title: Living with advanced cancer and an uncertain disease trajectory: an emerging patient population in palliative care?
abstract: OBJECTIVE
  This study explored how patients diagnosed with advanced cancer cope with an uncertain disease trajectory.
  
  
  METHODS
  27 patients with advanced cancer and with a prognosis of 12 months or more were recruited from the medical/radiation oncology and palliative care service at three metropolitan hospitals.
  
  
  METHODS
  A semistructured face-to-face interview was conducted. Interviews were audio-taped and transcribed verbatim. Data analysis was based on Grounded Theory using the constant comparison method.
  
  
  RESULTS
  Results indicate that patients cope by avoidance, remaining positive, maintaining as normal a life as possible, minimising the impact of the disease on their daily lives, comparing themselves favourably with others in a similar situation and focusing on the outcome of treatment to control disease progression. Most did not wish to discuss prognosis or have detailed information on disease progression.
  
  
  CONCLUSIONS
  Participants in this study represent an emerging cancer patient population who are receiving palliative therapies. While they have incurable cancer, they self-report as clinically well, they describe a good quality of life and the trajectory of their disease, while unpredictable, may extend over many months to years. Our study suggests that a flexible model of care is needed to support the needs of people who may still be receiving some form of chemotherapy and/or radiotherapy, and remain well. This model may need to take more of an intermittent approach, that is, as required for specific symptom management, rather than patients being linked continuously to a palliative care service for long periods of time.
authors.affiliation: Department of Palliative Care, Calvary Health Care Sydney, Kogarah, New South Wales, Australia Cunningham Centre for Palliative Care, Darlinghurst, New South Wales, Australia School of Medicine, University of Notre Dame Sydney, Darlinghurst, New South Wales, Australia.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Lobb
authors.affiliation: Department of Palliative Care, Calvary Health Care Sydney, Kogarah, New South Wales, Australia.
authors.forename: Judith
authors.initials: J
authors.lastname: Lacey
authors.affiliation: St. George Cancer Care Centre, St. George Hospital, Kogarah, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Kearsley
authors.affiliation: St. George Cancer Care Centre, St. George Hospital, Kogarah, New South Wales, Australia Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Winston
authors.initials: W
authors.lastname: Liauw
authors.affiliation: Department of Palliative Care, Calvary Health Care Sydney, Kogarah, New South Wales, Australia.
authors.forename: Lesley
authors.initials: L
authors.lastname: White
authors.affiliation: Department of Palliative Care, Calvary Health Care Sydney, Kogarah, New South Wales, Australia.
authors.forename: Annmarie
authors.initials: A
authors.lastname: Hosie
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D010166:Palliative Care; D011788:Quality of Life; D055815:Young Adult
keywords: Advanced Cancer; Models Of Care; Patient Coping; Uncertainty