Hospitalization for cancer treatment extends far beyond clinical procedures, laboratory tests, and medication schedules. For many patients, it becomes an emotionally demanding experience shaped by fear, physical dependence, disrupted routines, financial concerns, hospital conditions, and the quality of relationships formed with healthcare professionals.
A qualitative study published in Seminars in Oncology Nursing explored how hospitalized patients with cancer experience and manage these interconnected psychosocial challenges. Through interviews with patients receiving care in five Croatian hospitals, researchers identified a complex process in which emotional, social, physical, environmental, and relational factors collectively influenced patients’ ability to adapt during treatment.
Listening to Patients Across Five Oncology Departments
The grounded theory study was conducted across oncology departments at University Hospital Zagreb, University Hospital Sestre Milosrdnice, Clinical Hospital Dubrava, University Hospital Osijek, and University Hospital Split.
Between February and June 2025, researchers interviewed 35 hospitalized adults with confirmed cancer diagnoses. The semi-structured interviews lasted approximately 30 to 60 minutes and examined patients’ emotional experiences, social support, relationships with healthcare professionals, coping strategies, spirituality, and preferences for psychosocial care.
Participants had a mean age of 60.1 years, and 68.6% were men. Colorectal cancer was the most common diagnosis, accounting for 42.9% of the study population, followed by breast and gastric cancers. Most participants—91.4%—were receiving chemotherapy. Patients reported a median of seven hospitalizations, although the number ranged from one to 26.
The analysis identified one central process: navigating psychosocial challenges during cancer hospitalization.
Cancer Creates More Than One Crisis
Patients rarely experienced emotional, social, and physical difficulties separately. Instead, these challenges frequently appeared together and intensified one another.
The diagnosis itself often produced shock, fear, uncertainty, sadness, anger, loneliness, guilt, and emotional exhaustion. Some participants struggled to manage their emotions privately, while others deliberately concealed their distress to protect family members.
Uncertainty was especially difficult. Patients worried about treatment outcomes, unfamiliar hospital environments, disease progression, and the possibility of death. Maintaining hope while remaining aware of the seriousness of cancer created an ongoing emotional tension.
For some patients, the psychological burden became severe. The interviews included references to despair and thoughts of suicide, demonstrating the importance of recognizing distress before it reaches a crisis point.
Disease recurrence created a particularly difficult psychological challenge. Patients who believed that treatment had brought the disease under control described renewed emotional exhaustion when cancer returned.
When the Healthcare System Becomes Another Burden
The psychosocial burden was not limited to the disease itself.
Patients described financial difficulties related to treatment, private care, travel, and other medical expenses. Long waiting lists, staff shortages, equipment problems, inconsistent information, and poor coordination between services added further stress.
Some participants felt they were required to navigate the healthcare system independently at a time when they were physically and emotionally vulnerable. Difficulties obtaining information, arranging appointments, or identifying the correct point of contact contributed to frustration and a sense of abandonment.
Several patients also expressed concern that people with advanced or incurable disease might receive less attention within the healthcare system. These perceptions affected trust and increased feelings of vulnerability.
The findings show that administrative barriers and fragmented communication are not simply logistical problems. For hospitalized patients, they become part of the psychological experience of cancer.
The Physical Body Becomes Unfamiliar
Treatment-related symptoms influenced both emotional well-being and social identity.
Patients described fatigue, reduced mobility, prolonged bed rest, diarrhoea, constipation, wound care, stoma management, infection risk, and other adverse effects. Those who had previously been active and independent found dependence on family members or healthcare professionals particularly difficult.
Body image changes created another layer of distress. Hair loss, breast removal, scars, and other visible physical changes affected how patients viewed themselves and interacted with others.
These concerns were not presented as superficial. Participants described appearance as closely connected to identity, femininity, independence, confidence, and dignity.
Managing cancer alongside chronic conditions such as diabetes further complicated patients’ sense of physical security. The need for rest, physical activity, symptom control, and continued home-based care remained important throughout the treatment process.
The Hospital Environment Shapes Emotional Well-Being
The physical environment of the hospital had a direct influence on patients’ comfort and psychological state.
Noise, shared rooms, lack of privacy, uncomfortable beds, poor food quality, unreliable internet access, and outdated infrastructure were frequently mentioned. Patients described difficulty sleeping and relaxing when exposed to constant interruptions or the activities of other patients.
Some felt confined within the ward and reported a strong emotional improvement after returning home, where they could regain control over their routines and surroundings.
Smaller rooms, private spaces, quiet conditions, adequate heating, reliable hot water, and comfortable facilities were associated with greater dignity and security.
The findings suggest that a healing environment is not an optional addition to oncology care. The physical conditions in which treatment is delivered influence rest, anxiety, privacy, and the overall experience of hospitalization.
Clinical Skill Is Essential, but Presence Also Matters
Relationships with healthcare professionals were among the strongest influences on patients’ hospital experiences.
Participants valued technical competence, professionalism, responsiveness, and confidence. At the same time, they repeatedly emphasized kindness, empathy, honesty, eye contact, listening, and emotional presence.
Small gestures carried considerable meaning. A smile, a few encouraging words, a clear explanation, or an honest conversation helped patients feel safer and less isolated.
Patients appreciated professionals who answered questions directly and did not create unrealistic expectations. Honest communication strengthened trust, even when the information was difficult.
Nurses were central to these experiences because of their continuous presence on oncology wards. Patients described nursing care as a combination of clinical expertise, practical assistance, emotional reassurance, and human connection.
However, staffing limitations restricted the time nurses could devote to conversations and psychosocial support. One participant described a ward in which two nurses were responsible for approximately 40 patients. Although patients appreciated that nurses responded to clinical needs, they recognized that meaningful counselling was difficult under such conditions.
Psychological Support Cannot Depend on Patients Asking
Participants differed in their preferences for formal psychological support.
Some valued consultations with psychologists, counselling, group therapy, and other structured services. Others believed they could manage without professional support through family relationships, faith, personal resilience, or self-directed coping.
However, patients emphasized that psychological needs are highly individual. A person who appears to be coping well might still benefit from assessment, while another might prefer informal support.
Providing information about the diagnosis and treatment plan also contributed to emotional stability. Clear guidance helped patients regain a sense of control at a time when many aspects of life felt uncertain.
Music, conversation, distraction techniques, encouragement, telephone support, and individualized psychosocial plans were described as useful forms of assistance.
The study supports a proactive approach in which emotional well-being is assessed routinely rather than addressed only after a patient openly requests help.
Autonomy Restores a Sense of Control
Cancer hospitalization can reduce independence, but participation in care decisions can help restore it.
Patients wanted opportunities to ask questions, receive complete answers, express preferences, and contribute to decisions about their treatment. Being listened to strengthened dignity and trust.
Informed consent was viewed as more than a formal requirement. Patients associated it with respect, recognition, and personal control.
When healthcare professionals acknowledged patients’ opinions and allowed them to take an active role in care, patients described greater psychological comfort and stronger engagement with treatment.
Family and Fellow Patients Become Part of Care
Support from family members, friends, colleagues, and other patients played a central role in helping participants manage illness.
Family support offered emotional reassurance, practical assistance, and a sense of belonging. Some patients believed they would not have been able to endure treatment without it.
Relationships with fellow patients also reduced isolation. Shared experiences created a form of understanding that was sometimes difficult to find outside the oncology setting.
Conversations, companionship, patient associations, and community activities helped participants maintain social connection and purpose. Helping others was also described as a meaningful way to regain a sense of usefulness.
However, shared spaces could produce interpersonal tension. Differences in behavior, personality, and coping styles sometimes affected emotional comfort, highlighting the complexity of social relationships within hospital wards.
How Patients Protected Their Psychological Balance
Participants developed diverse strategies to manage the pressures of hospitalization.
Acceptance was one of the most prominent. Some patients described reaching a point at which they acknowledged the diagnosis and focused on completing treatment rather than resisting the reality of illness.
Optimism, humor, prayer, faith, self-reliance, perseverance, and adaptability were also important. Spiritual practices provided comfort and helped some patients structure their time during hospitalization.
Others relied on work, gardening, creative activities, familiar routines, or productive tasks to redirect attention away from cancer. Maintaining meaningful activities helped preserve identity and continuity with life before the diagnosis.
Patients also differed in how they handled distress. Some openly expressed emotions, while others used distraction, avoidance, or private reflection.
These coping strategies reflected personal histories, values, and lifelong patterns of responding to adversity.
Adaptation Is Not a Single Destination
Successful adaptation did not mean that patients stopped experiencing fear or uncertainty.
Instead, it involved integrating cancer into their lives while continuing to engage with treatment, relationships, and future plans. Patients described making peace with the diagnosis without abandoning hope.
Previous life experiences influenced this process. Those who had endured bereavement, illness, financial hardship, or other major difficulties often drew on coping skills developed earlier in life.
Adaptation remained fragile, particularly when the disease recurred or treatment outcomes were uncertain. Patients could experience periods of acceptance followed by renewed distress.
The findings demonstrate that psychosocial adaptation changes throughout the cancer trajectory and requires continued attention rather than a single intervention.
Building Care Around the Whole Patient
The researchers interpreted the findings through Watson’s Theory of Human Caring and its Caritas processes, which emphasize compassionate relationships, authentic presence, dignity, emotional expression, spirituality, and healing environments.
The study provides a foundation for developing Caritas-based approaches within oncology care. Potential areas for clinical attention include improving hospital environments, strengthening nurse education in psychosocial and relationship-centred care, establishing structured psychological support, and increasing patient participation in decisions.
At the system level, adequate staffing, improved infrastructure, stronger care coordination, and psycho-oncology education are central to creating conditions in which holistic care can be delivered.
The findings are specific to hospitalized patients in the Croatian healthcare context and require further evaluation in other clinical and cultural settings. The cross-sectional design also captured experiences at one point in time and could not show how psychosocial needs changed throughout treatment.
Nevertheless, the multicentre design and in-depth interviews provide a detailed view of how patients experience cancer hospitalization from inside the ward.
Cancer Care Is Also the Experience Around Treatment
For hospitalized patients, cancer care is shaped not only by the treatment they receive but also by the environment in which it is delivered, the information they are given, the relationships they form, and the degree of control they retain.
Fear, fatigue, financial pressure, body image changes, lack of privacy, and fragmented communication can accumulate into a substantial psychosocial burden. Compassionate professional relationships, accessible psychological care, family support, patient autonomy, and meaningful coping strategies can help patients navigate that burden.
Written by Nare Hovhannisyan, MD
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