Life After Cancer

Living With Risk

Krista L. Wilkins, PhD, RN; Roberta L. Woodgate, PhD, RN


Cancer Nurs. 2011;34(6):487-494. 

In This Article

Abstract and Introduction


Background: Recent research shows that cancer survivors are at greater risk of developing cancer than the general population. Although recommended, many cancer survivors receive no regular cancer screening. Cancer survivors' perceptions of their second cancer risk are, in part, suspected to influence their participation in cancer screening. Objective: This study was conducted to explore how cancer survivors define and interpret second cancer risk. Methods: An interpretive descriptive approach was taken whereby semistructured interviews were conducted with 22 cancer survivors (16 women and 6 men) drawn from a provincial cancer registry. The sample ranged in age from 19 to 87 years. The cancer history of the participants varied. Data were analyzed using the constant comparative method of data analysis. Results: The overall theme, "life after cancer—living with risk," described cancer survivors' sense that risk is now a part of their everyday lives. Two themes emerged from the data that speak to how cancer survivors lived with second cancer risk: (1) thinking about second risk and (2) living with risk: a family affair. Conclusions: Effective risk communication to support the decisions made by cancer survivors with respect to cancer screening is warranted. Implications for Practice: Study results provide foundational knowledge about the nature of second cancer risk that may be used to develop and refine standards for survivorship care including how second cancer risk can be best managed.


"Cancer can be beaten" is a common message delivered to the public about cancer. Although survival statistics support this message with rising survival rates for cancer survivors,[1,2] extending cancer survivors' life span has come at the cost of health problems that may occur when they are considered "cured" of their cancer. Studies consistently show that cancer survivors are at greater risk of developing cancer compared with the general population, predisposing them to morbidity and early mortality.[3,4]

In recent years, the importance of risk-modifying behaviors has extended to people who have had cancer because many of the risk factors for the development of a second cancer, such as genetics and cancer treatment, cannot be manipulated or present limited opportunities for change.[5] A large body of research that has attempted to explain why individuals initiate and maintain behaviors to prevent, detect, and manage cancer suggests that perceived cancer risk plays a major role in predicting these behaviors.[6,7] Some studies report that cancer survivors perceive they are less likely to develop cancer compared with their other people with similar characteristics. In contrast, other studies report that cancer survivors overestimate their cancer risk. How and why cancer survivors underestimate or overestimate their cancer risk may be influenced by the (1) presentation of cancer risk information as percentages or relative risks rather than descriptively or in terms of possible risk factors for cancer,[8] (2) use of mental shortcuts or heuristics,[9] and/or (3) treatment-related deficits in processing risk information that shape abstract reasoning, problem solving, and planning ability.[10] One qualitative study, to date, has examined the influence of personal beliefs and emotions of cancer survivors on their risk judgments.[11] In this study, Hodgkin lymphoma (HL) survivors underestimated their breast cancer risk and avoided cancer screening because they struggled to reconcile messages that they were "cured" with idea of being at increased risk for second cancers, they felt helpless in preventing a second cancer, and they received conflicting cancer screening recommendations.[11]

Much of the research on cancer risk perception has been quantitative, largely reductive, and not well suited to fully describing the multidimensionality of the concept of risk. There is a tendency to overlook the lived experience of those who are dealing with second cancer risks in their everyday lives. Qualitative research can provide us with a rich picture of the ways in which cancer survivors understand, experience, and construct second cancer risk.[7]


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