Pre-Operative Treatment for Oesophageal Cancer: Perspectives and Experiences

The relationship between cancer and psychological distress is widely
recognised and reflected by the large and growing body of psycho-oncology
research. Oesophageal cancer is an aggressive malignant disease which is
most frequently diagnosed once too advanced for curative treatment. For a
small proportion of patients, a risky and invasive oesophagectomy operation
can attempt to remove the cancer. The treatment process is physically and
emotionally gruelling, yet little research has focused on the experience for
patients. The majority of existing research has used quantitative methods.
This study aimed to increase understanding of how people with oesophageal
cancer experience the pre-operative treatment process and the approaching,
yet uncertain, surgery. Qualitative semi-structured interviews were carried out
with seven patients and eight members of their cancer centre’s multidisciplinary
team. This intended to increase insight into patients’ personal experiences and
staff’s accounts of diverse patients with whom they have worked. Analysis was
conducted using a critical realist epistemology and thematic analysis.
Three overarching patient themes were identified of ‘fear and the unknown’,
‘treatment brings hope and uncertainty’ and ‘committing to getting through
treatment’. Patient participants described determinedly following medical advice
whilst feeling fearful about surgery and its aftermath. Staff spoke more directly
about the risks, dilemmas and often harrowing effects of treatment, as well as
their efforts to support patients with this. Two main staff themes were developed
of ‘between the devil and the deep blue sea’ and ‘predicting the unpredictable’.
The findings suggest a need to consider decision-making in this particular
context. In clinical practice, healthcare professionals must facilitate careful
consideration of the subjective complexity central to treatment decisions.
Further research should examine the transmission of information about the risks
and potential consequences of surgery, the psychological processes involved in
patients’ decisions and methods for improving psychological preparation for
surgery.