It’s all about the CA-19-9. A longitudinal qualitative study of patients’ experiences and perspectives on follow-up after curative surgery for cancer in the pancreas, duodenum or bile-duct

Abstract

Background: Patients undergoing curative surgery for cancers of the pancreas, duodenum or bile ducts currently attend follow-up at specialized centers. Traditionally, follow-up after cancer has focused on cancer relapse. The Danish Health and Medicines Authority has recently pushed for a wider focus incorporating patients’ individual needs and concerns during cancer rehabilitation. We aimed to explore patients’ experiences of and perspectives on the rehabilitative scope of the current follow-up within the first year after curative treatment.

Material and methods: A qualitative longitudinal design was undertaken with individual semi-structured interviews. We included twelve patients attending current follow-up after treatment for cancer in the pancreas, duodenum or bile-duct. We interviewed the patients three times over a period of 9 months. Data were analyzed longitudinally using inductive content analysis.

Results: The patients experienced the cancer antigen (CA-19-9) as the center piece of follow-up, with consultations revolving largely around the CA-19-9 results. Parallel to and independent of follow-up, the patients described an array of creative strategies for adapting to their altered bodies and new life situation. The strategies included homemade endeavors to minimize gut symptoms, for example mint tablets or dairy products without lactose: realizing life-long dreams and resolving financial matters; confiding with likeminded outside the family or professionals outside the hospital. First encounters with HCPs were critically important with bad first encounters haunting patients throughout follow-up and good first encounters facilitating trust and reciprocity between patients and HCPs.

Conclusion: Patients in this study perceived detection of relapse through CA-19-9 as the focal point of follow-up, leaving other patient-important symptoms insufficiently addressed. We may, therefore, consider not using this relatively unprecise marker for relapse in the future. Balancing clinicians’ needs to diagnose relapse with patients’ needs for rehabilitation warrants attention in clinical practice and future research.

Acknowledgments

The authors would like to thank the patients who so generously shared their experiences in the interviews. The authors also wish to acknowledge the nurses in the ambulatory for recruiting patients and Laura Lauridsen for transcribing the interviews. Finally, the authors thank The Novo Nordisk Foundation and Copenhagen University Hospital Rigshospitalet for funding the study.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by The Novo Nordisk Foundation; under Grant nos. [NNF15OC0017022] and [NNF16OC0022680]; and Copenhagen University Hospital Rigshospitalet under Grant no. [PSP E-22647-02].