Chemotherapy Under Fire: Narratives of Patients With Cancer During Wartime

Patients with cancer living in regions of war face significant quality of life (QoL)-related concerns, both cancer- and war-related. This study examined the correlation between narratives of patients referred to an integrative oncology (IO) program in northern Israel and heart rate variability (HRV) measurements.

The study was nested within an ongoing prospective, randomized controlled trial, assessing IO interventions on QoL-related concerns among patients with cancer undergoing chemotherapy. Patients reporting cancer- and war-related concerns were eligible for study inclusion. Narratives from two open-ended questions addressing personal and health-related effects of the war were analyzed qualitatively using ATLAS.Ti software for systematic coding; and baseline electrocardiogram conducted for HRV measurement.

Analysis of 125 patient narratives identified many war-related experiences and emotions, most significantly stress, fear, anxiety, distress, sadness, loneliness, and reduced daily functioning. In 36 patients (28.8%), a significant association was found between war and cancer-related concerns (e.g., pain, appetite, gastro-intestinal and emotional distress, insomnia). HRV analysis suggested a correlation between expressing both cancer- and war-related concerns with higher Power high-frequency (HF) [correlation: 0.24 (0.01, 0.44), p = 0.039]; Power lower frequency (LF) [correlation: 0.27 (0.06, 0.47), p = 0.015]; and autocorrelation slope [0.25 (0.05, 0.44); p = 0.015].

Patients with cancer- and war-related concerns reported a significant impact of the war on health, especially QoL cancer-related concerns. Baseline HRV analysis suggests that those expressing both groups of concerns showed increased sympathetic and para-sympathetic activity. Further research is needed to examine the impact of war on cancer care.