A Preliminary Phenomenological Exploration of Experiences of the Empty Pelvis Syndrome Derived From a Modified‐Delphi: The Price of Survival Following Pelvic Exenteration for Advanced Pelvic Cancer

• Published in: Psycho-oncology (Chichester, England) England), 2024-10, Vol.33 (10), p.e9316-n/a
• Main Authors: West, Charles T., Denys, Andreas, Rose, Sam A., Pape, Eva, Ramshorst, Gabrielle H., Sutton, Paul A., Yano, Hideaki, West, Malcolm A., Mirnezami, Alex H., Calman, Lynn, Sodergren, Samantha C.
• Format: Article
• Language: English
• Subjects: Adaptation; Adaptation, Psychological; Adult; Aged; Cancer; cancer survivors; Complications; Female; Focus Groups; Health status; Humans; Interpretative phenomenological analysis; Intestinal obstruction; Male; Middle Aged; Obstruction; pelvic exenteration; Pelvic Exenteration - psychology; Pelvic Neoplasms - psychology; Pelvic Neoplasms - surgery; Pelvis; Physical symptoms; Postoperative Complications - psychology; psycho‐oncology; Qualitative Research; Quality of life; Quality of Life - psychology; Regret; surgical oncology; survivorship; Symptoms; Syndrome; Unpleasant
• ISSN: 1057-9249; 1099-1611; 1099-1611
• DOI: 10.1002/pon.9316

ABSTRACT Objective The empty pelvis syndrome (EPS) is common after pelvic exenteration (PE), causing fluid collections, bowel obstruction, perineal sinuses, and fistulas. The best approach to fill the pelvis to mitigate this remains controversial, and the impact of EPS on health‐related quality of life (HrQoL) is unknown. This study is the first to begin to explore lived‐experiences of EPS complications. Methods Unstructured EPS virtual focus group meetings were conducted with a convenience sample of patients who underwent PE, as an extension of a modified‐Delphi study. Interpretative phenomenological analysis was conducted on verbatim transcripts to generate group experiential themes. Results Twelve patients (eight UK, one Dutch, and three Belgian) participated in four focus groups. Eight EPS complications were reported, (two pelvic collections, five chronic perineal sinuses, and one bowel obstruction). Group experiential themes were ‘Out of Options’, depicting patients forced to accept complications or limited survival; ‘The New Normal’, with EPS potentially delaying adaptation to post‐PE HrQoL; ‘Information Influencing Adaptation,’ emphasising the significance of patients understanding EPS to cope with its effects; and ‘Symptoms,’ reporting manifestations of EPS, the resultant physical limitations, and an intangible feeling that patients lost part of themselves. Conclusions EPS may influence patient decision‐making, regret, adaptation, and information‐seeking. It can cause a variety of unpleasant symptoms and physical limitations, which may include phantom phenomenon. This work supports ongoing purposeful HrQoL research to better define these themes.