{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:58:37Z","timestamp":1790881117372,"version":"4.1.0"},"reference-count":64,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,3,6]],"date-time":"2022-03-06T00:00:00Z","timestamp":1646524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U54CA202995, U54CA202997, U54CA203000"],"award-info":[{"award-number":["U54CA202995, U54CA202997, U54CA203000"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Eliminating cancer-related disparities is a global public health priority. Approximately 40% of cancer survivors experience long-term effects of cancer which can lead to activity limitations and participation restrictions; yet discussions of disability are largely absent from clinical and research cancer health equity agendas. The purpose of this study was to explore how cancer survivors experience and make sense of the long-term disabling effects of cancer and its treatments. In this qualitative study, data were collected via in-depth semi-structured interviews with survivors of breast cancer, head and neck cancer, and sarcoma (n = 30). Data were analyzed thematically using a 2-phase iterative process proceeding from descriptive to conceptual coding. Survivors experienced a wide range of long-term physical, sensory, cognitive, and emotional effects, that intertwined to restrict their participation in self-care, work, leisure, and social roles. While the interaction between impairments and participation restrictions meets the definition of disability; participants articulated a range of responses when asked about their disability identity, including (1) rejecting, (2) othering, (3) acknowledging, and (4) affirming. Findings may be indicative of structural and internalized ableism which can impede cancer care and survivorship. To support cancer survivors\u2019 transition to post-treatment life, cancer care providers should implement anti-ableist practices and engage in frank discussions about cancer\u2019s long-term impacts.<\/jats:p>","DOI":"10.3390\/ijerph19053112","type":"journal-article","created":{"date-parts":[[2022,3,6]],"date-time":"2022-03-06T20:38:16Z","timestamp":1646599096000},"page":"3112","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":57,"title":["Cancer Survivors\u2019 Disability Experiences and Identities: A Qualitative Exploration to Advance Cancer Equity"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6386-2386","authenticated-orcid":false,"given":"Susan","family":"Magasi","sequence":"first","affiliation":[{"name":"Department of Occupational Therapy, University of Illinois at Chicago, 1919 W. 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Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S198","DOI":"10.2105\/AJPH.2014.302182","article-title":"Persons with disabilities as an unrecognized health disparity population","volume":"105","author":"Krahn","year":"2015","journal-title":"Am. J. Public Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1080\/09687599.2013.818773","article-title":"The social model of disability: Thirty years on","volume":"28","author":"Oliver","year":"2013","journal-title":"Disabil. Soc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1111\/josi.12354","article-title":"Ableism special issue introduction","volume":"75","author":"Bogart","year":"2019","journal-title":"J. Soc. Issues"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1377\/hlthaff.2020.01452","article-title":"Physicians\u2019 Perceptions of People with Disability and Their Health Care: Study reports the results of a survey of physicians\u2019 perceptions of people with disability","volume":"40","author":"Iezzoni","year":"2021","journal-title":"Health Aff."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.dhjo.2019.01.010","article-title":"Exploring issues relating to disability cultural competence among practicing physicians","volume":"12","author":"Agaronnik","year":"2019","journal-title":"Disabil. Health J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1007\/s11606-020-06327-7","article-title":"Perspectives of Patients with Pre-existing Mobility Disability on the Process of Diagnosing Their Cancer","volume":"36","author":"Agaronnik","year":"2021","journal-title":"J. Gen. Intern. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/PHM.0000000000001622","article-title":"Exploring Cancer Treatment Experiences for Patients with Preexisting Mobility Disability","volume":"100","author":"Agaronnik","year":"2021","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1177\/1359105311414952","article-title":"The impact of stigma in healthcare on people living with chronic illnesses","volume":"17","author":"Earnshaw","year":"2012","journal-title":"J. Health Psychol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1111\/josi.12340","article-title":"The association of group-based discrimination with health and well-being: A comparison of ableism with other \u201cisms\u201d","volume":"75","author":"Branco","year":"2019","journal-title":"J. Soc. Issues"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21442","article-title":"Cancer statistics, 2018","volume":"68","author":"Siegel","year":"2018","journal-title":"CA Cancer J. Clin."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21551","article-title":"Cancer statistics, 2019","volume":"69","author":"Siegel","year":"2019","journal-title":"CA Cancer J. Clin."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2577","DOI":"10.1002\/cncr.23448","article-title":"Physical and psychological long-term and late effects of cancer","volume":"112","author":"Stein","year":"2008","journal-title":"Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1177\/1539449219844749","article-title":"Catalyzing Research to Optimize Cancer Survivors\u2019 Participation in Work and Life Roles","volume":"39","author":"Newman","year":"2019","journal-title":"OTJR Occup. Particip. Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s11764-009-0098-x","article-title":"Confronting chemobrain: An in-depth look at survivors\u2019 reports of impact on work, social networks, and health care response","volume":"3","author":"Boykoff","year":"2009","journal-title":"J. Cancer Surviv."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1080\/16501960410016811","article-title":"ICF Core Sets for breast cancer","volume":"36","author":"Brach","year":"2004","journal-title":"J. Rehabil. Med."},{"key":"ref_17","unstructured":"World Health Organization (2001). International Classification of Functioning, Disability and Health: ICF, World Health Organization."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1001\/jama.299.3.332","article-title":"Turning the Disability TideThe Importance of Definitions","volume":"299","author":"Iezzoni","year":"2008","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"637","DOI":"10.7326\/0003-4819-145-9-200611070-00005","article-title":"Disparities in breast cancer treatment and survival for women with disabilities","volume":"145","author":"McCarthy","year":"2006","journal-title":"Ann. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.annepidem.2005.01.009","article-title":"Physical performance limitations and participation restrictions among cancer survivors: A population-based study","volume":"16","author":"Ness","year":"2006","journal-title":"Ann. Epidemiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/S0003-9993(99)90161-2","article-title":"Functional outcome in amputation versus limb sparing of patients with lower extremity sarcoma: A matched case-control study","volume":"80","author":"Davis","year":"1999","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/j.ejso.2014.03.015","article-title":"What do we know about survivorship after treatment for extremity sarcoma? A systematic review","volume":"40","author":"Furtado","year":"2014","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/j.clon.2017.04.001","article-title":"Issues of Survivorship and Rehabilitation in Soft Tissue Sarcoma","volume":"29","author":"Gerrand","year":"2017","journal-title":"Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1001\/archotol.130.6.764","article-title":"Disability in patients with head and neck cancer","volume":"130","author":"Taylor","year":"2004","journal-title":"Arch. Otolaryngol.\u2013Head Neck Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.pmrj.2013.08.605","article-title":"Upper body pain and functional disorders in patients with breast cancer","volume":"6","author":"Stubblefield","year":"2014","journal-title":"PM&R"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1177\/0194599818783964","article-title":"Pain in Head and Neck Cancer Survivors: Prevalence, Predictors, and Quality-of-Life Impact","volume":"159","author":"Cramer","year":"2018","journal-title":"Otolaryngol.\u2013Head Neck Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1302\/0301-620X.97B9.35192","article-title":"Physical functioning, pain and quality of life after amputation for musculoskeletal tumours: A national survey","volume":"97","author":"Furtado","year":"2015","journal-title":"Bone Jt. J."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Bennett, S., Pigott, A., Beller, E.M., Haines, T., Meredith, P., and Delaney, C. (2016). Educational interventions for the management of cancer-related fatigue in adults. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD008144.pub2"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1093\/annonc\/mdw099","article-title":"Risk factors, prevalence, and course of severe fatigue after breast cancer treatment: A meta-analysis involving 12,327 breast cancer survivors","volume":"27","author":"Abrahams","year":"2016","journal-title":"Ann. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1177\/0003489419826138","article-title":"Prevalence of Fatigue in Head and Neck Cancer Survivors","volume":"128","author":"Bossi","year":"2019","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.ejon.2010.06.004","article-title":"Anxiety and depression in sarcoma patients: Emotional adjustment and its determinants in the different phases of disease","volume":"15","author":"Paredes","year":"2011","journal-title":"Eur. J. Oncol. Nurs."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.maturitas.2015.04.010","article-title":"The prevalence of long-term symptoms of depression and anxiety after breast cancer treatment: A systematic review","volume":"82","author":"Maass","year":"2015","journal-title":"Maturitas"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e12667","DOI":"10.1111\/ecc.12667","article-title":"Sarcoma survivors\u2019 perspectives on their body image and functional quality of life post-resection\/limb salvage surgery","volume":"26","author":"Taylor","year":"2017","journal-title":"Eur. J. Cancer Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1200\/JCO.2012.46.2101","article-title":"Receipt of psychosocial care among cancer survivors in the United States","volume":"31","author":"Forsythe","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1037\/rep0000132","article-title":"Who self-identifies as disabled? An examination of impairment and contextual predictors","volume":"62","author":"Bogart","year":"2017","journal-title":"Rehabil. Psychol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1353\/wsq.2016.0008","article-title":"The Subjects of Survival: The Anti-Intersectional Routes of Breast Cancer","volume":"44","author":"Brandzel","year":"2016","journal-title":"Women\u2019s Stud. Q."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1080\/15298868.2012.681118","article-title":"Redefining disability, re-imagining the self: Disability identification predicts self-esteem and strategic responses to stigma","volume":"12","author":"Noel","year":"2013","journal-title":"Self Identity"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1002\/capr.12360","article-title":"Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern-based qualitative analytic approaches","volume":"21","author":"Braun","year":"2021","journal-title":"Couns. Psychother. Res."},{"key":"ref_39","unstructured":"Charmaz, K. (2014). Constructing Grounded Theory, Sage. [2nd ed.]."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How many interviews are enough?: An experiment with data saturation and variability","volume":"18","author":"Guest","year":"2006","journal-title":"Field Methods"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1177\/104973239500500201","article-title":"The Significance of saturation","volume":"5","author":"Morse","year":"1995","journal-title":"Qual. Health Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1080\/2159676X.2019.1704846","article-title":"To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales","volume":"13","author":"Braun","year":"2021","journal-title":"Qual. Res. Sport Exerc. Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1207\/s15430421tip3903_2","article-title":"Determining Validity in Qualitative Inquiry","volume":"39","author":"Creswell","year":"2000","journal-title":"Theory Pract."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21708","article-title":"Cancer statistics, 2022","volume":"72","author":"Siegel","year":"2022","journal-title":"CA Cancer J. Clin."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1037\/rep0000134","article-title":"Disability identity development: A systematic review of the literature","volume":"62","author":"Lyew","year":"2017","journal-title":"Rehabil. Psychol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1111\/josi.12320","article-title":"Identity management strategies for workers with concealable disabilities: Antecedents and consequences","volume":"75","author":"Santuzzi","year":"2019","journal-title":"J. Soc. Issues"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1111\/josi.12341","article-title":"Demographic, experiential, and temporal variation in ableism","volume":"75","author":"Harder","year":"2019","journal-title":"J. Soc. Issues"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1080\/09687590220148496","article-title":"Well, I know this is going to sound very strange to you, but I don\u2019t see myself as a disabled person: Identity and disability","volume":"17","author":"Watson","year":"2002","journal-title":"Disabil. Soc."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1177\/10442073050160030601","article-title":"Conceptualizing disability:Developing a framework for political disability identity","volume":"16","author":"Putnam","year":"2005","journal-title":"J. Disabil. Policy Stud."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1037\/rep0000258","article-title":"#SaytheWord: A disability culture commentary on the erasure of \u201cdisability\u201d","volume":"64","author":"Andrews","year":"2019","journal-title":"Rehabil. Psychol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s12160-017-9880-6","article-title":"Preparedness and cancer-related symptom management among cancer survivors in the first year post-treatment","volume":"51","author":"Leach","year":"2017","journal-title":"Ann. Behav. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1200\/EDBK_156164","article-title":"Developing high-quality cancer rehabilitation programs: A timely need","volume":"36","author":"Alfano","year":"2016","journal-title":"Am. Soc. Clin. Oncol. Educ. Book"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"150974","DOI":"10.1016\/j.soncn.2019.150974","article-title":"The who, what, why, when, where, and how of team-based interdisciplinary cancer rehabilitation","volume":"36","author":"Raj","year":"2020","journal-title":"Semin. Oncol. Nurs."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.pmr.2016.08.001","article-title":"Cancer rehabilitation: An overview of current need, delivery models, and levels of care","volume":"28","author":"Cheville","year":"2017","journal-title":"Phys. Med. Rehabil. Clin."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1080\/09638280701625534","article-title":"What does participation mean? An insider perspective from people with disabilities","volume":"30","author":"Hammel","year":"2008","journal-title":"Disabil. Rehabil."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"7103090010P1","DOI":"10.5014\/ajot.2017.713001","article-title":"Occupational therapy\u2019s role in cancer survivorship as a chronic condition","volume":"71","author":"Baxter","year":"2017","journal-title":"Am. J. Occup. Ther."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Braveman, B., and Hunter, E. (2017). Occupational Therapy Practice Guidelines for Cancer Rehabilitation with Adults, AOTA Press.","DOI":"10.7139\/2017.978-1-56900-409-8"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Loubani, K., Kizony, R., Milman, U., and Schreuer, N. (2021). Hybrid tele and in-clinic occupation based intervention to improve women\u2019s daily participation after breast cancer: A pilot randomized controlled trial. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18115966"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s11764-018-0730-8","article-title":"The effectiveness of mHealth for self-management in improving pain, psychological distress, fatigue, and sleep in cancer survivors: A systematic review","volume":"13","author":"Silva","year":"2019","journal-title":"J. Cancer Surviv."},{"key":"ref_62","unstructured":"Victorson, D., Maletich, C., Sufrin, N., Schuette, S., Gutierrez, B., Cordero, E., Johnson, C., Stencel, D., Bakosh, L., and Ring, M. (2016, January 17\u201320). Development of a new clinical mindfulness research tool \u201ciM-HERE\u201d to enhance, deliver, and streamline online mindfulness interventions. Proceedings of the International Congress on Integrative Medicine and Health (ICIMH), Las Vegas, NV, USA."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Victorson, D., Doninger, G., Victorson, S., Victorson, G., Hall, L., Maletich, C., Corr, B.R., Scortino, K., Burns, Z., and Allen, L. (2021). Psychosocial and biological outcomes of immersive, mindfulness-based treks in nature for groups of young adults and caregivers affected by cancer: Results from a single arm program evaluation from 2016\u20132021. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182312622"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1037\/bul0000156","article-title":"The social identity approach to disability: Bridging disability studies and psychological science","volume":"144","author":"Dirth","year":"2018","journal-title":"Psychol. Bull."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/5\/3112\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:33:01Z","timestamp":1760135581000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/5\/3112"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,6]]},"references-count":64,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["ijerph19053112"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19053112","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,6]]}}}