216 Chapter 9 their studies are conducted and the realization that multifaceted problems ask for a multifaceted research approach. This will eventually aid in deepening the understanding of the research results. For instance, all patients who performed the NCA in our studies also had to indicate their current experienced stress levels. In Chapter 3 we observed relatively low mean stress levels on the group level, but at the same time found substantial variations at the individual level. The majority of patients primarily attributed their stress to the uncertainties associated with their cancer diagnosis and upcoming treatment. When evaluating the pre-radiotherapy cognitive performance, the addition of a stress measurement provided us with the insight that the observed variety in cognitive functioning was not related to differences in experienced stress levels. Nevertheless, it is worth noting that experienced stress could potentially exert a notable impact on subjective cognitive functioning and QoL, which present intriguing avenues for future investigation. Subjective patient experiences When evaluating treatment-related side-effects, it is important to not only capture objectively measured changes, but also include subjective patient experiences. Especially since the goal of treatment is to maintain or even improve a patients’ QoL. The difficulty with assessing patient experiences, is that they are a relative and dynamic multidimensional concept influenced by multiple factors like psychosocial aspects (e.g. personality and coping style)23–27, personal expectations28 and the availability of a social support network29. It is challenging to find subjective measures that do justice to the complexity of individuals’ experiences. For example, we found that overall patients rated their own cognitive functioning as high when using the Cognitive Failure Questionnaire (CFQ). However, when those same patients were asked to rate their cognitive functioning on different cognitive domains relative to their pre-cancer cognitive functioning using visual analogue scales (VAS), a different picture emerged where patients reported multiple cognitive complaints [Student project, data not shown]. As illustrated in both Chapter 3 and 4, these VAS allowed patients to make a differentiated judgment regarding their subjective cognitive functioning and subsequent changes in their subjective cognitive functioning. It could be speculated that VAS as part of a semi-structured interview provides more room for patients to elaborate on their cognitive functioning and thereby fit with their individual experiences, especially when compared to confining cognitive functioning to a restricted set of questions like in the CFQ. In a study on fatigue in patients with rheumatoid arthritis, a single-item VAS even outperformed four longer fatigue questionnaires in terms of sensitivity to change and showed a good correlation with clinical variables.30 This underscores the effectiveness of a VAS as a suitable tool for use in both routine clinical practice and research. Moreover, a VAS
RkJQdWJsaXNoZXIy MTk4NDMw