"A machine that won't shut down, a clogged pipe": a qualitative study on the lived experience and integrative coping strategies of Chinese cancer patients with insomnia and cognitive impairment.

PURPOSE: Although the co-morbidity of insomnia and cancer-related cognitive impairment (CRCI) is very common, the experiences and integrative self-management strategies of Chinese cancer patients are less researched. The purpose of this study was to explore the experiences and understandings of Chinese cancer patients with co-occurring insomnia and CRCI, as well as the self-management strategies in the context of the integration of traditional Chinese and Western medicine.

METHODS

This study employed a descriptive qualitative design. Semi-structured interviews were conducted with 20 cancer patients at a tertiary hospital in China. The participants were predominantly breast and lung cancer patients, with an average age of 56.85 years, comprising 11 females and 9 males. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke's thematic analysis by two researchers.

RESULTS

Three core themes were identified: (1) "A machine that won't shut down" and "a brain fog that won't clear": This theme describes the composite experience of the symptom cluster. (2) Seeking Attribution: Patients attribute the onset of symptoms to factors such as chemotherapy or age. Diverse attributions influence coping behaviors. (3) Treatment Crossroads: Seeking Balance and Control. Patients demonstrated an active, agentic process of integrative self-management.

CONCLUSION

Chinese cancer patients experience insomnia and the CRCI symptom cluster as a deeply disruptive cycle that challenges their sense of self. Our findings underscore the necessity of developing culturally sensitive supportive care models that acknowledge and empower patients' active role in managing complex symptom burdens.