‘Again’: the impact of recurrence on survivors of cancer and family members

Aim. To examine the psychosocial impact of recurrence on survivors of cancer and their family members. Background. Cancer recurrence is described as one of the most stressful phases of cancer. Recurrence brings back many negative emotions, which are different and may be more intense than those after first diagnosis of cancer. Survivors and their family members have to deal with new psychological distress. Design. A qualitative descriptive study was conducted in four cancer units of two hospitals in North of Spain. Methods. Fifteen survivors of cancer with a recent diagnosis of recurrence, 13 family members and 14 nurses were interviewed. Data collection and analysis were based on the constant comparative method of grounded theory. Results. Four major categories were found: (1) ‘Again’: when cancer comes back, (2) the shock of recurrence, (3) the impact of the diagnosis on family life, and (4) factors that influence the impact of recurrence. Learning that cancer had come back was, for most of the families, more devastating than hearing that they had cancer for the first time. Signs of shock and suffering were experienced by families as an initial response to recurrence. The new diagnosis often entailed a change in the family life. Survivorship period and age seemed also significant in the psychosocial experience of recurrence. Conclusions. The term ‘again’, used by all the participants to describe a recurrence of the disease, symbolised a beginning and a continuation with cancer; it implied a re‐encounter with health services, and it represented new suffering for the families. Relevance to clinical practice. Therapeutic nursing interventions should be planned and provided to both patients with recurrent cancer and their family members. Family nursing can play an important role in helping families master the impact of the recurrent illness.