Due to a growing population with both cancer and chronic diseases, we explored patients’ experiences of living with a cancer diagnosis and comorbidities, the possible effects on everyday living and management of comorbidities.
Methods
Semi-structured interviews were conducted during 2016 with 15 patients in Denmark, with finished cancer treatment and preexisting comorbidities. Analysis was performed by Systematic Text Condensation.
Results
Symptoms which disrupted everyday function were given attention, regardless of the disease from which the symptoms originated. The awareness of cancer and comorbidities constituted an inverse process over time. Most patients perceived cancer as being transient, whereas experiences of comorbidities varied from ignorance to worry. Most patients reported maintaining their chronic illness consultations with their general practitioner as before cancer.
Conclusion
Patients prioritized an everyday life with normal chores highly in contrast to paying attention to diseases. Disruptive symptoms, rather than specific diseases, took up patients’ attention. Cancer did not change the patients’ attendance at chronic care consultations. General practitioners should focus on maintaining the patient’s functional level in everyday life. Further, they should continue to prioritize the chronic care management, as this might increase the patients’ own view of the importance of self-management.
De AngelisRSantMColemanMP, et al.
Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE-5 – a population-based study. Lancet Oncol2014;
15: 23–34.
2.
FerlayJSoerjomataramIDikshitR, et al.
Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer2015;
136: E359–E386.
3.
BarnettKMercerSWNorburyM, et al.
Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet (London, England)2012;
380: 37–43.
4.
RitchieCSZhaoFPatelK, et al.Association between patients’ perception of the comorbidity burden and symptoms in outpatients with common solid tumors. Cancer2017;
123: 3835–3842.
5.
SogaardMThomsenRWBossenKS, et al.
The impact of comorbidity on cancer survival: a review. Clin Epidemiol2013;
5: 3–29.
6.
BaroneBBYehHCSnyderCF, et al.
Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis. JAMA2008;
300: 2754–2764.
7.
CheungWYNevilleBACameronDB, et al.
Comparisons of patient and physician expectations for cancer survivorship care. J Clin Oncol2009;
27: 2489–2495.
8.
KendallMBoydKCampbellC, et al.
How do people with cancer wish to be cared for in primary care? Serial discussion groups of patients and carers. Fam Pract2006;
23: 644–650.
9.
TarrantCWindridgeKBakerR, et al. ‘
Falling through gaps’: primary care patients’ accounts of breakdowns in experienced continuity of care. Fam Pract2015;
32: 82–87.
10.
CowieLMorganMWhiteP, et al.
Experience of continuity of care of patients with multiple long-term conditions in England. J Health Serv Res Policy2009;
14: 82–87.
11.
AnvikTHoltedahlKAMikalsenH. “
When patients have cancer, they stop seeing me” – the role of the general practitioner in early follow-up of patients with cancer – a qualitative study. BMC Fam Pract2006;
7: 19.
12.
SnyderCFFrickKDHerbertRJ, et al.
Quality of care for comorbid conditions during the transition to survivorship: differences between cancer survivors and noncancer controls. J Clin Oncol2013;
31: 1140.
13.
EarleCCNevilleBA.Under use of necessary care among cancer survivors. Cancer2004;
101: 1712–1719.
14.
SabatinoSACoatesRJUhlerRJ, et al.
Provider counseling about health behaviors among cancer survivors in the United States. J Clin Oncol2007;
25: 2100.
15.
YaoNCamachoFTChukmaitovAS, et al.
Diabetes management before and after cancer diagnosis: missed opportunity. Ann Transl Med2015;
3: 72.
16.
SarfatiDKoczwaraBJacksonC.The impact of comorbidity on cancer and its treatment. CA Cancer J Clin2016;
66: 337–350.
17.
BratzkeLCMuehrerRJKehlKA, et al.
Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature. Int J Nurs Stud2015;
52: 744–755.
18.
MorrisRLSandersCKennedyAP, et al.
Shifting priorities in multimorbidity: a longitudinal qualitative study of patient’s prioritization of multiple conditions. Chronic Illness2011;
7: 147–161.
19.
GoebelJValinskiSHersheyDS.Improving coordination of care among healthcare professionals and patients with diabetes and cancer. Clin J Oncol Nurs2016;
20: 645–651.
20.
HersheyDSTiptonJGivenB, et al.
Perceived impact of cancer treatment on diabetes self-management. Diabetes Educ2012;
38: 779–790.
21.
LiddyCBlazkhoVMillK.Challenges of self-management when living with multiple chronic conditions: systematic review of the qualitative literature. Can Fam Physician2014;
60: 1123–1133.
22.
BowerPHarknessEMacdonaldW, et al.
Illness representations in patients with multimorbid long-term conditions: qualitative study. Psychol Health2012;
27: 1211–1226.
23.
SontagS.Illness as metaphor and AIDS and its metaphors. New York, NY: Farrar, Straus, and Giroux, 1991.
24.
SimonAEWardleJMilesA.Is it time to change the stereotype of cancer: the expert view. Cancer Causes Control2011;
22: 135–140.
25.
NiederdeppeJLevyAG.Fatalistic beliefs about cancer prevention and three prevention behaviors. Cancer Epidemiol Biomark Prev2007;
16: 998–1003.
26.
BarskovaTOesterreichR.Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: a systematic review. Disabil Rehabil2009;
31: 1709–1733.
27.
HellmanS.Evolving paradigms and perceptions of cancer. Nat Clin Pract Oncol2005;
2: 618–624.
28.
PhillipsJLCurrowDC.Cancer as a chronic disease. Collegian2010;
17: 47–50.
29.
FoleyKLFarmerDFPetronisVM, et al.
A qualitative exploration of the cancer experience among long-term survivors: comparisons by cancer type, ethnicity, gender, and age. Psychooncology2006;
15: 248–258.
30.
PedersenKMAndersenJSSondergaardJ.General practice and primary health care in Denmark. J Am Board Fam Med2012;
25: S34–S38.
MalterudK.Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health2012;
40: 795–805.
33.
International Standard Classification of Education, 2011.
34.
WhitakerKLCrommeSWinstanleyK, et al.
Emotional responses to the experience of cancer ‘alarm’ symptoms. Psychooncology2016;
25: 567–573.
35.
SalamonsenAKiilMAKristoffersenAE, et al.
“My cancer is not my deepest concern”: life course disruption influencing patient pathways and health care needs among persons living with colorectal cancer. Patient Prefer Adher2016;
10: 1591–1600.
36.
OrtenbladLMeillierLJonssonAR.Multi-morbidity: a patient perspective on navigating the health care system and everyday life. Chronic Illness2018;
14: 271–282.
37.
O’BrienRWSGrahamGCMGuthrieB, et al.
The “Everyday work” of living with multimorbidity in socioeconomically deprived areas of Scotland. J Comorb2014;
4: 1–10.
38.
GannikD.Situational disease: elements of a social theory of disease based on a study of back trouble. Scand J Primary Health Care Suppl2002;
20: 25–30.
39.
AlonzoAA.Everyday illness behavior: a situational approach to health status deviations. Soc Sci Med1979;
13a: 397–404.
40.
Junius-WalkerUVoigtIWredeJ, et al.
Health and treatment priorities in patients with multimorbidity: report on a workshop from the European General Practice Network meeting ‘Research on multimorbidity in general practice’. Eur J Gen Pract2010;
16: 51–54.
41.
CoventryPASmallNPanagiotiM, et al.
Living with complexity; marshalling resources: a systematic review and qualitative meta-synthesis of lived experience of mental and physical multimorbidity. BMC Fam Pract2015;
16: 171.
42.
ReadJRSharpeLModiniM, et al.
Multimorbidity and depression: a systematic review and meta-analysis. J Affect Disord2017;
221: 36–46.
43.
Klil-DroriAJAzoulayLPollakMN.Cancer, obesity, diabetes, and antidiabetic drugs: is the fog clearing?Nat Rev Clin Oncol2017;
14: 85–99.
44.
KoeneRJPrizmentAEBlaesA, et al.
Shared risk factors in cardiovascular disease and cancer. Circulation2016;
133: 1104–1114.
45.
DalstedRJGuassoraADThorsenT.Danish general practitioners only play a minor role in the coordination of cancer treatment. Danish Med Bull2011;
58: A4222.
46.
RichardsHEmslieC.The ‘doctor’ or the ‘girl from the University’? Considering the influence of professional roles on qualitative interviewing. Fam Pract2000;
17: 71–75.
