title: Psychological burden on patients with cancer of unknown primary: from onset of symptoms to initial treatment.
abstract: OBJECTIVE
  Supportive care is a critical issue especially for patients with cancer of unknown primary since they often face serious situations, continuing to seek for relevant diagnosis and treatment with the primary sites unknown. However, there are only few research reports on this subject. The aim of this study was to clarify the experience on patients with cancer of unknown primary until they have their initial treatment and to obtain suggestions of supportive care for them.
  
  
  METHODS
  A qualitative study using semi-structured interviews regarding the experience on patients with cancer of unknown primary was conducted.
  
  
  RESULTS
  Data of the experience of the nine patients with cancer of unknown primary until their initial treatment were collected by semi-structured interviews. Patients' speech at interviews recorded in verbatim reports was assigned with 545 codes, 102 subcategories and 38 categories. Experience of the patients with cancer of unknown primary was categorized into five phases: Phase 1: period of making self-judgment on symptoms; Phase 2: period of suspecting serious disease, and seeking for appropriate medical treatment; Phase 3: period of searching for cause of disease while having painful symptoms and anxiety; Phase 4: period of having fear for death, frustration with unknown cause and denial of unknown state; Phase 5: period of struggling but being determined to face disease.
  
  
  CONCLUSIONS
  Experience of patients with cancer of unknown primary from onset of symptoms to their initial treatment was categorized into five phases, mainly manifesting their psychological burden. These findings will warrant for the future study of supportive care for patients with cancer of unknown primary.
authors.affiliation: Division of Nursing, Nagoya City University Hospital, Nagoya nrkyokyo@med.nagoya-cu.ac.jp.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Ishida
authors.affiliation: Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya.
authors.forename: Shoko
authors.initials: S
authors.lastname: Ando
authors.affiliation: Division of Chemotherapy, Nagoya City University Hospital, Nagoya.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Komatsu
authors.affiliation: Division of Chemotherapy, Nagoya City University Hospital, Nagoya.
authors.forename: Shiori
authors.initials: S
authors.lastname: Kinoshita
authors.affiliation: Division of Chemotherapy, Nagoya City University Hospital, Nagoya.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Mori
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Akechi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000523:psychology*; D036301:Qualitative Research
keywords: cancer of unknown primary; experience; psychological burden; supportive care