) 26 (44.8) 31 (67.4) 74 (52.1) 6.96 .138
Normal activity but job impossible 18 (47.4) 29 (50.0) 14 (30.4) 61 (43.0)
Simple job possible 3 (7.9) 3 (5.2) 1 (2.2) 7 (4.9)
Cost burden Patient 12 (31.6) 23 (39.7) 15 (32.6) 50 (35.2) 3.54 .471
Spouse 21 (55.2) 24 (41.4) 19 (41.3) 64 (45.1)
Parents, children, others 5 (13.2) 111 (18.9) 12 (26.1) 28 (19.7)
Economic level High 18 (47.4) 26 (44.8) 19 (41.3) 63 (44.4) 0.69 .952
Middle 17 (44.7) 29 (50.0) 24 (52.2) 70 (49.3)
Low 3 (7.9) 3 (5.2) 3 (6.5) 9 (6.3)
Table 3.
Health Promotion Behavior, Post Traumatic Growth & Quality of Life according to Stages of Survivorship in Gynecologic Cancer Patients (N=142)
Characteristics Categories Acute SSa (n=38) Extended SSb (n=58) Lasting SSc (n=46) Total F p Tukey HSD
M±SD M±SD M±SD M±SD
Health promoting behavior Nutrition 2.86±0.57 2.51±0.52 2.67±0.61 2.66±0.58 2.76 .067  
Physical activity 3.07±0.68 2.78±0.59 2.93±0.71 2.90±0.66 1.01 .366
Stress management 2.90±0.58 2.57±0.56 2.69±0.72 2.70±0.63 1.75 .178
Interpersonal relations 2.92±0.61 2.38±0.56 2.65±0.71 2.61±0.66 4.84 .009 b＜a
Health responsibility 2.84±0.66 2.34±0.59 2.63±0.73 2.57±0.68 4.93 .009 b＜a
Spiritual growth 2.73±0.67 2.27±0.62 2.55±0.75 2.48±0.70 2.99 .054  
Total 2.87±0.50 2.45±0.52 2.67±0.66 2.65±0.59 3.58 .030 b＜a
Post traumatic growth Appreciation for life 3.57±0.98 3.00±1.08 3.37±1.25 3.27±1.13 2.35 .099  
New possibilities 3.27±1.45 2.67±1.18 3.13±1.07 2.98±1.13 2.94 .056
Personal strength 3.24±0.95 2.59±1.45 3.30±1.20 3.00±1.16 5.90 .003 b＜a, c
Spiritual change 3.71±1.19 3.15±1.34 3.60±1.14 3.44±1.17 2.57 .080  
Relating to others 3.43±1.10 2.94±1.11 3.34±1.12 3.20±1.13 1.97 .143
Total 3.40±0.95 2.83±1.08 3.31±1.05 3.18±1.05 3.50 .033 b＜a
Quality of life Physical status 2.56±0.82 2.49±0.86 2.82±0.74 2.61±0.82 2.55 .082  
Emotional status 2.48±1.08 2.48±0.86 3.07±0.80 2.67±0.94 7.88 .001 a, b＜c
Social status 2.03±1.03 1.95±0.96 2.22±1.06 2.06±1.01 1.47 .233  
Concern status 1.37±1.17 1.41±1.16 2.29±1.28 1.69±1.27 11.76 ＜.001 a, b＜c
Coping function 2.93±0.66 2.36±0.86 2.46±0.96 2.55±0.87 3.79 .025 b, c＜a
Total   2.42±0.56 2.28±0.63 2.69±0.56 2.31±0.63 7.82 .001 b＜c
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    The Comparison of Health Promotion Behavior, Post Traumatic Growth and Quality of Life according to Stages of Survivorship in Patients with Female Genital Neoplasm
    Korean J Adult Nurs. 2013;25(3):312-321.   Published online June 30, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.3.312
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    The Comparison of Health Promotion Behavior, Post Traumatic Growth and Quality of Life according to Stages of Survivorship in Patients with Female Genital Neoplasm
    Korean J Adult Nurs. 2013;25(3):312-321.   Published online June 30, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.3.312
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    The Comparison of Health Promotion Behavior, Post Traumatic Growth and Quality of Life according to Stages of Survivorship in Patients with Female Genital Neoplasm
    The Comparison of Health Promotion Behavior, Post Traumatic Growth and Quality of Life according to Stages of Survivorship in Patients with Female Genital Neoplasm

    General Characteristics according to Stages of Survivorship in Gynecologic Cancer Patients (N=142)

    Characteristics Categories Acute SS (n=38) Extended SS (n=58) Lasting SS (n=46) Total (n=142) x2 p
    n (%) n (%) n (%) n (%)
    Age (year) 20~39 2 (5.3) 9 (15.5) 3 (6.5) 14 (9.9) 25.53 ＜.001
    40~49 19 (50.0) 12 (20.7) 7 (15.3) 38 (26.8)
    50~59 15 (39.4) 26 (44.8) 18 (39.1) 59 (41.6)
    ≥60 2 (5.3) 11 (19.0) 18 (39.1) 31 (21.8)
    Education level ≤Elementary school 3 (7.9) 10 (17.2) 12 (26.1) 25 (17.6) 8.55 .200
    Middle school 9 (23.7) 15 (25.9) 15 (32.7) 39 (27.5)
    High school 17 (44.7) 24 (41.4) 11 (23.9) 52 (36.6)
    ≥University 9 (23.7) 9 (15.5) 8 (17.4) 26 (18.3)
    Marital status Non married 5 (13.2) 6 (10.3) 6 (13.1) 17 (12.0) 4.21 .378
    Married 29 (76.3) 45 (77.6) 29 (63.0) 103 (72.5)
    Divorce and others 4 (10.5) 7 (12.1) 11 (23.9) 22 (15.5)
    Job Yes 19 (50.0) 21 (36.2) 13 (28.3) 53 (37.3) 4.25 .119
    No 19 (50.0) 37 (63.8) 33 (71.7) 89 (62.7)
    Religion Yes 31 (81.6) 36 (62.1) 33 (71.7) 100 (70.4) 4.25 .119
    No 7 (18.4) 22 (37.9) 13 (28.2) 42 (29.6)
    Monthly income (10,000 won) ＜100 8 (21.1) 12 (20.7) 21 (45.7) 41 (28.9) 14.18 .028
    100~199 9 (23.7) 21 (36.2) 12 (26.0) 42 (29.6)
    200~299 10 (26.3) 16 (27.6) 5 (10.9) 31 (21.8)
    ≥300 11 (28.9) 9 (15.5) 8 (17.4) 28 (19.7)

    SS=survival stage.

    Disease Characteristics according to Stages of Survivorship in Gynecologic Cancer Patients (N=142)

    Characteristics Categories Acute SS (n=38) Extended SS (n=58) Lasting SS (n=46) Total (n=142) x2 p
    n (%) n (%) n (%) n (%)
    Diagnosis Cervical cancer 13 (34.2) 25 (43.1) 23 (50.0) 61 (43.0) 13.82 .032
    Endometrial cancer 12 (31.6) 12 (20.7) 13 (28.3) 37 (26.1)
    Ovarian cancer 6 (15.8) 1 (1.7) 2 (4.3) 9 (6.3)
    Others cancer 7 (18.4)) 20 (34.5) 8 (17.4) 35 (24.6)
    Recurrence Yes 3 (7.9) 19 (32.8) 6 (13.0) 28 (19.7) 10.88 .004
    No 35 (92.1) 39 (67.2) 40 (87.0) 114 (80.3)
    Treatment method Surgery 9 (23.7) 21 (36.2) 10 (21.7) 40 (28.1) 13.44 .036
    Chemotherapy 7 (18.4) - 6 (13.0) 13 (9.2)
    Surgery+Chemotherapy+R adiation therapy 17 (44.7) 27 (46.6) 19 (41.4) 63 (44.4)
    Other (hormone therapy, radiation therapy) 5 (13.2) 10 (17.2) 11 (23.9) 26 (18.3)
    Disease stage Stage I 18 (47.4) 32 (55.2) 21 (45.7) 71 (50.1) 3.06 .801
    Stage II 11 (28.8) 12 (20.7) 11 (23.9) 34 (23.9)
    Stage III 8 (21.1) 13 (22.4) 11 (23.9) 32 (22.5)
    Stage IV 1 (0.7) 1 (1.7) 3 (6.5) 5 (3.5)
    Perceived health status activity Asymptomatic normal 17 (44.7) 26 (44.8) 31 (67.4) 74 (52.1) 6.96 .138
    Normal activity but job impossible 18 (47.4) 29 (50.0) 14 (30.4) 61 (43.0)
    Simple job possible 3 (7.9) 3 (5.2) 1 (2.2) 7 (4.9)
    Cost burden Patient 12 (31.6) 23 (39.7) 15 (32.6) 50 (35.2) 3.54 .471
    Spouse 21 (55.2) 24 (41.4) 19 (41.3) 64 (45.1)
    Parents, children, others 5 (13.2) 111 (18.9) 12 (26.1) 28 (19.7)
    Economic level High 18 (47.4) 26 (44.8) 19 (41.3) 63 (44.4) 0.69 .952
    Middle 17 (44.7) 29 (50.0) 24 (52.2) 70 (49.3)
    Low 3 (7.9) 3 (5.2) 3 (6.5) 9 (6.3)

    Health Promotion Behavior, Post Traumatic Growth & Quality of Life according to Stages of Survivorship in Gynecologic Cancer Patients (N=142)

    Characteristics Categories Acute SSa (n=38) Extended SSb (n=58) Lasting SSc (n=46) Total F p Tukey HSD
    M±SD M±SD M±SD M±SD
    Health promoting behavior Nutrition 2.86±0.57 2.51±0.52 2.67±0.61 2.66±0.58 2.76 .067  
    Physical activity 3.07±0.68 2.78±0.59 2.93±0.71 2.90±0.66 1.01 .366
    Stress management 2.90±0.58 2.57±0.56 2.69±0.72 2.70±0.63 1.75 .178
    Interpersonal relations 2.92±0.61 2.38±0.56 2.65±0.71 2.61±0.66 4.84 .009 b＜a
    Health responsibility 2.84±0.66 2.34±0.59 2.63±0.73 2.57±0.68 4.93 .009 b＜a
    Spiritual growth 2.73±0.67 2.27±0.62 2.55±0.75 2.48±0.70 2.99 .054  
    Total 2.87±0.50 2.45±0.52 2.67±0.66 2.65±0.59 3.58 .030 b＜a
    Post traumatic growth Appreciation for life 3.57±0.98 3.00±1.08 3.37±1.25 3.27±1.13 2.35 .099  
    New possibilities 3.27±1.45 2.67±1.18 3.13±1.07 2.98±1.13 2.94 .056
    Personal strength 3.24±0.95 2.59±1.45 3.30±1.20 3.00±1.16 5.90 .003 b＜a, c
    Spiritual change 3.71±1.19 3.15±1.34 3.60±1.14 3.44±1.17 2.57 .080  
    Relating to others 3.43±1.10 2.94±1.11 3.34±1.12 3.20±1.13 1.97 .143
    Total 3.40±0.95 2.83±1.08 3.31±1.05 3.18±1.05 3.50 .033 b＜a
    Quality of life Physical status 2.56±0.82 2.49±0.86 2.82±0.74 2.61±0.82 2.55 .082  
    Emotional status 2.48±1.08 2.48±0.86 3.07±0.80 2.67±0.94 7.88 .001 a, b＜c
    Social status 2.03±1.03 1.95±0.96 2.22±1.06 2.06±1.01 1.47 .233  
    Concern status 1.37±1.17 1.41±1.16 2.29±1.28 1.69±1.27 11.76 ＜.001 a, b＜c
    Coping function 2.93±0.66 2.36±0.86 2.46±0.96 2.55±0.87 3.79 .025 b, c＜a
    Total   2.42±0.56 2.28±0.63 2.69±0.56 2.31±0.63 7.82 .001 b＜c
    Table 1. General Characteristics according to Stages of Survivorship in Gynecologic Cancer Patients (N=142)

    SS=survival stage.

    Table 2. Disease Characteristics according to Stages of Survivorship in Gynecologic Cancer Patients (N=142)

    Table 3. Health Promotion Behavior, Post Traumatic Growth & Quality of Life according to Stages of Survivorship in Gynecologic Cancer Patients (N=142)

    Table 1.

    Table 2.

    Table 3.

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