4CPS-204 An exploration of patients’ perceptions of colorectal cancer and its management : a qualitative study at initiation of treatment with chemotherapy

Abstract

Background and importance Chemotherapy remains the backbone of treatment for colorectal cancer, often administered in combination with surgery. Due to its mode of action, it may lead to adverse effects that can affect patients’ physically and psychosocially. However, there is a paucity of studies that portray the patients’ perceptions of colorectal cancer and chemotherapy at initiation of treatment. Aim and objectives The aim of the study was to explore patients’ perceptions of colorectal cancer and chemotherapy at initiation of treatment. Material and methods In-depth semi-structured interviews were conducted with 16 patients with newly diagnosed colorectal cancer on their first cycle of treatment with XELOX or FOLFOX. The study took place at the national oncology centre, between October 2018 and September 2019. Interviews were audio recorded and transcribed verbatim. Data were analysed independently by two researchers using interpretative phenomenological approach. Ethical approval was granted. Results Three themes were identified: patients’ perceptions, knowledge, and influences on patients’ attitudes and knowledge about the illness and treatment. The ‘shock’ experienced by patients on receiving a diagnosis of cancer was worse among those patients who were initially misdiagnosed for benign gastrointestinal disease. They could not believe that colorectal cancer presented with vague symptoms such as altered bowel habit and abdominal pain. Patients felt ‘devastated’ on being advised that they were to receive chemotherapy as despite improvements in treatment this illness was still associated with a fatal outcome. A nurse-led general information session was provided to all patients who were about to initiate chemotherapy as a group. Despite this, a lack of knowledge about treatment-specific adverse effects was evident through the patients’ expectation of experiencing severe alopecia and debilitating fatigue with their proposed treatment. At this phase of the treatment journey, patients’ knowledge was heavily based on perception. Witnessing relatives and friends’ cancer experiences affected patients’ attitude towards chemotherapy by expecting a challenging treatment journey. However, this patients’ negative perception towards treatment was outweighed by their expected treatment’s curative potential. Conclusion and relevance Being aware of patients’ perceptions towards colorectal cancer and its management with chemotherapy may assist healthcare professionals in addressing misperceptions and irrational fear. Pharmacists, being experts in medicines, are well-positioned to conduct individual counselling using patient-tailored treatment-specific information prior initiation of treatment.