Patients with cervical cancer may under-report physical and emotional symptoms: a mixed-methods study of symptoms and quality-of-life to inform palliative care needs

Background: Despite high physical and emotional burdens, palliative care (PC) is underutilized in cervical cancer. There are limited data exploring patient perspectives on how treatments, symptoms and side effects contribute to PC needs. We investigated treatment experiences of patients with cervical cancer to determine potential PC strategies and intervention areas. Methods: We performed a convergent mixed methods study. Eligible patients were ≥18, English-speaking, with newly (≤12 months) diagnosed cervical cancer. Participants completed semi-structured interviews followed by the Functional Assessment of Cancer Therapy survey with cervix-specific sub-scale (FACT-Cx). Interviews were de-identified, professionally transcribed and coded. Descriptive statistics were performed for demographics and treatment information. Results: 17 patients participated. Most were white (11/17, 64.7%) and received radiation (11/17, 64.7%). Central interview themes were the significant impact of physical and emotional symptoms, a desire for on-going support services during periods of illness adjustment, and the high emotional toll of cervical cancer. Median scores on functional (18/28) and emotional (17/24) domains of the FACT-Cx were lowest. Pain and fatigue were the most reported symptoms. Patients disclosed more symptoms on the FACT-Cx than in interviews, particularly regarding mental health. Conclusions: Patients with recently diagnosed and treated cervical cancer reported high physical symptom burdens, rates of anxiety and depression, and need for social support. There was discrepancy in symptom reporting between qualitative and quantitative study components. Improved symptom screening, monitoring and assessment of psychosocial symptoms, and development of enhanced social support are priority areas in developing early integrated PC in this population.