Colorectal Cancer and Synchronous Liver-Limited Metastases: An Individual Case-Based Qualitative Study (CoSMIC-Q)

Abstract

Background: Contemporary management of colorectal cancer with synchronous liver-limited hepatic metastases is complex. Although there is a large body of cohort data, there is no research exploring patient and clinician perspectives. This study explores the experiences and views of patients and their clinicians following treatment for colorectal cancer with synchronous liver metastases. Methods: This is a qualitative study based on interviews with patients who had completed treatment for colorectal cancer with synchronous liver metastases together with their relatives and treating clinicians. The interviews were recorded, transcribed and analysed using thematic analysis method. Codes were developed both horizontally regarding each interview as a standalone hermeneutic unit and vertically by scanning across interviews for specific terms. Results: Four overarching themes emerged: patients’ experience of initial diagnosis, involvement in treatment, views on the order of staged resections and views about research. For patients, the first consultation is critically important. Patients generally perceived sufficient autonomy in decision-making. In treatment options there is a preference for synchronous surgery balanced by an understanding of the greater risk. Patients did not want liver-first surgery due to perceptions of risk of continued seeding from an in situ primary tumour. Clinicians accepted limited evidence for decision making but felt that trials of treatment sequencing were not feasible. Conclusions: This first qualitative study, exploring patient perceptions in colorectal cancer with synchronous liver metastases, demonstrates the need to incorporate patients’ views into formulating individual treatment plans. Effective first consultation and communication are central to patient participation and shared decision-making.