Key challenges in communication across milestones of cancer care continuum: a systematic review

Effective communication is essential in cancer care, significantly influencing patients' emotional, psychological, and physical outcomes. As patients' needs and goals evolve across different stages of the cancer journey, communication barriers also change. This systematic review aimed to identify key communication barriers between healthcare providers and cancer patients across the cancer care continuum.

Two reviewers systematically searched four databases (PubMed, Embase, Cochrane Library, and Web of Science) to identify studies examining communication barriers between healthcare providers and cancer patients at specific stages of care. This review is registered with PROSPERO (CRD420251074785).

A total of 139 articles were included and categorized into six distinct stages of the cancer journey. (1) During the screening phase, patients were reluctant to discuss or undergo cancer screening due to limited knowledge, the belief that cancer is unlikely in the absence of symptoms, and fear or anxiety about a potential diagnosis. (2) In the diagnosis phase, receiving cancer as 'bad news', combined with extensive information about treatment and prognosis, led to shock, emotional distress, and informational overload. (3) During treatment, patients found it difficult to discuss adverse effects, including fatigue, nausea, vomiting, and sexual health concerns. Many perceived these symptoms as normal indicators of treatment effectiveness and hesitated to burden their physicians. Female patients, in particular, reported difficulty discussing sexual health, especially with male physicians. (4) In the follow-up phase, limited consultation time contributed to insufficient discussions about long-term adverse effects, relapse risk, prognosis uncertainty, and individualized survivorship care planning. (5) In the recurrence phase, disclosing cancer recurrence was described by oncologists as particularly challenging, as patients often responded with anger, blame, or emotional withdrawal. (6) In end-of-life care, both patients and healthcare providers frequently delayed or avoided end-of-life conversations for various reasons.

Communication barriers between healthcare providers and cancer patients are multifaceted and stage-specific, arising from emotional, cognitive, and relational factors on both sides.