A Conceptual Disease Model for Advanced/Metastatic Gastric or Gastroesophageal Junction Cancer (aGC/GEJC): Results From a Targeted Literature Review and Patient Interviews

OBJECTIVES: Despite approvals of first-line immunotherapies for aGC/GEJC, patients’ median survival is around 14 months and their quality of life (QoL) is affected by disease-related symptoms and treatment-related side effects. This study identified disease- and treatment-related symptoms of aGC/GEJC and their impact on patients’ lives.

METHODS: Targeted literature reviews (TLRs) were conducted in 2017 and 2021 to identify primary qualitative studies on patients’ experiences with aGC/GEJC from 2021 and earlier. These were used to develop a preliminary conceptual disease model of aGC/GEJC. Next, one-to-one concept elicitation interviews were conducted. Patients with aGC/GEJC were asked about their symptoms, impacts on daily life, experience of care, treatment expectations, and clinical trials. The conceptual model was refined using these patient experience data.

RESULTS: The TLRs identified 6 studies in total. Forty-seven symptoms (15 disease-related, 20 treatment-related, 12 disease- and treatment-related) and 35 impacts emerged. Interviews with 20 patients identified 36 symptoms. The 12 most important symptoms (mentioned by ≥50% of patients; average disturbance ratings: ≥5, scale: 0, not disturbing–10, extremely disturbing) were: nausea, fatigue, temperature sensitivity, indigestion, weakness, diarrhea, vomiting, early satiety, swallowing difficulties, taste alterations, abdominal pain, general pain. Symptoms were mostly attributed to systemic treatments. Thirty-one impacts emerged from the interviews, the most common being emotional disturbances, impacts on daily activities and families, and requiring assistance from caregivers. Patients were mostly positive about their experience of care, willing to enroll in clinical trials, and keen to receive innovative treatments with few side effects. The final conceptual disease model details the symptoms and impacts of aGC/GEJC.

CONCLUSIONS: The conceptual model provides valuable data on symptoms and impacts of aGC/GEJC affecting patients' daily lives, which could inform the development of innovative treatments to help improve survival and QoL. Interviews also helped understand patients’ perspectives on clinical trials.