Strength in Struggle: A Qualitative Interpretative Meta-Synthesis of Older Adults' Experiences Undergoing Cancer Treatment

Background: The burden of a cancer diagnosis falls predominantly on older people with almost half of all new diagnoses occurring in people aged >70 years. Research has revealed that older people with cancer struggle by the loss of self-identity, self-esteem, and expression of personal desires. About 44% older cancer patients experiences psychological distress, and among these 40% have anxiety symptoms/disorders. There has been an increase in qualitative studies on the lived experiences of older adults with cancer, but there is a recognizable gap of literature synthesis of the knowledge gained from these existing studies. Thus, the aim of this study was to examine the lived experiences of older adults’ who are undergoing cancer treatment using a qualitative interpretative meta-synthesis (QIMS).

Methods: A QIMS was deemed appropriate for this study due to its approach to synthesize from several qualitative studies to have an in-depth understanding and analysis of a phenomenon while maintaining the integrity of the original studies. A comprehensive literature search yielded 425 potentially relevant studies. Of these, a total of seven studies met the inclusion criteria for the QIMS. The total sample included 111 older adults (aged 55-95) from China, United States, United Kingdom, Netherlands, Norway, and Canada.

The QIMS process included developing a research question, creating a strategic sampling structure, analysing the data (i.e., theme extraction, theme synthesis, and triangulation), and establishing roles and credibility of the authors. The first author extracted the original themes followed by the initial analysis of participant quotes within each original study using a coding application, Dedoose. The first and second author met multiple times over the course of four weeks to reach a mutual agreement on the translation of the initial codes into new, overarching themes.

Results: The analysis generated four themes: (1) learning to live with cancer: participants described their broad range of experiences while coming in terms of living with cancer at an old age, such as coping with pain, discomfort and almost learning to re-live again; (2) patients’ experience on receiving care: a significant barrier identified in all seven studies was the lack of appropriate care and healthcare support for the participants and several raised their concerns and difficulties that they underwent during their treatment; (3) Independence and Autonomy: Participants mentioned their desire for independence despite the illness which holds a significant impact in their lives and how having a sense of control in their lives directly helps them in maintaining their autonomy., and (4) Embracing uncertainty amidst diagnosis: This theme highlighted the uncertainty, unpredictable nature of the illness and existential contemplations that accompany a cancer diagnosis, and how it affected their decision-making in daily life.

Conclusion and Implications: Results of the QIMS highlighted the need for healthcare systems that prioritizes patient-centered care and comprehensive support services for older adults with cancer, and to enhance provider training and integrated care models. The study also recommends on adapting more holistic care which encompasses physical and psychosocial aspects to improve outcomes and quality of life for older adults with cancer.