Living with advanced cancer and an uncertain disease trajectory: an emerging patient population in palliative care?. Issue 4 (28th January 2013)

• Record Type: Journal Article
• Authors: Lobb, Elizabeth A; Lacey, Judith; Kearsley, John; Liauw, Winston; White, Lesley; Hosie, Annmarie
• Other Names: Thomas David author non-byline.
• Is Part Of: BMJ supportive & palliative care. Volume 5:Issue 4(2015)
• Page Start: 352
• Page End: 357
• Publication Date: 2013-01-28
• Subjects: Advanced Cancer -- Patient Coping -- Uncertainty -- Models Of Care; Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/bmjspcare-2012-000381
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Objective: This study explored how patients diagnosed with advanced cancer cope with an uncertain disease trajectory. Subjects: 27 patients with advanced cancer and with a prognosis of 12 months or more were recruited from the medical/radiation oncology and palliative care service at three metropolitan hospitals. Methods: A semistructured face-to-face interview was conducted. Interviews were audio-taped and transcribed verbatim. Data analysis was based on Grounded Theory using the constant comparison method. Results: Results indicate that patients cope by avoidance, remaining positive, maintaining as normal a life as possible, minimising the impact of the disease on their daily lives, comparing themselves favourably with others in a similar situation and focusing on the outcome of treatment to control disease progression. Most did not wish to discuss prognosis or have detailed information on disease progression. Conclusions: Participants in this study represent an emerging cancer patient population who are receiving palliative therapies. While they have incurable cancer, they self-report as clinically well, they describe a good quality of life and the trajectory of their disease, while unpredictable, may extend over many months to years. Our study suggests that a flexible model of care is needed to support the needs of people who may still be receiving some form of chemotherapy and/or radiotherapy, and remain well. This model may need to take more of an intermittent approach, that is, as required for specific symptom management, rather than patients being linked continuously to a palliative care service for long periods of time.