Outcomes 1. Describe the most common health-illness transitions experienced by patients with pancreatic cancer 2. Describe the relationship between management of health-illness transitions and psychological distress Original Research Background Health-illness transitions (HITs) include care transitions (changes in cancer status, treatment, or goals of care) and personal transitions (physical, emotional, social, or spiritual changes). Management of HITs is an important self-management skill because unmanaged HITs can increase distress. HITs experienced during pancreatic cancer have not been previously described, and patients with pancreatic cancer may have an abbreviated opportunity to learn self-management of HITs. Research Objectives To elucidate how patients with pancreatic cancer experience and manage HITs and whether HITs are associated with distress. Methods We enrolled patients with pancreatic cancer undergoing chemotherapy at Memorial Sloan Kettering Cancer Center. We assessed extent and management of HITs via the Measurement of Transitions in Cancer Scale and evaluated psychological distress via the Distress Thermometer (DT). Open-ended questions explored transitions not captured by the existing scale and the influence of COVID-19 on experience and management of HITs. Descriptive statistics were used to summarize demographic and clinical characteristics, HIT variables, and distress scores. We calculated Spearman's correlations between distress and unmanaged transitions and used thematic analysis for examination of qualitative data. Results Among 55 participants (median age = 70;98% pancreatic adenocarcinoma;median time since diagnosis = 4 months), all experienced at least 1 HIT and managed transitions moderately well. Physical (95%) and emotional (93%) transitions were most common. Unmanaged transitions and distress were correlated;severely distressed participants (7-10 on the DT) reported more HITs and worse management. Participants suggested new transition types: financial and caregiver. COVID-19 increased distress and complicated transition management. Participants reported that HITs made self-management more difficult and identified facilitators and barriers. Conclusion Patients with pancreatic cancer experience multiple HITs, which, when unmanaged, are associated with distress. Implications for Research, Policy, or Practice Findings about HITs can inform interventions targeting self-management skill building to alleviate distress and improve quality of life among patients with pancreatic cancer. Because HITs may vary for patients with different cancers, cancer-specific examination and intervention development will be needed.
Health-Illness Transition Experiences Among Patients with Pancreatic Cancer