Chemotherapy Under Fire : Narratives of Patients With Cancer During Wartime

This is the authors' abstract. We don't add key points for this paper.

STUDY OBJECTIVE: Patients with cancer living in regions of war face significant quality of life (QoL)-related concerns, both cancer- and war-related. This study examined the correlation between narratives of patients referred to an integrative oncology (IO) program in northern Israel and heart rate variability (HRV) measurements. METHODS: The study was nested within an ongoing prospective, randomized controlled trial, assessing IO interventions on QoL-related concerns among patients with cancer undergoing chemotherapy. Patients reporting cancer- and war-related concerns were eligible for study inclusion. Narratives from two open-ended questions addressing personal and health-related effects of the war were analyzed qualitatively using ATLAS.Ti software for systematic coding; and baseline electrocardiogram conducted for HRV measurement. RESULTS: Analysis of 125 patient narratives identified many war-related experiences and emotions, most significantly stress, fear, anxiety, distress, sadness, loneliness, and reduced daily functioning. In 36 patients (28.8%), a significant association was found between war and cancer-related concerns (e.g., pain, appetite, gastro-intestinal and emotional distress, insomnia). HRV analysis suggested a correlation between expressing both cancer- and war-related concerns with higher Power high-frequency (HF) [correlation: 0.24 (0.01, 0.44), p = 0.039]; Power lower frequency (LF) [correlation: 0.27 (0.06, 0.47), p = 0.015]; and autocorrelation slope [0.25 (0.05, 0.44); p = 0.015]. CONCLUSIONS: Patients with cancer- and war-related concerns reported a significant impact of the war on health, especially QoL cancer-related concerns. Baseline HRV analysis suggests that those expressing both groups of concerns showed increased sympathetic and para-sympathetic activity. Further research is needed to examine the impact of war on cancer care.