Development of a disease conceptual model of patient experience with metastatic colorectal cancer: identification of the most salient symptoms and impacts

PURPOSE: Patients with metastatic colorectal cancer (mCRC) experience multiple symptoms and impacts affecting their health-related quality of life. However, there is limited data on self-reported experience of the most relevant and bothersome aspects of patients living with mCRC. METHODS: Semi-structured interviews were conducted in patients with mCRC to identify and understand the signs, symptoms and impacts experienced. Patients were also asked to rate the level of bothersomeness for each concept reported on a scale ranging from 0 (“not bothersome at all”) to 10 (“extremely bothersome”). Verbatim transcripts were analysed following a thematic analysis approach. The most salient concepts were identified (i.e. reported by > 50% of patients with a bothersome rating ≥ 5 out of 10). RESULTS: Twenty-five patients (USA; age: 26 to 72 years old) were interviewed. Patients reported 58 signs and symptoms, amongst which 8 were considered salient: fatigue, nausea, neuropathy, diarrhoea, loss of appetite, constipation, weight loss, and abdominal pain; 35 impacts were identified, and 7 were considered salient: reduced ability to work, interference with daily activities, impact on cognitive functioning, financial impact, sleep changes, impact on social life and walking difficulties. The concepts identified helped refine a literature-based disease conceptual model of patient experience with mCRC. CONCLUSIONS: The interviews provided insights into the most bothersome and salient signs, symptoms and impacts affecting the HRQoL of patients living with mCRC. IMPLICATIONS FOR CANCER SURVIVORS: There is a need to improve clinical strategies for future clinical development and inform clinical practice decision-making for mCRC survivors.