Risk of Recurrence after Lung Cancer: A Multiple Case Study of Communication

Surgical treatment of early stage lung cancer offers the best chance of long-term survival, either on its own, or as part of multi-modality treatment. However, the potential for future recurrence of cancer is a realistic concern and increases strongly by cancer stage. Research findings around information needs of patients with cancer are complex and contradictory and few studies have included patients with early stage lung cancer. This study explores communication regarding risk of recurrence following lung cancer surgery using a qualitative multiple case study approach. Purposive sampling identified twelve cases centred on patients with a range of lung cancer stages and management plans. Case studies began at first post-surgical consultation and continued for six months after surgery. Patient participants followed two distinct treatment pathways after surgery, either straight into long-term follow-up, or to see an oncologist to discuss adjuvant treatment. Data collection included audio recordings of consultations, in-depth interviews with patients and their associated professionals, and collection of documentary evidence. Data were analysed using a Framework approach, with latent themes developed at a higher level using Thematic Analysis techniques. This multi-perspectival dataset gave rich, longitudinal insights into communication around recurrence risk following lung cancer surgery. Three overarching themes were developed: ‘Predicting the Future’, ‘Maintaining hope’ and ‘Hope Dances’. Fundamentally different conceptions of long-term outcome were seen amongst patient and professional participants. Discussion of recurrence risk was generally minimised during observed consultations. However, patients with more favourable prognoses tended to have more explicit discussions around the subject. Patients and professionals shared an imperative to maintain patient hope, which powerfully determined how potential recurrence was discussed. Participants engaged in active strategies to support hope, which included tacit co-construction of hope for the future. Findings are considered in terms of the clinical communication implications, supporting patients after treatment finishes and the need for further research.