Abstract
Purpose
Understanding the experience of late effects from the perspective of cancer survivors is essential to inform patient-centred care. This study investigated the nature and onset of late effects experienced by survivors and the manner in which late effects have affected their lives.
Methods
Sixteen purposively selected cancer survivors participated in a qualitative interview study. The data were analysed inductively using a narrative schema in order to derive the main themes that characterised patients’ accounts of late effects.
Results
Individual survivors tended to experience more than one late effect spanning a range of physical and psychological effects. Late effects impacted on relationships, working life, finances and the ability to undertake daily activities. Survivors reported experiencing psychological late effects from around the end of treatment whereas the onset of physical effects occurred later during the post-treatment period. Late effects were managed using formal health services, informal social support and use of ‘wellbeing strategies’. Survivors engaged in a process of searching for reasons for experiencing late effects and struggled to make sense of their situation. In particular, a process of ‘peer-patient comparison’ was used by survivors to help them make sense of, or cope with, their late effects. There appeared to be an association between personal disposition and adaptation and adjustment to the impact of late effects.
Conclusions
Cancer survivors identified potential components for supported self-management or intervention programmes, as well as important considerations in terms of peer comparisons, personal disposition and making sense of experienced late effects.
Similar content being viewed by others
References
Coleman MP, Forman D, Bryant H et al (2011) Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet 377:127–138. doi:10.1016/S0140-6736(10)62231-3
Department of Health, Macmillan Cancer Support and NHS Improvement (2013) Living with and beyond cancer: taking action to improve outcomes. Williams Lea, London
Treanor CJ, Donnelly M (2014) The late effects of cancer and cancer treatment: a rapid review. J Community Support Oncol 12:137–148. doi:10.12788/jcso.0035.Volume
Treanor C, Santin O, Mills M, Donnelly M (2013) Cancer survivors with self-reported late effects: their health status, care needs and service utilisation. Psychooncology 22:2428–2435. doi:10.1002/pon.3304
Selamat MH, Loh SY, Mackenzie L, Vardy J (2014) Chemobrain experienced by breast cancer survivors: a meta-ethnography study investigating research and care implications. PLoS One 9:e108002. doi: 10.1371/journal.pone.0108002
Bennion AE, Molassiotis A (2013) Qualitative research into the symptom experiences of adult cancer patients after treatments: a systematic review and meta-synthesis. Support Care Cancer 21:9–25. doi:10.1007/s00520-012-1573-x
Macmillan Cancer Support (2013) Cured—but at what cost? Long-term consequences of cancer and its treatment. Macmillan Cancer Support, London
Dooks P, McQuestion M, Goldstein D, Molassiotis A (2012) Experiences of patients with laryngectomies as they reintegrate into their community. Support Care Cancer 20:489–498. doi:10.1007/s00520-011-1101-4
Santin O, Mills M, Treanor C, Donnelly M (2012) A comparative analysis of the health and well-being of cancer survivors to the general population. Support Care Cancer 20:2545–2552. doi:10.1007/s00520-011-1372-9
Tighe M, Molassiotis A, Morris J, Richardson J (2011) Coping, meaning and symptom experience: a narrative approach to the overwhelming impacts of breast cancer in the first year following diagnosis. Eur J Oncol Nurs 15:226–232. doi:10.1016/j.ejon.2011.03.004
Benzein E, Norberg A., Saveman B-I (2001) The meaning of the lived experience of hope in patients with cancer in palliative home care. Palliat Med 15:117–126. doi: 10.1191/026921601675617254
Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3:77–101. doi:10.1191/1478088706qp063oa
Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19:349–357. doi:10.1093/intqhc/mzm042
Sagen A, Kaaresen R, Sandvik L, Thune I, Risberg MA (2014) Upper limb physical function and adverse effects after breast cancer surgery: a prospective 2.5-year follow-up study and preoperative measures. Arch Phys Med Rehabil 95:875–881. doi:10.1016/j.apmr.2013.12.015
Thomas BC, Waller A, Malhi RL, Fung T, Carlson LE, Groff SL, et al. (2014) A longitudinal analysis of symptom clusters in cancer patients and their sociodemographic predictors. J Pain Symptom Manag 14:566–578. doi:10.1016/j.jpainsymman.2013.04.007
Ho S-Y, Rohan KJ, Parent J, Tager F A., McKinley PS (2015) A longitudinal study of depression, fatigue, and sleep disturbances as a symptom cluster in women with breast cancer. J Pain Symptom Manag 49: 707-715. doi: 10.1016/j.jpainsymman.2014.09.009
Trudel-Fitzgerald C, Savard J, Ivers H (2014) Longitudinal changes in clusters of cancer patients over an 18-month period. Health Psychol 33:1012–1022. doi:10.1037/a0033497
Da Silva G, dos Santos MA (2010) Stressors in breast cancer post-treatment: a qualitative approach. Rev Lat Am Enfermagem 18:688–695. doi:10.1590/S0104-11692010000400005
Johansson K, Holmström H, Nilsson I, Ingvar C, Albertsson M, Ekdahl C (2003) Breast cancer patients’ experiences of lymphoedema. Scand J Caring Sci 17:35–42. doi:10.1046/j.1471-6712.2003.00119.x
Gill KM, Mishel M, Belyea M, et al (2004) Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors. Oncol Nurs Forum 31:633–639. doi:10.1188/04.ONF.633-639
Gray RE, Fitch M, Greenberg M, Hampson A, Doherty M, Labrecque M (1998) The information needs of well, longer-term survivors of breast cancer. Patient Educ Couns 33:245–255. doi:10.1016/S0738-3991(98)00024-X
Foster C, Wright D, Hill H, Hopkinson J, Roffe L (2009) Psychosocial implications of living 5 years or more following a cancer diagnosis: a systematic review of the research evidence. Eur J Cancer Care 18:223–247. doi:10.1111/j.1365-2354.2008.01001.x
Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M (2010) It’s not over when it’s over: long-term symptoms in cancer survivors—a systematic review. Int J Psychiatry Med 40:163–181. doi:10.2190/PM.40.2.c
Connerty TJ, Knott V (2013) Promoting positive change in the face of adversity: experiences of cancer and post-traumatic growth. Eur J Cancer Care 22:334–344. doi:10.1111/ecc.12036
Macmillan Cancer Support (2009) It’s no life: living with the long term effects of cancer. Macmillan Cancer Support, London
Shaw AK, Pogany L, Speechley KN, Maunsell E, Barrera M, Mery LS (2006) Use of health care services by survivors of childhood and adolescent cancer in Canada. Cancer 106:1829–1837. doi:10.1002/cncr.21798
Harris SR, Hugi MR, Olivotto IA, Levine M (2001) Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema CMAJ 164:191–199
Andersen BL, DeRubeis RJ, Berman BS, et al (2014) Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol 32:1605–1619. doi:10.1200/JCO.2013.52.4611
Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, Bandera EV, Hamilton KK, Grant B, McCullough M, Byers T (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62:243–274. doi:10.3322/caac.21142
Mishra SI, Scherer RW, Geigle PM, Topaloglu O, Gotay CC, Snyder C (2012) Exercise interventions on health-related quality of life for cancer survivors (review). Cochrane Database Syst Rev 8. doi: 10.1002/14651858.CD007566.pub2.
Shneerson C, Taskila T, Holder R (2014) Patterns of self-management practices undertaken by cancer survivors: variations in demographic factors. Eur J Cancer Care doi:. doi:10.1111/ecc.12252
Helgeson VS, Cohen S (1996) Social support and adjustment to cancer: reconciling descriptive, correlational, and intervention research. Health Psychol 15:135–148. doi:10.1037/0278-6133.15.2.135
Brearley SG, Stamataki Z, Addington-Hall J (2011) The physical and practical problems experienced by cancer survivors: a rapid review and synthesis of the literature. Eur J Oncol Nurs 15:204–212. doi:10.1016/j.ejon.2011.02.005
American Psychiatric Association (2013) Diagnostic statistical manual of mental disorders, 5th edn. American Psychiatric Association, Washington
Festinger LA (1958) Theory of social comparison processes. Hum Relations (7):117–140. doi:10.1177/001872675400700202
Taylor SE, Lobel M (1989) Social comparison activity under threat: downward evaluation and upward contacts. Psychol Rev 96:569–575. doi:10.1037/0033-295X.96.4.569
Bennenbroek FTC, Buunk BP, van der Zee KI, Grol B (2002) Social comparison and patient information: what do cancer patients want? Patient Educ Couns 47:5–12. doi:10.1016/S0738-3991(02)00018-6
Brakel TM, Dijkstra A, Buunk AP (2012) Effects of the source of social comparison information on former cancer patients’ quality of life. Br J Health Psychol 17:667–681. doi:10.1111/j.2044-8287.2012.02064.x
Brakel TM, Dijkstra A, Buunk AP, Siero FW (2012) Impact of social comparison on cancer survivors’ quality of life: an experimental field study. Health Psychol 31:660–670. doi:10.1037/a0026572
Brakel TM, Dijkstra A, Buunk AP (2014) Targeting cancer patients’ quality of life through social comparison: a randomised trial. Psychol Health 29:950–966. doi:10.1080/08870446.2014.901514
Carver CS (2006) Resilience and thriving: issues, models, and linkages. J Soc Issues 54:245–266. doi:10.1111/j.1540-4560.1998.tb01217.x
Cunningham AJ, Watson K (2004) How psychological therapy may prolong survival in cancer patients: new evidence and a simple theory. Integr Cancer Ther 3:214–229. doi:10.1177/1534735404267553
Feros DL, Lane L, Ciarrochi J, Blackledge JT (2013) Acceptance and commitment therapy (ACT) for improving the lives of cancer patients: a preliminary study. Psychooncol 22:459–464. doi:10.1002/pon.2083
Fiszer C, Dolbeault S, Sultan S, Brédart A (2014) Prevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: a systematic review. Psychooncol 23:361–374. doi:10.1002/pon.3432
Paschali AA, Hadjulis M, Papadimitriou A, Karademas EC (2015) Patient and physician reports of the information provided about illness and treatment: what matters for patients’ adaptation to cancer during treatment? Psychooncol doi:. doi:10.1002/pon.3741
Acknowledgments
We are grateful to the Northern Ireland Primary Care Research Network for their help and support during the recruitment.
Conflict of interest
The authors declare that they have no competing interests.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Treanor, C., Donnelly, M. Late effects of cancer and cancer treatment—the perspective of the patient. Support Care Cancer 24, 337–346 (2016). https://doi.org/10.1007/s00520-015-2796-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-015-2796-4