Factors underlying metastatic breast cancer patients' perceptions of symptom importance: a qualitative analysis

Abstract

The symptom literature in cancer has primarily examined symptom severity, frequency and distress. Assessing cancer patients' perceptions of symptom importance-how important it is for them to see improvement in a symptom following an interventionand factors influencing these judgments would also inform patient-centred care, but this analysis has not been undertaken. This qualitative study aimed to identify factors underlying perceptions of symptom importance among 25 symptomatic metastatic breast cancer (MBC) patients. Participants were recruited from a cancer centre in the Midwestern USA. Semi-structured interviews focused on patients' rationale for considering common symptoms (i.e., anxiety, sadness, sleep problems, pain or fatigue) to be important. Thematic analyses revealed five interrelated factors underlying MBC patients' perceptions of symptom importance: activity restriction, concentration difficulties, exacerbation of other physical symptoms, symptom-related long-term health concerns and negative impact on their relationships with others. Patients most frequently stated that a physical or psychological symptom was important because of the resulting activity restriction. Additionally, some patients considered pain to be important because it signalled potential long-term health concerns, such as worsening metastatic disease. Findings suggest that clinicians should take into account MBC patients' perceptions of symptom importance and factors underlying these judgments when making shared treatment decisions. K E Y W O R D Sanxiety, fatigue, metastatic breast cancer, pain, psychological, symptoms

Metastatic breast cancer patients’ expectations and priorities for symptom improvement

“…Findings regarding the importance of fatigue and sleep problems are consistent with prior research indicating that these symptoms are highly prevalent and distressing, interfere with functioning, and are rated by patients as highly important to monitor [3, 35–37]. Qualitative evidence suggests that MBC patients may prioritize treatment of symptoms which are the most bothersome and have the greatest functional impact [37]. Our findings regarding the importance of thinking problems coincide with evidence demonstrating the quality-of-life and functional impact of subjective and objective cognitive symptoms related to cancer and its treatment [38, 39].…”

“…Fatigue, sleep problems, and thinking problems required the greatest amount of improvement for treatment to be considered successful, had the highest usual severity ratings, and were rated as highly important by a subgroup. Findings regarding the importance of fatigue and sleep problems are consistent with prior research indicating that these symptoms are highly prevalent and distressing, interfere with functioning, and are rated by patients as highly important to monitor [3, 35–37]. Qualitative evidence suggests that MBC patients may prioritize treatment of symptoms which are the most bothersome and have the greatest functional impact [37].…”

Barriers and facilitators to participating in physical activity for adults with breast cancer receiving adjuvant treatment: A qualitative metasynthesis

“…A recent metasynthesis provided further qualitative evidence for the positive impacts of engaging in physical activity among cancer survivors . Nevertheless, the debilitating side effects of their treatment and how their concerns about the potential adverse effects of physical activity affect their levels of physical activity during treatment are widely reported and synthesised within this review. Our findings suggest that it would be beneficial to encourage women to participate in a manageable level of physical activity whilst undergoing treatment, but the activity needs to be something that can be tailored depending on the severity of the side effects the women may be experiencing.…”

The Sum of Fears in Cancer Patients Inside the Context of the COVID-19

“…The use of some chemotherapeutic drugs can have a deleterious effect on the cognitive functions of patients causing them to have problems involving memory and concentration ( 47 , 48 ). In addition, the presence of side effects such as nausea and fatigue can lead to an increase in anxiety and depressive symptoms ( 49 , 50 ).…”