Perspectives of patients and significant others on colorectal cancer services in Malta

Abstract

Introduction: Cancer is a growing public health concern worldwide, remaining a major cause of morbidity and mortality. Demographic changes, particularly the growth of older populations, continue to drive increased cancer prevalence. Advances in early detection and treatment have shifted many diagnoses of cancer toward long-term management, placing additional pressure on health systems already managing rising demand. Inefficiencies and care that does not benefit patients contribute to considerable waste of healthcare resources. To ensure care is meaningful and responsive, it is critical to understand the real-world experiences of people receiving treatment and those who support them. This study sought to explore the patients’ experiences of the healthcare system whilst undergoing antineoplastic treatment for colorectal cancer. Method: A longitudinal qualitative approach was used, consisting of two complementary studies running in parallel. Participants were recruited at the start of treatment at the National Oncology Centre in Malta. Eligible patients were beginning first-line chemotherapy for colorectal cancer with either FOLFOX (12-cycle regimen) or XELOX (8-cycle regimen). Each patient identified at least one significant other who played a meaningful caregiving. Semi-structured interviews were conducted repeatedly over a six-month period: every 12 weeks with patients and every 24 weeks with significant others. All interviews were transcribed verbatim and analysed using thematic analysis to identify recurrent patterns and changes in perspective over time. Results: An equal number of patients and their significant others participated in the interviews (16 each), totaling 32 participants. Most patients were female and undergoing FOLFOX treatment (n=10). Spouses were the most common nominated support person (n=6). Three themes were identified: “patients’ experiences of cancer services”, “healthcare professionals’ communication with patients and others” and “recommendations for services”. Participants consistently reported overall satisfaction with oncology services, particularly valuing the personalised support provided by nurse navigators. Negative experiences were primarily associated with diagnostic delays. As treatment progressed, many participants described increased emotional sensitivity to the language used by healthcare professionals. Suggestions for service improvement included offering cancer care in community-based settings, such as ambulatory care services. Conclusion: Efforts to improve cancer care should prioritise early diagnostic access, strengthen communication and continuity of care. Information and support should be tailored to individual needs. Integrating patients’ and significant others’ perspectives into service design and evaluation can further enhance the quality and relevance of care delivery.