Understanding the Experience of Patients With Early-Stage Cancers: A Targeted Qualitative Literature Review

OBJECTIVES: Health-related quality of life (HRQoL) is anticipated to be better in patients with early-stage cancer compared with those with advanced disease. However, there is limited understanding of the patient experience (i.e., symptoms, HRQoL impacts) of early-stage cancers. This study aimed to synthesize existing qualitative literature describing the patient experience of early-stage breast, renal cell carcinoma (RCC), bladder, head and neck, melanoma, non-small cell lung cancer (NSCLC), and endometrial cancers and develop preliminary conceptual models of the patient experience in these populations.

METHODS: A targeted literature search was conducted in OVID SP® (MEDLINE®, Embase®, PsycINFO®). Qualitative or mixed-methods studies describing the patient experience of at least one out of seven early-stage cancers were included. Relevant concepts were identified, extracted and categorized into domains, to form preliminary conceptual models.

RESULTS: Forty-eight articles across six early-stage cancers were extracted. Most of the studies included early-stage breast cancer patients (n=23 articles) and no literature for RCC was identified. A diverse range of disease-related signs/symptoms (n=40), HRQoL impacts (n=52), treatment-related symptoms (n=25) and HRQoL impacts (n=25) were identified. Pain (n=27 articles) and fatigue (n=18 articles) (both as disease- and treatment-related symptoms) were most commonly reported across cancer types. Other signs/symptoms corresponded with the specific cancer site (e.g., dermatological symptoms in melanoma). Psychological/emotional impacts (e.g. worry/anxiety, fear of recurrence/diagnosis/dying, low mood/depression, low self-esteem/confidence due to treatment) were most frequently reported across cancers (n=38 articles). The conceptual models outline the cancer types and number of sources each concept was identified in.

CONCLUSIONS: Despite improved survival outcomes associated with early-stage disease, these findings demonstrate the significant burden of diagnosis and treatment of early-stage cancers, particularly with regards to fatigue, pain, and psychological impacts. Further qualitative research may help confirm the most salient concepts in early-stage cancers, particularly in cancers where evidence is lacking (e.g. RCC).