Disability, community participation, and life satisfaction in working-age cancer survivors
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Ada Chen1, Jing Tao2, Lidian Chen2
1Kessler Foundation, East Hanover, NJ, USA. achen@kesslerfoundation.org.
Objective:
To examine whether community participation mediates the disability-life satisfaction association in working-age cancer survivors, and whether contextual factors moderate this pathway.
Design:
Cross-sectional online survey.
Subjects:
2,999 working-age US cancer survivors, employed or seeking employment (mean age 42.8 years; 53.1% male; 75.7% in remission).
Methods:
Disability (World Health Organization Disability Assessment Schedule 2.0), perceived community participation (5-item Wisconsin Community Participation Scale), and life satisfaction (Satisfaction With Life Scale) were assessed. A single-mediator model was estimated with bias-corrected bootstrap; 7 moderators were tested with false-discovery-rate correction.
Results:
Disability was associated with lower participation (β = -0.14) and life satisfaction (β = -0.12); participation with greater life satisfaction (β = 0.57). The indirect association (β = -0.08, 95% CI -0.10 to -0.06) accounted for 39.8% of the modest total association, but for only 13.0% when the full 12-item participation scale was used. At high instrumental support the conditional indirect association was indistinguishable from zero; at high self-efficacy and hope it reversed in sign.
Conclusion:
In this cross-sectional study, community participation statistically accounted for a measure-dependent part of the disability-life satisfaction association, and contextual factors were associated with differential attenuation across pathway segments. These hypothesis-generating findings require longitudinal confirmation before informing practice.
