Symptom Experiences before Medical Help-Seeking and Psychosocial Responses of Patients with Esophageal Cancer: A Qualitative Study

Abstract

Objective. The purpose of this study was to investigate patients with esophageal cancer symptom experiences before seeking medical help and psychosocial responses. Methods. Within one month of diagnosis, semistructured interviews were held with 14 adult patients with esophageal cancer. To fully comprehend the symptom experiences that patients with esophageal cancer had prior to seeking medical help and the psychosocial responses they had to these experiences, thematic analysis and interpretative phenomenological analysis were used. Results. Patients with esophageal cancer recounted their symptom experiences, and psychosocial responses were categorized into three main themes: physical, psychological, and social. Three subthemes were included in the physiological aspect: early symptoms (warning signs), specific symptoms (the catalyst for seeking medical help), and concurrent symptoms (masked side effects). Four subthemes were associated with psychological aspects: unfairness, regret, worry, and acceptance. Two subthemes were related to the social element, namely, dragging down one’s family and societal self-isolation. Conclusion. Due to the self-remitting nature of early symptoms, the normalization of their interpretation, and concealment by other illnesses, patients with esophageal cancer may delay medical help-seeking. The findings could serve as a reference for healthcare professionals to implement tailored psychosocial interventions and help patients identify symptoms early in order to seek medical help.

Adult Cancer Patients’ Perceptions of Factors That Influence Hospital Admissions

“…Another strength is interviewing the patient within 24 to 48 hours after admission while they can still recall and speak about the experience. The patient characteristics described in this study suggest risks for self-care impairment: older age, advanced stage cancer, active cancer treatment, and comorbidities, and some had impaired ambulation, suggesting functional compromise 33 . This is not surprising since most had stage 4 disease, which can compromise their capacity to perform self-care and symptom management strategies at home 2,9,16 …”

“…The patient characteristics described in this study suggest risks for self-care impairment: older age, advanced stage cancer, active cancer treatment, and comorbidities, and some had impaired ambulation, suggesting functional compromise. 33 This is not surprising since most had stage 4 disease, which can compromise their capacity to perform self-care and symptom management strategies at home. 2,9,16 Almost half were admitted within 30 days of prior hospitalization and with fever, pain, shortness of breath, and assorted gastrointestinal symptoms such as nausea and vomiting, which meets the criteria in the CMS OP-35 measure.…”

“…Although most wanted to avoid hospitalization and were educated and prepared to self-care at home, some “watched and waited,” hoping for symptoms to improve, 33 but most were not aware or undecided of other ways to manage symptoms. One reason for this may be because education provided by physicians and nurses is usually focused on anticipated and common treatment-related side effects.…”