OBJECTIVES: Emotional distress and anxiety symptoms arising from cancer diagnoses often do not fit the usual clinical definitions of common mental disorders. However, psychological care of cancer remains stigmatised and less understood, leading to negative impacts on quality of life and treatment compliance which increases mortality risks. The Psycho-Onco EMotional Anxiety (POEM) framework, a narrative medicine-based approach of narrative interviewing, aims to identify and map psychological factors that drive and maintain symptoms of anxiety in the context of an ongoing cancer threat.

METHODS: Paired interviews with cancer patients (lung/bladder/prostate) and their caregivers as well as digital ethnography and narrative interviewing approach were conducted to holistically capture contextual, interpersonal, and intrapersonal factors impacting cancer patients’ experience. Meta- and sub-themes identified from cognitive content and psychological processes as well as existing beliefs and schema were mapped along the patient journey. Cultural discourse analyses provided socio-cultural and environmental context.

RESULTS: Anxiety among patients stem from their cancer experience (disease outlook, sociocultural beliefs/self-blame, symptoms, treatment), psychological factors (sense of uncertainty, fear of cancer recurrence, treatment burden), and carers’ burden (reliance on carers for decision-making, support, and information). Perceived lack of patients’ psychological capability was associated with knowledge gaps about their condition (outlook, role of genetic mutations, treatment benefits). These were attributed to inadequate physician-patient communication and patients’ hesitancy to share their concerns with their physicians. Physicians’ underestimation of physiological status (e.g., pain), factors underlying patients’ anxiety, patients’ knowledge about treatment benefits, and lack of shared decision-making potentially contributed to the emotional and psychological burden experienced. There was also an incongruence of key support services desired by the patients and those recommended by physicians.

CONCLUSIONS: The POEM framework provides a patient-centred understanding of how people living with cancer experience anxiety along the patient journey, potentially supporting decision-making and addressing unmet needs of cancer care.