Sibeoni et al.

BMC Cancer (2018) 18:951

https://doi.org/10.1186/s12885-018-4868-6

RESEARCH ARTICLE Open Access

Patients’ quality of life during active cancer

treatment: a qualitative study
Jordan Sibeoni1,2* , Camille Picard3,4, Massimiliano Orri2,5, Mathilde Labey2,6, Guilhem Bousquet7,8,
Laurence Verneuil2 and Anne Revah-Levy1,2

Abstract
Background: Patients’ quality of life has become a major objective of care in oncology. At the same time, it has
become the object of increasing interest by researchers, working with both quantitative and qualitative methods.
Progress in oncology has enabled more patients to survive longer, so that cancer is increasingly often a chronic
disease that requires long-term treatment that can have negative effects on patients’ quality of daily life. Nonetheless,
no qualitative study has explored what patients report affects their quality of daily life during the treatment period. This
study is intended to fill this gap.
Methods: We conducted a multicenter qualitative study based on 30 semi-structured interviews. Participants,
purposively selected until data saturation, had diverse types of cancer and had started treatment at least 6 months
before interview. Data were examined by thematic analysis.
Results: Our analysis found two themes: (1) what negatively affected for patient’s quality of daily life during the
treatment period, a question to which patients responded by talking only about the side effects of treatment; and (2)
what positively affected their quality of daily life during the treatment period with three sub-themes: (i) The interest in
having —investing in — a support object that can be defined as an object, a relationship or an activity particularly
invested by the patients which makes them feel good and makes the cancer and its treatment bearable, (ii)The
subjective perception of the efficacy of the antitumor treatment and (iii) the positive effects of relationships, with
friends and family, and also with their physician.
Conclusions: Patients must be involved in their care if they are to be able to bear their course of treatment and find
ways to endure the difficult experience of cancer care. The support object represents an important therapeutic lever
that can be used by their oncologists. They should be interested in their support objects, in order to support the
patients in this investment and to help them to maintain it throughout the health care pathway. Furthermore, showing
interest in this topic, important to the patient, could improve the physician-patient relation without using up very
much of the physician’s time.
Keywords: Qualitative research, Oncology, Care, Physician-patient relationship, Quality of life

* Correspondence: jordan.sibeoni@ch-argenteuil.fr
Jordan Sibeon and Camille Picard have contributed equally to this article.
Laurence Verneuil and Anne Revah-Levy are co-senior authors.
1
Service Universitaire de Psychiatrie de l’Adolescent, Argenteuil Hospital
Centre, 69 rue du LTC Prud’hon, 95107 Argenteuil, France
2
ECSTRRA Team, UMR-1153, Inserm, Paris Diderot University, Sorbonne Paris
Cite, Paris, France
Full list of author information is available at the end of the article

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Sibeoni et al. BMC Cancer (2018) 18:951 Page 2 of 8

Background effects during this period [22]. This phase of curative

In the field of oncology, medical advances and the devel- treatment, before the questions of survival and of pallia-
opment of evidence-based medicine (EBM) have produced tive care arise, also affects patients’ quality of daily life.
major progress in terms of both survival and quality of Based on an exploration of the daily life of patients
care. At the same time, patients’ quality of life (QoL) has during the active treatment period, this qualitative study
become a major objective of cancer care, considered by aimed to explore what affected their quality of daily life,
some authors to be the leading patient-reported outcomes either during the treatment or in their daily life.
for all treatment in this field [1].
There is accordingly a substantial literature on QoL
and the health-related QoL of patients with cancer. It Methods
has primarily focused on: This exploratory national multicenter study involved
oncology departments at three university hospitals, two
– the impact on QoL of specific types of cancer [2–4]; located in the Paris area (Saint-Louis Hospital, Paris, and
or a specific treatment by surgery, radiation therapy, Avicenne Hospital, Bobigny), and one in northern France
chemotherapy, or hormonal therapy [5–7]; (Caen). The study design is detailed in Table 1. We used a
– psychosocial interventions aimed at improving the qualitative methodology: sampling was purposive [23],
QoL of cancer patients [8, 9]; data were collected from individual interviews, and data
– factors associated with QoL in cancer patients: saturation was achieved according to the principle of the-
anxiety and depression [10], coping strategies [11], oretical sufficiency [24]. The analysis, aided by Nvivo 11
physical exercise [12], and finances [13]. software, used a thematic approach [25], Table 2 summa-
rizes the different stages of our thematic analysis. This
QoL in oncology is explored principally among two study complies with the SRQR guideline [26].
populations of patients: those with cancer at an ad- In the results that follow, extracts of the transcripts
vanced stage or in palliative care [14, 15] and survivors have been selected to exemplify the themes described.
of specific types of cancers [16, 17]. All personal information has been removed, to protect
Moreover, in these studies, the term Qol is understood the confidentiality of the participants. The verbatim ac-
as the results of quantitative measures to assess levels of count has been freely translated into English for the sole
wellness of the patient are the quality of life, that is to purposes of this article.
quantify the impact of a cancer using a psychometric ap-
proach and several concepts such as for instance physical Results
functioning, role-physical, bodily pain, general health per- We included 30 patients. All of the patients asked for
ceptions, vitality, social functioning, role-emotional, and interviews agreed to participate. Table 3 presents their
mental health [18]. social and clinical characteristics. Our sample was 57%
Exploring the quality of life of patients with cancer female (M = 13, F = 17) and had a mean age of 63.5 years
also requires to take an interest in their daily lives and - from 31 to 77 years old-. The median time since diag-
to focus directly on their views. That requires to con- nosis was 4 years, and all patients had undergone several
sider quality of life otherwise, based on the subjective different treatments.
experience of the patients’ day-to-day lives, what we The presentation of our results is structured by two
chose to name quality of daily life. themes: (1) what negatively affected for their quality of
Qualitative methods are useful in this context, aiming as daily life during the treatment period, a question to
they do to describe and understand complex phenomena which patients responded by talking only about the side
in greater depth [19]. They are a tool of choice for focus- effects of treatment; and (2) what positively affected
ing on the views of patients directly in their context. Yet, their quality of daily life during the treatment period:
qualitative methods are rarely used among patients with use of a support object/activity during the treatment
cancer to address the views of cancer patients about their period, antitumor treatment, and relationships.
quality of daily life, again principally among survivors or
those in advanced-stage or palliative situations [20, 21].
To our knowledge, no study has ever explored how What negatively affected for quality of daily life:
cancer patients experience their quality of daily life dur- Treatment side effects
ing the treatment period. Their increased survival due to The adverse effects of antitumor treatments
advances in oncology has led to longer, chronic disease The patients included in our study found the adverse
and requires them to be in treatment for longer periods, effects of antitumor treatments difficult to live with.
with an accompanying risk of impaired quality of life on First, they dreaded these effects, especially those due to
a daily basis and long-term physical and psychological chemotherapy.
Sibeoni et al. BMC Cancer (2018) 18:951 Page 3 of 8

Table 1 Design of the study Table 1 Design of the study (Continued)

Qualitative approach Phenomenology Qualitative approach Phenomenology
Research paradigm Constructivism ° Audio-recorded with participants’ permission
° Transcribed literally into verbatim.
Ethical issues The Paris-Descartes University review board
° Anonymized
(CERES) approved the research protocol (IRB
number: 20140600001072). All participants Interviewers Experienced qualitative researchers
provided written informed consent. - A psychologist (MO)
- Two psychiatrists (JS, ML)
Sampling strategy Purposive sampling strategy with maximum
variation: Duration of From 60 to 90 min.
- To include patients that differed with respect interviews
to cancer site and type, stage, duration of
treatment and age. Data analysis Thematic analysis:
- To identify, analyze and report themes within
- To “challenge” the findings continuously by
data (a theme = a label that summarizes the
including participants who might invalidate
what was previously found. essence of a number of related codes)
- To identify the similarities and the differences
Recruitment strategy - Inclusion criteria were discussed with physicians in the participants’ narratives.
of the oncology departments where recruitment - To discern recurrent patterns and to integrate
was planned. new elements that emerged from the analysis
- With respect with maximum variation purposive - Data-driven analysis with inductive approach
sampling strategy, physicians were asked to = coding the data without any reference to
identify 3 to 5 suitable patients who met the theoretical notions or researcher’s
inclusion criteria preconceptions.
- Physicians mentioned the study to potential
participants and gave them an information Criteria to ensure Analysis conducted independently by three
sheet about it. validity researchers (JS, MO, ML)
- To verify that the themes identified were an
- Researchers met the interestesed patients
exact reflection of the data.
° To describe the study
° To collect social and demographic data Research group monthly meetings:
° To obtain their written consent. - To discuss the results
- To be supervised by two researchers more
Participants Inclusion criteria: distant from the material (ARL, LV).
- Age: 18 years or older (no upper limit) - After negotiation of disagreements and
- Treatment started at least 6 months before discrepancies within the research team during
interview regular meetings, consensus was reached on
- Able to communicate in French all findings.
Exclusion criteria
- Age: < 18 years
- In the terminal phase (expected survival less
than 6 months)
Data saturation Data saturation according to the principle of P3: “It's true that I was very afraid of chemotherapy. I
theoretical sufficiency: said to myself that everyone who has chemo, they are
- When new participants were not adding very sick. They vomit. I told myself, I'm going to lose
anything significant to the database
- When the themes obtained offered a sufficient my hair, I'm going to lose weight, I'm going to vomit.
explanatory framework in view of the data I'm not going to eat.”
collected.
- Two further individual interviews were
conducted with no new themes emerging, P4: “All that I knew about chemo was from movies in
so to ensure full data saturation. the 1980s where people were as sick as dogs all the
Data collection Between November 2014 and June 2015 time for weeks.”
period
Data collection Individual semi-structured interviews: Then they complained about the side effects, such as
methods - To get rich and detailed personal data from nausea and vomiting or asthenia, which strongly affected
each participant
- Interactive conversational style
their day-to-day quality of life. They also reported that
- Using a list of area of experience: they were unable to accomplish the tasks of daily living
° Topic 1: Story of the illness (beginning of or to do any leisure activities.
the story)
° Topic 2: exploration of daily life during the
treatment period P10: “I could never go back to the work I did before, I
▪ At home wouldn't have the energy.”
▪ In relationships
▪ At work (if maintained)
▪ In treatment P12: “Chemo is so powerful and so noxious at the
- All interviews were: same time that really, what a bitch when you see
° Conducted in a private room in the hospital
of treatment
the side effects. I couldn't do my errands, couldn’t
go shopping or to the movies for months.”
Sibeoni et al. BMC Cancer (2018) 18:951 Page 4 of 8

Table 2 Thematic analysis

Activities Rationale
Stage 1 Repeatedly read each transcript, as a whole Obtain a global picture of the interview and become familiar with the
interviewee’s verbal style and vocabulary.
Each new reading of the transcript might also provide new perspectives.
Stage 2 Code the transcript by making notes corresponding to Pay particular attention to linguistic details and the vocabulary used by the
the fundamental units of meanings. participant, for instance when he/she uses a metaphor to explain or name a
phenomenon, in order to make inductive descriptive notes using the
participant’s own words.
Stage 3 Make conceptual notes through processes of condensation, Categorize initial notes and reach a higher level of abstraction.
abstraction, and comparison of the initial notes.
Stage 4 Identify initial themes. Themes are labels that summarize the essence of a number of related
Provide text quotes that illustrate the main ideas of each conceptual notes. They are used to capture the experience of the
theme. phenomenon under study.
Stage 5 Identify recurrent themes across transcripts and produce Move from the particular to the shared across multiple experiences. Recurrent
a coherent ordered table of the themes and sub-themes. themes reflect a shared understanding of the phenomena among all
participants.
During this more analytic stage, researchers try to make sense of the
associations between the themes found.

Finally, they lamented the persistent sensory effects, What positively affects the quality of daily life
such as the loss of a sense of taste, and those that impaired Patients’ narratives about what allowed them to maintain
their self-image, such as the loss of hair, mentioned as a good quality of daily life on a daily basis during treat-
often by men as by women. ment were richer and more varied. They emphasized three
different aspects:
P17: “I had chemo, hard chemo. It made my hair fall
out, it destroyed everything it went through. If you talk – (i) The interest in having —investing in — a support
about the effects of chemo, it's the hair, and then the object. We have chosen to translate the French
nails, and gastrointestinal problems.” idiom “objet d’étayage” by the English term Support
object. “Objet d’étayage”/support object can be
defined as an object, a relationship or an activity
The paradoxical experience of adverse effects particularly invested by the patients in their daily
We also found a paradoxical experience around these lives, which makes them feel good and makes the
side effects. Simultaneously, chemotherapy made them cancer and its treatment bearable.
feel bad and had numerous burdensome effects, but – (ii) Their subjective perception of the efficacy of the
these also became an indicator of its therapeutic antitumor treatment also exerted a positive impact
efficacy. on their quality of daily life.
– (iii) The positive effects of relationships.
P20: “It destroys the diseased cells, with an impact
that we call side effects, collateral damage.”
The support object
P29: “What matters is the result. We know that chemo Most of the patients had an activity or relationship
kills good cells, but it also kills the bad ones.” especially important to them that was good for them
and helped them to live better with their disease and
Similarly, we observed patients’ ambivalence toward its treatment. This real function of this object was to
invasive treatment such as surgery, experienced as support them.
burdensome and dangerous but also as radical and
more effective. P1: “My camping car. That's what saved me. I love to
travel! Roaming, I love it.”
P23: “I had a rotten bladder, they took it out, but the
party goes on, if I can say it like that.” For some patients, this was a regular physical activity.
They described a physical effect, that is, an awareness
P28: “The lung operation was hard to stand, you of their physical capacity. They also mentioned a mo-
don't recover just like that, but then, afterwards, it ment of escape, where they were not thinking about
went better.” their disease and, for those who did team sports, the
Sibeoni et al. BMC Cancer (2018) 18:951 Page 5 of 8

Table 3 Summary of participants P10: “What helped me most was all the beautiful
n (%) performances I saw, which are still like a small fire
Gender, women 17 (57) inside me.”
Age, mean y 63,5
For others, it could be work, or religious or spiritual
30–40 3 (10)
practice, or meditation.
40–50 5 (17)
50–60 6 (20) P7: “I'm a deputy mayor in my municipality; [the
60–70 9 (30) cancer] doesn't keep me from going to spend two hours
≥ 70 7 (23) a day at city hall and participating in town council
Cancer type
meetings. I live normally.”
Breast carcinoma 9 (30)
P30: “Yoga with its Hindu philosophy, it really puts
Lung carcinoma 1 (3) things in perspective.”
Melanoma 7 (23)
Skin lymphoma 6 (20)
Bladder/kidney carninoma 3 (10) Subjective perception of the effectiveness of antitumor
Prostate carcinoma 1 (3)
treatment
What positively affected patients’ quality of daily life, ac-
Testis germ cell cancer 1 (3)
cording to them, was perceiving that their antitumor
Ovaries 2 (7) treatment was effective. They had a representation of
Disease stage cancer treatment as a battle against the disease; treat-
Metastatic 14 (47) ment was perceived as effective if it halted the disease
Localized 16 (53) and ineffective if it did not.
Treatment recieved
P11: “Chemo, that helped me. Stopped the bad stuff.”
Intravenous chemotherapy only 6 (20)
Intravenous chemotherapy + others 19 (63) P7: “I cannot say that the treatment is helpful today,
Oral chemotherapy, other treatments 5 (17) because I have more lesions today than I did two
Duration of cancer treatment period months ago.”
Less than 1 year 6 (20)
1 to 3 years 6 (20)
Some patients relied on and appropriated clinical or
paraclinical efficacy criteria, such as tumor size on im-
3 to 5 years 12 (40)
aging or the lab measurements of tumor markers.
More than 5 years 6 (20)
Recruitment site P2: “When the PSA goes down, I'm in a better mood, it
Paris St Louis Hospital 15 (50) makes me happy.”
Bobigny, Avicenne Hospital 3 (10)
Caen, university hospital centre 12 (40)
The type of treatment also influenced the perception
of efficacy. Patients found it easier to perceive surgical
treatment as effective. Patients described surgery as a
ability to maintain a social association outside of a one-time procedure with generally a curative objective:
health context. total ablation of the tumor.

P27: “I began to play golf too: to let go and not think P18: “As soon as they told us the day after the
about anything. And that, it was really good. It's always operation that it had succeeded, all we had to do was
really good, it lets you think only about yourself, already, wait to get better. Finally it wasn't so awful.”
a little, and to escape from all that. It lets you really
concentrate, to empty your head and not think about Inversely, patients perceived the unavailability of surgi-
anything but yourself.” cal treatment as inefficacy.

For other patients, it was a hobby or traveling, again P5: “But they didn't operate on me. Because otherwise,
something that let them take themselves out of the every- I said, take off both breasts and we're done. But
day and escape from the disease and from treatment. apparently it wasn't possible, it was inoperable.”
Sibeoni et al. BMC Cancer (2018) 18:951 Page 6 of 8

Relationships P18: “Twice I had a roommate who I got along well

Relationships had an important place in patients’ with, who I talked to. Yes that helps pass the time, it's
discourse. always nice.”
The presence of family and close friends was very im-
portant for the patients, so that they were not alone and
so that they had support during treatment, and also in Discussion
their daily life. Our results are structured around the dialectic with, on
the one hand, what negatively affected quality of daily
P3: “What's sure is I had my friend. He came each life, which for all patients was always only the side ef-
time I had chemo. He was with me. It's true that, if I fects of treatment, and on the other hand, what had a
had been all alone, at home, it would have been positive effect on quality of daily life, including a support
harder. He helped me.” object or activity, the perceived efficacy of the treatment,
and relationships.
The relationship with the physician was also very import- The only topic covered in the patient’s narratives of
ant. What was helpful, according to the patients, was the things that negatively affected their quality of daily life was
establishment of a trusting relationship with the physician side effects, which recurred over and over, invading their
together with the latter’s involvement and availability. discourse throughout the interviews. Both the ubiquity
and the invasiveness of side effects in the patients’ experi-
P10: “I know that he is someone who is very ence lead us to discuss two specific points: the potentially
committed, very involved, who won't let me down.” post-traumatic dimension of this experience of side effects
and the importance of daily life for the patients.
Patients were also very sensitive to the physician’s abil- Several studies have found a relatively substantial fre-
ity to listen and to reassure. quency of post-traumatic symptoms, and even of full
post-traumatic stress disorder (PTSD) in patients with
P17: “And it's also the difference between a good and a cancer [27]. PTSD is a mental health condition triggered
bad doctor, because behind that it means he’s by a traumatic event, either experienced or witnessed.
listening.” Symptoms include intrusive memories (flashbacks) and
uncontrollable thoughts about the event, nightmares,
The quality of the relationship appeared more import- avoidance reactions, severe anxiety, negative mood and
ant than the time spent with the patient or the informa- emotional reactions. PTSD cause significant social distress
tion provided. and can lead to other psychiatric issues such as depression
[28]. A meta-analysis found a lifetime prevalence of
P18: “I never need to spend very long with a doctor, cancer-related PTSD of 12.6% [29]. The adverse effects of
finally. I often go right to the essential part. We all know antitumor treatments are reported to be a potentially de-
that we're not the only person they are taking care of, terminant factor of these symptoms but are not consid-
but, no, I never had the impression I'm being rushed.” ered as a separate experience in the patient’s history. Our
results suggest, nonetheless, that the experience of the
The patients also reported positive effects of a conviv- side effects of antitumor treatment in these patients could
ial and sympathetic treatment environment, directly as- have a specific post-traumatic dimension, and could be
sociated with their relationship with the health care considered as a traumatic stressor [30], that may thus re-
team and especially the nurses. quire targeted screening, evaluation, and interventions.
There is a substantial literature describing the influence
P17: “Support from the nurses has always been great. I of these side effects on treatment decisions [31] as well as,
don't know how they do it, but they manage to say especially, their negative impact on patients’ QoL [32–34].
something nice to everyone. To show their interest, and Prolonging treatment and focusing only on survival, does
even to remember people.” not meet all patients’ needs [35]. In our results, the
patients underlined the importance of living with cancer
Finally, relationships with the other patients were also on a day-to-day basis, that is, not only living as long as
experienced as helpful, when it provided hope, mutual possible, but also as well as possible in their everyday life.
assistance, and friendliness. The importance of interpersonal relationships and of the
quality of the physician-patient relationship has been
P4: “She told me she had had a remission for 18 years. known and reported repeatedly in the literature [36, 37].
But suddenly, there was hope. If she could have 18 Our results describe an original aspect of what directly and
years, I can too.” positively affects patients’ quality of daily life: involvement
Sibeoni et al. BMC Cancer (2018) 18:951 Page 7 of 8

with a support object. The support object, in our opinion, sample was 4 years. Our results might not be relevant for
represents an important therapeutic lever that can be used patients who have just started treatment. Further qualita-
to improve the physician-patient relationship. That is, tive studies should be made to address this specific period
when patients are able to choose and be involved with a of time. Finally, our results don’t mention the influence of
support object or activity, the physician must support them age on the quality of daily life. Further qualitative studies
and converse with them on this topic. with specific age populations should be made to explore
the extensive role age plays in this matter.
Clinical implications
Numerous studies have showed that physicians fail to take Conclusion
the spiritual and religious concerns of their severely ill pa- Quality of life is a daily concern for patients during cancer
tients into account [38], despite the demonstrated benefits treatment. This qualitative study provides access to patients’
in terms of patients’ satisfaction and the importance of experience of their care and daily lives, allowing us to see
these aspects to their QoL [39]. In the field of cancer care, cancer care through the patients’ eyes. In their daily clinical
physicians should be interested in their patients’ support practice, doctors face multiple constraints – of time and
objects, whatever they are. First, this allows doctors to workload —that hinder them from taking their patients’
support the patients in their investment in this object and subjective health status into account. We suggest as a start
to help them maintain this investment throughout the that they include in their practice a systematic interest for
health care pathway. Second, showing interest during the support object that their patients have chosen.
visits in this topic, important to the patient, and convers-
Abbreviations
ing about it could help to establish a trusting relationship EBM: Evidence Based Medicine; PTSD: Post-traumatic stress disorder;
and therefore, according to our results, improving his or QoL: Quality of life
her quality of daily life, without using up very much of the
Acknowledgements
physician’s time. That is, with the increasing transform- We would like to thank all the patients for their participation in this study.
ation of cancer into a chronic disease comes the need for We also want to thank Jo Ann Cahn for the translation in English.
a different kind of relationship, one in which physicians
Funding
can fulfill the relational needs of care. The issue here is The study was supported by Grant No. 00050334 from the Fondation de
not that oncologists should replace psychologists or psy- France, “Soigner, soulager, accompagner” 2014.
chiatrists [40], but rather that they have a relational tool
Availability of data and materials
that enables them to support the patient in their manage- The datasets analyzed during the current study are available from the
ment of a serious and very trying chronic disease and thus corresponding author on reasonable request.
to help them to maintain their quality of daily life. We
Authors’ contributions
chose to focus on patients’ daily life during their treatment JS, LV, ARL conceived and designed the study; JS, CP, MO, ML collected the
period. This differs from, and is complementary with, data; JS, CP, MO, ML, GB, LV, ARL analyzed the data; JS, LV, ARL wrote the
others approaches such as shared decision making [41] or paper. All authors had full access to all of the data in the study and take
responsibility for the integrity of the data and the accuracy of the data
self-management [38], that also seek to improve patients’ analysis. All authors read and approved the final manuscript.
quality of daily life and patient-physician relations.
Ethics approval and consent to participate
The Paris-Descartes University review board (CERES) approved the research
Study limitations
protocol (IRB number: 20140600001072). All participants provided written in-
Our qualitative study took place in three different cen- formed consent.
ters and included patients with various types of cancer.
These points make our findings transferable to other Consent for publication
Not applicable.
cancer contexts. However, some limitations must be
taken into consideration. First, this took place in France, Competing interests
and caution is required in transposing our results to The authors declare that they have no competing interests.

other places, especially non-Western countries, because

cancer care depends strongly on the organization of the Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in
medical system as well as on the country’s economy. published maps and institutional affiliations.
Second, our recruitment process did not allow us to in-
clude patients who have dropped out of treatment or Author details
1
Service Universitaire de Psychiatrie de l’Adolescent, Argenteuil Hospital
those using complementary or alternative treatment, al- Centre, 69 rue du LTC Prud’hon, 95107 Argenteuil, France. 2ECSTRRA Team,
though they are relatively frequent in this clinical popu- UMR-1153, Inserm, Paris Diderot University, Sorbonne Paris Cite, Paris, France.
3
lation [42]. This might have limited our findings. Third, Department of Dermatology, Caen University Hospital, F-14033 Caen,
France. 4Université de Caen Normandie, Medical School, F-14000 Caen,
all patients had undergone several treatments for at least France. 5McGill Group for Suicide Studies, Douglas Mental Health University
6 months and the median time since diagnosis in our Institute, Department of Psychiatry, McGill University, Montreal, Canada.
Sibeoni et al. BMC Cancer (2018) 18:951 Page 8 of 8

6
EPSM Lille métropole, pôle de psychiatrie adulte 59g21, Lille, France. 21. Burke S, Wurz A, Bradshaw A, Saunders S, West MA, Brunet J. Physical
7
Université Paris 13 – Léonard de Vinci, Villetaneuse, France. 8AP-HP-Hôpital activity and quality of life in Cancer survivors: a meta-synthesis of qualitative
Avicenne, Service d’Oncologie médicale–Bobigny, Bobigny, France. research. Cancers. 2017;9(6):53.
22. Stein KD, Syrjala KL, Andrykowski MA. Physical and psychological long-term
Received: 8 February 2018 Accepted: 26 September 2018 and late effects of cancer. Cancer. 2008;112(S11):2577–92.
23. Patton MQ. Purposeful Sampling. Qualitative research & evaluation methods.
3rd ed. Thousand Oaks: Sage; 2002. p. 230–48.
24. Dey I. Grounding grounded theory: guidelines for qualitative inquiry. San
References Diego: Academic Press; 1999.
1. Sosnowski R, Kulpa M, Ziętalewicz U, Wolski JK, Nowakowski R, Bakuła R, 25. Braun V, Clarke V, Terry G. Chapter 7 thematic analysis. In: Qualitative
Demkow T. Basic issues concerning health-related quality of life. Cent Eur J research in clinical and Health Psychology- Poul Rohleder, Antonia C Lyons
Urol. 2017;70(2). Palgrave Macmillan,. Palgrave Macmillan; 2014.
2. Bennett BM, Wells JR, Panter C, Yuan Y, Penrod JR. The Humanistic Burden 26. O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for
of Small Cell Lung Cancer (SCLC): A Systematic Review of Health-Related reporting qualitative research: a synthesis of recommendations. Acad Med.
Quality of Life (HRQoL) Literature. Frontiers in Pharmacology. 2017;15(8). 2014;89(9):1245–51.
3. Korol EE, Wang S, Johnston K, Ravandi-Kashani F, Levis M, van Nooten F. 27. Mehnert A, Koch U. Prevalence of acute and post-traumatic stress disorder
Health-related quality of life of patients with acute myeloid leukemia: a and comorbid mental disorders in breast cancer patients during primary
systematic literature review. Oncol Ther. 2017;5(1):1–16. cancer care: a prospective study. Psycho-Oncology 2007; 1;16(3):181–188.
4. Walter T. Maintaining quality of life for patients with neuroendocrine 28. Zhen R, Quan L, Zhou X. Co-occurring patterns of post-traumatic stress
tumours. Lancet Oncol. 2017;18(10):1299–300. disorder and depression among flood victims: a latent profile analysis. J
5. Ganguli A, Wiegand P, Gao X, Carter JA, Botteman MF, Ray S. The impact of Health Psychol. 2018:135910531876350.
second-line agents on patients’ health-related quality of life in the 29. Abbey G, Thompson SBN, Hickish T, Heathcote D. A meta-analysis of
treatment for non-small cell lung cancer: a systematic review. Qual Life Res. prevalence rates and moderating factors for cancer-related post-traumatic
2013;22(5):1015–26. stress disorder. Psycho-Oncology 2015; 1;24(4):371–381.
6. Mutsaers A, Greenspoon J, Walker-Dilks C, Swaminath A. Systematic review of 30. Larsen SE, Berenbaum H. Did the DSM-5 improve the traumatic stressor
patient reported quality of life following stereotactic ablative radiotherapy for criterion?: association of DSM-IV and DSM-5 criterion a with posttraumatic
primary and metastatic liver cancer. Radiat Oncol. 2017;12(1). stress disorder symptoms. Psychopathology. 2017;50(6):373–8.
7. Siyam T, Ross S, Campbell S, Eurich DT, Yuksel N. The effect of hormone 31. Koedoot C g, de Haes J, Heisterkamp S, Bakker P, de Graeff A, de Haan R.
therapy on quality of life and breast cancer risk after risk-reducing salpingo- Palliative chemotherapy or watchful waiting? A vignettes study among
oophorectomy: a systematic review. BMC Womens Health. 2017;17(1). oncologists. JCO 2002 1;20(17):3658–3664.
8. RETURN TO BREAST Collaborative group, D’Egidio V, Sestili C, Mancino M, 32. Lemieux J, Maunsell E, Provencher L. Chemotherapy-induced alopecia and
Sciarra I, Cocchiara R, et al. Counseling interventions delivered in women effects on quality of life among women with breast cancer: a literature
with breast cancer to improve health-related quality of life: a systematic review. Psycho-Oncology 2008; 1;17(4):317–328.
review. Qual Life Res. 2017;26(10):2573–92. 33. Rosen AC, Case EC, Dusza SW, Balagula Y, Gordon J, West DP, et al. Impact
of dermatologic adverse events on quality of life in 283 Cancer patients: a
9. McLachlan S-A, Allenby A, Matthews J, Wirth A, Kissane D, Bishop M, et al.
questionnaire study in a dermatology referral clinic. Am J Clin Dermatol
Randomized trial of coordinated psychosocial interventions based on
2013 1;14(4):327–333.
patient self-assessments versus standard care to improve the psychosocial
34. Hershman D, Calhoun E, Zapert K, Wade S, Malin J, Barron R. Patients’
functioning of patients with Cancer. J Clin Oncol. 2001;19(21):4117–25.
perceptions of physician-patient discussions and adverse events with
10. Gonzalez-saenz de Tejada M, Bilbao A, Baré M, Briones E, Sarasqueta C,
Cancer therapy: patient perceptions of adverse events with chemotherapy.
Quintana JM, et al. Association between social support, functional status,
Arch Drug Inf. 2008;1(2):70–8.
and change in health-related quality of life and changes in anxiety and
35. Earle CC, Landrum MB, Souza JM, Neville BA, Weeks JC, Ayanian JZ.
depression in colorectal cancer patients: social support, functional status,
Aggressiveness of Cancer care near the end of life: is it a quality-of-care
HRQoL, and distress in CRC. Psycho-Oncology. 2017;26(9):1263–9.
issue? J Clin Oncol 2008 10;26(23):3860–3866.
11. Chirico A, Lucidi F, Merluzzi T, Alivernini F, Laurentiis MD, Botti G, et al. A
36. Song Y, Lv X, Liu J, Huang D, Hong J, Wang W, et al. Experience of nursing
meta-analytic review of the relationship of cancer coping self-efficacy with
support from the perspective of patients with cancer in mainland China:
distress and quality of life. Oncotarget. 2017;8:36800–11. https://doi.org/10.
nursing support for patients with cancer. Nurs Health Sci. 2016;18(4):510–8.
18632/oncotarget.15758.
37. Wei C, Nengliang Y, Yan W, Qiong F, Yuan C. The patient-provider discordance
12. Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK,
in patients’ needs assessment: a qualitative study in breast cancer patients
et al. Effects and moderators of exercise on quality of life and physical
receiving oral chemotherapy. J Clin Nurs. 2017;26(1–2):125–32.
function in patients with cancer: an individual patient data meta-analysis of
38. Best M, Butow P, Olver I. Doctors discussing religion and spirituality: a
34 RCTs. Cancer Treat Rev. 2017;52:91–104.
systematic literature review. Palliat Med 2016; 1;30(4):327–337.
13. Shao Z, Zhu T, Zhang P, Wen Q, Li D, Wang S. Association of financial status
39. Williams JA, Meltzer D, Arora V, Chung G, Curlin FA. Attention to inpatients’
and the quality of life in Chinese women with recurrent ovarian cancer.
religious and spiritual concerns: predictors and association with patient
Health Qual Life Outcomes. 2017;15(1).
satisfaction. J Gen Intern Med. 2011;26(11):1265–71.
14. Faguet GB. Quality end-of-life cancer care: an overdue imperative. Crit Rev
40. Jacobsen PB, Jim HS. Psychosocial interventions for anxiety and depression
Oncol Hematol. 2016;108:69–72.
in adult Cancer patients: achievements and challenges. CA Cancer J Clin.
15. Park S-A, Chung SH, Lee Y. Factors influencing the quality of life of patients
2008;58(4):214–30.
with advanced cancer. Appl Nurs Res. 2017;33:108–12.
41. Kehl KL, Landrum MB, Arora NK, Ganz PA, Van Ryn M, Mack JW, Keating NL.
16. Høxbroe Michaelsen S, Grønhøj C, Høxbroe Michaelsen J, Friborg J, von
Association of actual and preferred decision roles with patient-reported
Buchwald C. Quality of life in survivors of oropharyngeal cancer: a systematic
quality of care: shared decision making in cancer care. JAMA Oncol. 2015;
review and meta-analysis of 1366 patients. Eur J Cancer. 2017;78:91–102.
1(1):50–8.
17. The ACTION Study Group. Health-related quality of life and psychological 42. Hanlon P, Daines L, Campbell C, McKinstry B, Weller D, Pinnock H.
distress among cancer survivors in Southeast Asia: results from a Telehealth interventions to support self-management of long-term
longitudinal study in eight low- and middle-income countries. BMC Med. conditions: a systematic metareview of diabetes, heart failure, asthma,
2017;15(1). https://doi.org/10.1186/s12916-016-0768-2. chronic obstructive pulmonary disease, and cancer. J Med Internet Res.
18. Kaplan RM, Ries AL. Quality of life: concept and definition. J Chron Obstruct 2017;19(5).
Pulmon Dis. 2007;4(3):263–71.
19. Morse JM. Qualitative health research: creating a new discipline. Walnut
Creek: Left Coast Press; 2012. p. 176.
20. Jassim GA, Whitford DL. Understanding the experiences and quality of life
issues of Bahraini women with breast cancer. Soc Sci Med. 2014;107:189–95.