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Open Access Article

Identifying Primary Concerns in Patients Newly Diagnosed With Lung Cancer

Rebecca H. Lehto
ONF 2011, 38(4), 440-447 DOI: 10.1188/11.ONF.440-447

Purpose/Objectives: To compare illness concerns before and after surgery in patients newly diagnosed with early-stage lung cancer, and to determine whether perceived healthcare environment factors were associated with reduced concerns and cancer-related worry.

Design: Participants completed a semistructured interview using the conceptual content cognitive map (3CM) method. Important concepts were identified in a spatial array representative of a cognitive map of the illness.

Setting A comprehensive cancer center and a Veterans Affairs medical center in the midwestern United States.

Sample: 34 men (n = 22) and women (n = 12), aged 47-83 years (X = 65, SD = 10), with newly diagnosed lung cancer were interviewed at the time of diagnosis and again three to four weeks after surgery.

Methods: Content and frequency analysis and descriptive statistics were used to characterize the data. Correlation studies and paired t tests were used to determine relationships among the main study variables.

Main Research Variables: Illness perceptions, worry, and health environment experience.

Findings: Twelve primary content domains were identified pre- and postoperatively (seven negative and five positive). Cancer-related worry was related to negative content and to fears both before and after surgery. Positive health environment perceptions were related to positive content after surgery.

Conclusions: The findings demonstrate important areas of concern that can be targeted to reduce psychological distress and promote adaptation.

Implications for Nursing: The willingness of nurses to identify concerns, assist patients to participate in care, and identify strategies to manage unresolved issues early in the treatment trajectory is integral to optimize long-term adjustment.


American Cancer Society. (2010). <i>Cancer facts and figures, 2010</i>. Atlanta, GA: Author.

Borkovec, T.D., Alcaine, O.M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In R.G. Heimberg, C.L. Turk, & D.S. Mennin (Eds.), <i>Generalized anxiety disorder: Advances in research and practice</i> (pp. 77-108). New York, NY: Guilford Press.

Buchanan, D., Milroy, R., Baker, L., Thompson, A.M., & Levack, P.A. (2009). Perceptions of anxiety in lung cancer patients and their support network. Retrieved from <a target="_blank" href='http://www.springerlink.com/content/0w70385172956762/'>http://www.spring...

Chapple, A., Ziebland, S., & McPherson, A. (2004). Stigma, shame, and blame experienced by patients with lung cancer. <i>BMJ, 328</i>, 1470-1473. doi:10.1136/bmj.38111.639734.7C

Cimprich, B., & Ronis, D. (2003). An environmental intervention to restore attention in women with newly diagnosed breast cancer. <i>Cancer Nursing, 26</i>, 284-292. doi:10.1097/00002820-200308000-00005

Eheman, C.R., Berkowitz, Z., Lee, J., Mohile, S., Purnell, J., Rodriguez, E.M., … Morrow, G. (2009). Information-seeking styles among cancer patients before and after treatment by demographics and use of information sources. <i>Journal of Health Communication, 14</i>, 487-502. doi:10.1080/10810730903032945

Else-Quest, N.M. (2006). <i>The development of adaptive cognitions, guilt, and shame in cancer patients</i> (Doctoral dissertation). University of Wisconsin, Madison, WI. Retrieved from University of Michigan Microform 3222779, Ann Arbor, MI: Proquest Information and Learning Company.

Hamer, M., Chida, Y., & Molloy, G.J. (2009). Psychological distress and cancer mortality. <i>Journal of Psychosomatic Research, 66</i>, 255-258.

Hickey, G., & Kipping, C. (1996). A multistage approach to the coding of data from open-ended questions. <i>Nurse Researcher, 4</i>, 81-91.

Hill, K.M., Muers, A.Z., Connolly, K., & Round, C. (2003). Do newly diagnosed lung cancer patients feel their concerns are being met? <i>European Journal of Cancer Care, 12</i>, 35-45.

Jemal, A., Siegel, R., Xu, J., & Ward, E. (2010). Cancer statistics, 2010. <i>CA: A Cancer Journal for Clinicians, 60</i>, 277-300.

Kaplan, S., & Kaplan, R. (1981). <i>Cognition and environment</i>. New York, NY: Praeger.

Kearney, A.R., & Kaplan, S. (1997). Toward a methodology for the measurement of knowledge structures of ordinary people: The conceptual content cognitive map (3CM). <i>Environment and Behavior, 29</i>, 579-617. doi:10.1177/0013916597295001

Lerman, C., Trock, B., Rimer, B.K., Boyce, A., Jepson, C., & Engstrom, P.F. (1991). Psychological and behavioral implications of abnormal mammograms. <i>Annals of Internal Medicine, 114</i>, 657-661.

Li, J., & Girgis, A. (2006). Supportive care needs: Are patients with lung cancer a neglected population? <i>Psycho-Oncology, 15</i>, 509-516.

Maliski, S.L., Sarna, L., Evangelista, L., & Padilla, G. (2003). The aftermath of lung cancer: Balancing the good and the bad. <i>Cancer Nursing, 26</i>, 237-244. doi:10.1097/00002820-200306000-00011

Matsuoka, Y., Nakano, T., Inagaki, M., Sugawara, Y., Akechi, T., Imoto, S., … Uchitomi, Y. (2002). Cancer-related intrusive thoughts as an indicator of poor psychological adjustment at three or more years after breast surgery: A preliminary study. <i>Breast Cancer Research and Treatment, 76</i>, 117-124. doi:10.1023/A:1020572505095

McCaul, K.D., Branstetter, A.D., O'Donnell, S.M., Jacobson, K., & Quinlan, K.B. (1998). A descriptive study of breast cancer worry. <i>Journal of Behavioral Medicine, 21</i>, 565-579. doi:10.1023/A:1018748712987

McIllmurray, M.B., Thomas, C., Francis, B., Morris, S., Soothill, K., & Al-Hamad, A. (2001). The psychosocial needs of cancer patients: Findings from an observational study. <i>European Journal of Cancer Care, 10</i>, 261-269. doi:10.1046/j.1365-2354.2001.00280.x

Molina, J.R., Yang, P., Cassivi, S.D., Schild, S.E., & Adiel, A.A. (2008). Non-small cell lung cancer: Epidemiology, risk factors, treatment, and survivorship. <i>Mayo Clinic Proceedings, 83</i>, 584-594. doi:10.4065/83.5.584

Sink, K.K. (2001). <i>Perceptions, informational needs, and feelings of competency of new parents</i> (Doctoral dissertation). Retrieved from University of Michigan Microform 3001050, Ann Arbor, MI: Proquest Information and Learning Company.

Stark, D., Kiely, M., Smith, A., Velikova, G., House, A., & Selby, P. (2002). Anxiety disorders in cancer patients: Their nature, associations, and relationship to quality of life. <i>Journal of Clinical Oncology, 20</i>, 3137-3148. doi:10.1200/JCO.2002.08.549

Stefanek, M.E., Shaw, A., DeGeorge, D., & Tsottles, N. (1989). Illness-related worry among cancer patients: Prevalence, severity, and content. <i>Cancer Investigation, 7</i>, 365-371. doi:10.3109/07357908909039865

Sugimura, H., & Yang, P. (2006). Long-term survivorship in lung cancer: A review. <i>Chest, 129</i>, 1088-1097. doi:10.1378/chest.129.4.1088

Tishelman, C., Lövgren, M., Broberger, E., Hamberg, K., & Sprangers, M.A.G. (2010). Are the most distressing concerns with inoperable lung cancer adequately assessed? A mixed-methods analysis. <i>Journal of Clinical Oncology, 28</i>, 1942-1949. doi:10.1200/JCO.2009.23.3403

Uchitomi, Y., Nagai, K., Nishiwaki, Y., Akechi, T., & Okamura, H. (2003). Depression and psychological distress in patients during the year after curative resection of non-small cell lung cancer. <i>Journal of Clinical Psychology, 21</i>(1), 69-77.

Vodermaier, A., Linden, W., & Siu, C. (2009). Screening for emotional distress in cancer patients: A systematic review of assessment instruments. <i>Journal of the National Cancer Institute, 101</i>, 1464-1488. doi:10.1093/jnci/djp336

Vos, M.S., & de Haes, J.C. (2007). Denial in cancer patients, an explorative review. <i>Psycho-Oncology, 16</i>, 12-25. doi:10.1002/pon.1051

Weisman, A.D., & Worden, J.W. (1976-1977). The existential plight in cancer: Significance of the first 100 days. <i>International Journal of Psychiatry in Medicine, 7</i>, 1-15.

Zabora, J., BrintzenhofeSoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. <i>Psycho-Oncology, 10</i>, 19-28.