Symptom monitoring and the uncertain threat of disease recurrence: A deductive thematic analysis with adolescent and young adult (AYA) cancer survivors.

Authors

null

Lauren C Heathcote

Stanford University School of Medicine, Palo Alto, CA

Lauren C Heathcote, Nele Loecher, Sheri Spunt, Pamela Simon, Gary Dahl, Silvana Moiceanu, Gael Cruanes, Perri Tutelman, Lidia Schapira, Claudia Mueller, Bill Chiu, Laura Simons

Organizations

Stanford University School of Medicine, Palo Alto, CA, Lucile Packard Children’s Hospital Stanford, Dalhousie University, Halifax, NS, Canada, Stanford Cancer Center, Palo Alto, CA

Research Funding

Other Foundation
American Psychological Foundation, Stanford Maternal and Child Health Research Institute

Background: Symptom monitoring plays an important role in both the physical and psychological challenges of surviving cancer. Anecdotally, cancer survival is characterized by uncertainty, symptom-related fear, and the interpretation of normal bodily sensations as symptomatic of cancer recurrence. This fear may lead to over-vigilance of benign bodily sensations, increasing anxiety and decreasing quality of life. Yet, there are few studies investigating how cancer survivors interpret and make sense of post-cancer symptoms. These studies are needed to guide considerations for clinical practice and the development of supportive interventions. Methods: We conducted in-depth semi-structured interviews with 18 AYA cancer survivors about how they interpret, manage, and respond to physical symptoms during survivorship. Participants were 15-25 years old. The sample was diverse in terms of disease history, ethnicity (8 Hispanic), and gender (9 females, 1 nonbinary). We conducted thematic analysis using a deductive coding scheme that was developed using our Cancer Threat Interpretation (CTI) theoretical model of cognitive, affective, and behavioral processes in post-cancer symptom perception. Results: AYA cancer survivors reported experiencing anxiety in the face of common physical sensations. These sensations were often interpreted as potential signs of recurrence or as late effects of treatment. Survivors most commonly reported worries about pain and fatigue, but also other sensations such as breathlessness. We coded participant transcripts into the following themes: biased attending towards symptoms, biased interpretations of symptoms as threatening, fear and worry about symptoms, and behavioral response to symptoms. In addition, we generated a new theme that was not previously captured in the CTI model: trust in the body. Conclusions: Knowing how to appraise and respond to symptoms such as pain is a challenge for AYA cancer survivors. This rich qualitative data provides support for the CTI model and suggests future directions. The results of this study can inform how clinicians talk to their patients about symptom monitoring after treatment ends.

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Abstract Details

Meeting

2019 Supportive Care in Oncology Symposium

Session Type

Poster Session

Session Title

Poster Session B

Track

Mental Health and Psychological Well-being,Psychosocial and Spiritual/Cultural Assessment and Management,Models of Care,Patient Reported Outcomes and Patient Experience,Prevention, Assessment, and Management of Disease and Treatment-related Symptoms,Prognostication ,Survivorship and Late Effects of Cancer

Sub Track

Survivorship and Late Effects of Cancer

Citation

J Clin Oncol 37, 2019 (suppl 31; abstr 147)

DOI

10.1200/JCO.2019.37.31_suppl.147

Abstract #

147

Poster Bd #

F9

Abstract Disclosures

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