Del Mar Hita Millan Isabel, Cameron Josie, Yang Yuan, Humphris Gerry
Medical School, University of St Andrews, St Andrews KY16 9AJ, UK.
Edinburgh Cancer Centre, Western General Hospital, Edinburgh EH4 2XU, UK.
Ecancermedicalscience. 2019 Dec 12;13:984. doi: 10.3332/ecancer.2019.984. eCollection 2019.
There is minimal qualitative research on fear of cancer recurrence (FCR) in patients who are still undergoing treatment. This study explored how breast cancer patients' illness beliefs changed during radiotherapy treatment, so as to provide their longitudinal perspective across sessions. These beliefs were mapped to Lee-Jones FCR model to assess its applicability to patients during this key treatment phase. A framework qualitative analysis was employed for verbatim interactions between patients ( = 8) and their radiographer ( = 2) over a minimum of three weekly review sessions (26 review consultations in total). Results proved suggested evolution and repetition of themes within and across sessions. Most themes were consistent with the early stages of the Lee-Jones et al model (antecedents and FCR) such as internal and external cues, cognitions and emotions. The crucial observation was that somatic stimuli were interpreted as side effects of radiotherapy treatment rather than cancer symptoms. Patients were still undergoing their last phase of major treatment, whereas the Lee-Jones model has been constructed to explain patients' past treatment experience. New themes emerged, including current exercise, concurrent illnesses/problems, cancer treatment as a constant reminder (of diagnosis) and associated sleeping difficulties. Decatastrophising of symptoms and experiences relating to cancer and its treatment was also a prominent theme indicating a possible coping mechanism to reduce worries about treatment side effects and associated experiences. Finally, some evidence was found from failure of emotional/fear processing in patients due to early surface reassurance by health professionals - a possible explanation of how FCR might arise. Early detection of FCR and promoting support while patients are still undergoing treatment might prevent patients from developing FCR after treatment.
对于仍在接受治疗的患者，关于癌症复发恐惧（FCR）的定性研究极少。本研究探讨了乳腺癌患者在放疗治疗期间的疾病信念如何变化，以便提供他们在整个疗程中的纵向观点。这些信念被映射到Lee-Jones FCR模型，以评估其在这一关键治疗阶段对患者的适用性。采用框架定性分析方法，对8名患者及其2名放射技师在至少三次每周复查 session（共26次复查咨询）中的逐字互动进行分析。结果表明，各session内和各session间的主题存在演变和重复。大多数主题与Lee-Jones等人模型的早期阶段（前因和FCR）一致，如内部和外部线索、认知和情绪。关键的观察结果是，躯体刺激被解释为放疗治疗的副作用而非癌症症状。患者仍在接受主要治疗的最后阶段，而Lee-Jones模型是为解释患者过去的治疗经历而构建的。新的主题出现了，包括当前的锻炼、并发疾病/问题、癌症治疗作为（诊断的）持续提醒以及相关的睡眠困难。对与癌症及其治疗相关的症状和经历进行灾难化消除也是一个突出的主题，表明这可能是一种减少对治疗副作用及相关经历担忧的应对机制。最后，发现了一些证据，表明由于医护人员早期表面上的安抚，患者在情绪/恐惧处理方面存在失败——这可能是FCR产生的一种解释。在患者仍在接受治疗时早期发现FCR并提供支持，可能会防止患者在治疗后出现FCR。
