The cascade of disadvantage: A qualitative study of treatment burden in older adults with lung cancer alongside comorbidity.

PURPOSE: The treatment burden experienced by older adults with lung cancer and comorbidity adversely affects their well-being and quality of life. However, it remains unclear how specific burdens interact to create a self-reinforcing system. This study aimed to explore the systemic and dynamic process.

METHOD: This study used purposive sampling to recruit 15 participants aged 65 years or older with lung cancer and at least one comorbidity from a tertiary hospital in China. Data were collected through in-depth, semi-structured interviews and analyzed using the Colaizzi phenomenological method.

RESULTS

This study developed the "Cascade of Disadvantage" model to elucidate the cumulative interaction of five core burdens in this population. The model proposes three interconnected mechanistic pathways driving this process: (1) the sequential pathway, outlining a discernible, staged sequence where burdens trigger one another from the Symptom Storm through Self-Management Overload, Financial Toxicity, and Decisional Paralysis to the Internalization of Disadvantage; (2) the dynamic pathway, characterized by immediate, multidirectional interactions among burdens that drive fluctuating crises independent of sequence; and (3) the amplifying pathway, defined by vicious feedback loops where burdens mutually intensified. These pathways integrate isolated burdens into a self-reinforcing system that progressively erodes patients' capacity to manage and tolerate treatment.

CONCLUSION

The "Cascade of Disadvantage" model conceptualizes treatment burden as a self-reinforcing system. Consequently, nursing care should evolve from managing isolated burdens to actively intercepting its three core pathways. This shift positions nurses as essential "Cascade Interceptors" for safeguarding patients' dignity and well-being.