A longitudinal qualitative analysis of the factors that influence patient distress within the lung cancer population
Introduction
The mean survival period from diagnosis of lung cancer is only eight months [1]. The health of patients also typically deteriorates over this period as a consequence of both their illness and the side-effects of treatment. Lung cancer diagnosis and the treatment which follows are also frequently associated with adverse effects on the emotional and psychological well being of patients and their families, friends and carers [2].
Although evidence consistently suggests that symptom severity correlates with patient distress, and that for lung cancer patients distress and psychological functioning near diagnosis predict survival [3], [4], [5] symptom experiences within this population are poorly understood in comparison with other forms of cancer [6], [7]. Much of the research which has examined symptom experiences and distress has used quantitative cross sectional approaches and therefore changes in symptom experiences over time remain somewhat opaque [8]. Furthermore it is unlikely that the relationship between patient’ distress and symptom severity and/or quality of life remains consistent over the disease trajectory: what is most salient and distressing for a patient may well change over the course of their illness. It has been fairly common practice within this population to use assessments of current levels of symptom frequency and symptom intensity as proxy measures of patient distress; however a number of researchers have argued that symptom frequency and intensity sometimes offer a poor reflection of the distress reported by patients [9], [10]. Given these gaps in the literature, longitudinal and qualitative examination of lung cancer patients’ symptom experiences and the explanatory models used by patients and their caregivers offers the possibility of expanding on our understanding of patient symptom experiences and distress across the disease trajectory of lung cancer.
Section snippets
Method
Patients and caregivers took part in semi-structured qualitative narrative interviews at four time points: at the beginning of treatment and then subsequently at three, six, and twelve months. Patients with inoperable primary lung cancer receiving treatment at a specialist cancer hospital between September 2005 and September 2007 were eligible for inclusion in the study along with their principal caregivers. As can be seen in more detail in our previous report [11], 62 patients were approached
Results
The patient sample had a mean age of 66.7 years (range 48–93). Patients were treated mostly with a combination of chemotherapy and radiotherapy (most common chemotherapy being gemcitabine with carboplatin) and had a palliative treatment intent. The majority (70%) had comorbidities, most commonly chronic obstructive pulmonary disease (18%). Caregivers had a mean of 60.4 years (range 40–81) and 14/15 were spouses/partners of the patient.
The analysis indicated that a number of factors influenced
Discussion
This study highlights that symptom distress in patients with lung cancer is a dynamic and complex experience, depending on symptom anticipation, symptom novelty, impact of the symptom on daily life and previous symptom experience, and mediated by symptom attribution to non-cancer and manageable causal factors. This calls into question the appropriateness of research that seeks to relate single symptoms to patient distress for populations that are likely to experience a range of co-occurring
Conclusion
The analysis suggests that the relationship between symptom characteristics and patient distress is unlikely to be static since patient anticipation, along with the novelty of symptoms and treatment processes, and patients’ judgements of relative severity/frequency/duration are certain to evolve over time. Furthermore the study highlights the fact that symptoms in lung cancer rarely occur in isolation. Co-occurring symptoms which are individually of relatively low severity appear sometimes to
Conflict of interest statement
None declared.
Acknowledgments
This study was partly supported by grants from the Christie Charitable Trust and the National Cancer Research Institute in the UK.
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