Understanding the 'work' of transitional cancer survivorship: Case studies of rural older adults and their support persons

Background: In spite of the considerable progress that has been made in cancer care, stark disparities persist in the cancer burden and health outcomes of certain groups of cancer survivors such as rural-dwelling and minority older adults. Actions taken by patients and caregivers in the months following completion of primary treatment can have significant impacts on long-term outcomes of cancer survivorship. Understanding the 'work' performed by survivors and their support persons during this transitional period of cancer survivorship may help to explain disparities.;Design and Methods: A prospective longitudinal case study design was used to follow eleven rural-dwelling dyads (n=22) from around the time of a new cancer diagnosis to at least three months post-completion of primary cancer treatment. Dyads included white and African American older adults treated for early-stage breast and prostate cancer, and their primary support persons. Data collection and analysis methods were framed in theory derived from the sociology of 'work'.;Findings: Analyses resulted in refinements to an adapted framework describing the `work' of transitional cancer survivorship. In the months following treatment, rural older adult participants who were treated for cancer had a need for life to be as 'normal' as possible. This need posed challenges to the provision of formal and informal support. Participants also benefited from re-engagement with 'productive' everyday life work tasks following the biographical disruption of cancer illness. None of the individuals treated for cancer identified themselves using the term 'survivor'. Case comparisons revealed possible mechanisms underlying cancer health disparities during survivorship.;Conclusions: Exploration of the 'work' of transitional cancer survivorship in a population at-risk for negative outcomes post-cancer treatment revealed new areas for further study, theoretical refinement, and intervention development. Implications for practice, theory, and future research are discussed.