{"paper_id":"58148e5d-fb99-4463-ae19-8b2531c6d07b","body_text":"Follow-up Experiences of Cervical Cancer Patients after Radiotherapy: A Qualitative \nStudy\nLan Xiong¹, Haoyun Wang1, Qingcai Wu², Wenwen Cai², Xinyue Deng2, Yalan Song¹*\nAffiliations\n1.Guangzhou Medical University, Guangzhou, Guangdong 510180, China\n2.Affiliated Cancer Hospital of Guangzhou Medical University, Guangzhou, \nGuangdong 510095, China\n* Corresponding author: Yalan Song, Email: syalan@126.com\nAbstract\nBackground\nCervical cancer remains one of the leading malignancies threatening women’s health worldwide, \nparticularly in developing countries. Radiotherapy is a cornerstone treatment modality but often \nleads to long-term physical, psychological, and social challenges that significantly impair survivors’ \nquality of life. Nursing follow-up plays a crucial role in survivorship care; however, patients’ \nexperiences and perspectives during this period remain underexplored in China.This study aimed to \nexplore the subjective experiences of cervical cancer patients during nursing follow-up after \nradiotherapy, with a particular focus on their perceptions and coping strategies related to physical \nsymptoms, psychological wellbeing, social support, and information needs.\nMethods\nThis qualitative study was conducted in the Department of Radiotherapy, Affiliated Cancer Hospital of \nGuangzhou Medical University, China. Sixteen cervical cancer patients who had completed \nradiotherapy and entered the follow-up stage were purposively recruited. Guided by supportive care \ntheory, semi-structured in-depth interviews were conducted to explore participants’ experiences. \nData were transcribed verbatim, anonymized, and analyzed using Interpretative Phenomenological \nAnalysis (IPA).\nResults\nThe analysis identified six major themes reflecting patients’ multidimensional experiences during \nnursing follow-up: (i) Persistent discomfort and daily life impact ,(ii) Insufficient understanding of the \nrole of nursing follow-up, (iii) Psychological stress and need for support, (iv) Sexual health concerns, (v) \nHelp and conflicts in family support, (vi) Information needs and preferences. These findings highlight \nboth the ongoing difficulties faced by cervical cancer survivors and their expectations for more \ncomprehensive and empathetic follow-up care.\nConclusion\nCervical cancer survivors after radiotherapy encounter a complex interplay of physical, psychological, \nsexual, familial, and informational challenges during follow-up. Patients expressed a strong need for \nindividualized, continuous, and empathetic nursing support to enhance recovery and adaptation. \nStrengthening the proactivity and professionalism of follow-up services, particularly in sexual health \ncounseling, psychosocial support, and health education, may improve survivorship outcomes. Future \n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \nNOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.\n\nmulticenter and mixed-methods studies are warranted to inform the development of a more \ncomprehensive follow-up care system.\nIntroduction\nCervical cancer is the fourth most common malignancy among women worldwide. Although its \nincidence and mortality have declined in some countries, it remains highly prevalent in many \ndeveloping regions [1]. In China, recent statistics (2022) reported 111,820 new cervical cancer cases \nand 61,579 deaths annually. Cervical cancer ranks sixth in incidence and seventh in mortality among \nfemale malignancies, posing a serious threat to women’s health [2,3].\nRadiotherapy (RT) is one of the main treatment modalities for cervical cancer. While effective in \neradicating malignant cells, RT inevitably damages surrounding healthy tissues, including the cervix, \nuterus, vagina, bladder, and rectum [4]. As a result, survivors often experience long-term \ncomplications such as pelvic floor dysfunction, urinary and bowel disturbances, and sexual \ndysfunction, all of which significantly impair quality of life [5,6]. A longitudinal study of cervical cancer \nsurvivors found that women who received radiotherapy reported worse physical functioning, somatic \nsymptoms, sexual functioning, and menopausal complaints compared to those treated with surgery \nalone [7].\nBeyond physical sequelae, cervical cancer survivors face considerable psychological and social \nchallenges [8]. Many women experience uncertainty about fertility after treatment, leading to \nheightened anxiety and negative emotional responses, which may hinder recovery and coping [9]. The \nabsence of structured psychosocial support during follow-up can exacerbate emotional distress [10,11]. \nIn addition, social stigma associated with gynecological cancers and limited access to reliable health \ninformation further compromise survivors’ quality of life. Compared with the general population and \nsurvivors of other gynecological malignancies, cervical cancer patients report lower levels of overall \nlife satisfaction [12,13].\nFollow-up care plays a vital role in survivorship management, helping to prevent or mitigate \ntreatment-related physical, psychological, and social issues, thereby improving quality of life [14]. \nAccording to the NCCN Clinical Practice Guidelines in Oncology: Cervical Cancer (Version 4.2025), \nrecommended follow-up schedules for women after definitive treatment include every 3–4 months in \nyears 1–2, every 6–12 months in years 3–5, and annually after 5 years if no recurrence is detected [15]. \nHowever, adherence to follow-up in primary care remains suboptimal, with rates of delayed or missed \nfollow-up ranging from 4% to 75%, particularly among women who are younger, less educated, or \nsocioeconomically disadvantaged [16].\nWhen nursing follow-up fails to provide systematic and individualized support that addresses both \nphysiological and psychological needs, patients may experience reduced adherence, inadequate \ninformation, and increased emotional burdens such as anxiety and distress [17]. A deeper \nunderstanding of survivors’ needs and experiences during follow-up requires a multidimensional \nperspective [18]. Yet, qualitative studies exploring follow-up experiences among cervical cancer \npatients after radiotherapy remain scarce, especially those capturing patients’ subjective narratives \nwithin real-world clinical settings.\n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\nTo address this gap, this study analyzed interview data from 16 cervical cancer survivors who were \nundergoing nursing follow-up after radiotherapy. Six major themes were identified: Persistent \ndiscomfort and daily life impact , Insufficient understanding of the role of nursing follow-up, \nPsychological stress and need for support, Sexual health concerns,Help and conflicts in family support, \nInformation needs and preferences. \n The following sections present these findings in detail, supported by participant narratives and \nrelevant literature.\nMethods\nStudy design and theoretical framework\nGuided by the Supportive Care Framework, this study adopted a phenomenological qualitative design \nto explore women’s subjective experiences during post-radiotherapy nursing follow-up. The approach \nfocused on multi-dimensional needs and responses—physical, psychological, social, informational, \nand sexual health—and on unmet needs and expectations for care.\nSetting\nFieldwork was conducted from March 1 to June 30, 2025, in the Department of Radiotherapy at the \nAffiliated Cancer Hospital of Guangzhou Medical University (Guangzhou, China), a regional oncology \ncenter with standardized radiotherapy pathways and an established nursing follow-up system. This \nsetting provided a real-world clinical context for the inquiry.\nParticipants and recruitment\nParticipants were women with a confirmed diagnosis of cervical cancer who had completed \nradiotherapy and entered the follow-up phase (nursing follow-up and/or return visits for clinical \nreview). Purposive sampling was used to recruit patients who could articulate their experiences and \nconsent to participation.\nInclusion criteria: (1) histologically diagnosed cervical cancer; (2) completion of radiotherapy and \ncurrently in follow-up; (3) ability to communicate clearly in Mandarin; (4) voluntary participation with \nwritten informed consent.\nTo ensure maximum variation, we considered age, marital status, education, employment, cancer \nstage, treatment modalities, and time since radiotherapy. Recruitment was supported by ward/clinic \nnurses through brief announcements and one-to-one screening in inpatient and outpatient areas. \nSixteen women were enrolled; thematic saturation was reached with the 16th interview when no new \ncategories or themes emerged.\nData collection\nA semi-structured interview guide (expert-reviewed and refined after two pilot interviews) covered: \nunderstanding of nursing follow-up, bodily and emotional changes, rehabilitation and daily life, social \nsupport, and information needs. Trained qualitative researchers conducted all interviews in quiet, \n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\nprivate consultation rooms. With permission, interviews were audio-recorded; field notes captured \nsalient non-verbal cues. Each interview lasted ~30–60 minutes. Clinical charts were reviewed, with \nconsent, to supplement diagnostic, treatment, and follow-up information. Interviews used \nopen-ended questions with probes to elicit depth. The full guide is provided in Appendix 1.\nData analysis\nInterviews were transcribed verbatim and de-identified. Analysis followed Interpretative \nPhenomenological Analysis (IPA) procedures: iterative reading for immersion; open coding; \ndeveloping data-driven categories; clustering subthemes; and refining overarching themes supported \nby exemplar quotations. Coding was facilitated by NVivo 12 (QSR International). Two researchers \nindependently coded transcripts and met to discuss discrepancies until consensus was reached; an \naudit trail documented analytic decisions.\nTrustworthiness\nCredibility was enhanced through brief member checks at the end of each interview (oral summaries \nfor confirmation/clarification). Dependability and confirmability were supported by a detailed \nprotocol and audit trail describing design, instruments, recruitment, data collection, and analysis \nsteps. Transferability was addressed via maximum-variation sampling and thick description with \nillustrative quotes. To manage bias, the team held regular reflexive meetings to examine assumptions \nand ensure consistency in theme development.\nEthics\nThe study received approval from the hospital ethics committee. All participants received oral and \nwritten study information and provided written informed consent, including consent for \naudio-recording and use of anonymized data for publication. Procedures adhered to the Declaration \nof Helsinki. Participant confidentiality was protected through coded identifiers and secure data \nhandling.\nResults\nParticipant characteristics\nA total of sixteen women participated in the in-depth interviews. The mean age of participants was \n58.0 years (SD = 12.38), with the majority (62.5%) between 51 and 70 years. Most participants were \nmarried, while three were either unmarried or widowed. Educational attainment varied: seven \nwomen had a college degree or higher, whereas nine women had secondary education or below, \nincluding primary and middle school levels.Regarding occupational status, five participants were \nemployed at the time of interview, three were retired, and the remainder were unemployed or \nhomemakers. Most women resided in urban or peri-urban areas, providing them with basic access to \nmedical facilities.Clinically, eleven participants were diagnosed at stage III cervical cancer. The interval \nsince completion of radiotherapy ranged from 4 months to 8 years, with a mean duration of 22 \nmonths. All participants had undergone radiotherapy, with treatment regimens reflecting common \n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\nclinical practice. Specifically, ten women received combined surgery, chemotherapy, and radiotherapy; \nthree underwent chemotherapy plus radiotherapy; two had surgery plus radiotherapy; and one \nreceived surgery plus chemotherapy. This distribution broadly represented the mainstream \ntherapeutic approaches for cervical cancer (Table 1).\nThemes identified\nParticipants reported a wide range of complex experiences across physical, psychological, and social \ndimensions during nursing follow-up after radiotherapy. The diagnosis and treatment of cervical \ncancer not only posed challenges to women’s physical health but also had profound impacts on their \ndaily lives, emotional well-being, family relationships, and expectations for the future. From \nparticipants’ narratives, six core themes were identified: persistent discomfort and daily life impact, \ninsufficient understanding of the role of nursing follow-up, psychological stress and need for support, \nsexual health concerns, help and conflicts in family support, and information needs and \npreferences(Table 2).\nTheme 1: Persistent discomfort and daily life impact\nMost participants reported that they continued to experience varying degrees of physical discomfort \nafter the completion of radiotherapy. These symptoms not only interfered with daily life but also \naffected psychological well-being and social participation. Such discomfort often persisted or recurred, \ncreating an ongoing burden during the recovery phase. Interview data revealed two subthemes \nclosely related to post-radiotherapy physical symptoms and their impact on daily functioning: \nOngoing physical symptoms and interference and Pronounced fatigue and functional limitations.\nOngoing physical symptoms and interference\nMany patients continued to experience bodily symptoms such as lymphedema, urinary and \ngastrointestinal side effects, and skin discomfort after radiotherapy, which significantly interfered \nwith their daily activities. In addition, the absence of professional rehabilitation guidance led some \nparticipants to rely on self-management, potentially increasing health risks.\n“The skin around the radiotherapy site turned dark. I used protective spray, but if it \nwas not applied properly—like the crease between the buttocks—it could easily \ncause an allergic reaction.” (Participant 3)\n“I feel pain when urinating in the morning, especially the first time after waking up. \nLater in the day, if I drink enough water, the pain subsides. I also feel that \nradiotherapy has affected my intestines. For example, before treatment I could \ndrink cold water without any issues, but now my intestines feel fragile. Even just a \nfew sips of cold water can trigger diarrhea—it’s as if my intestines have become \nvery sensitive.” (Participant 4)\n“My leg often swells up for no clear reason. I think surgery and radiotherapy \ndamaged it, so it keeps swelling and treatment does not help. I usually go for \nmassages outside, but I am not sure whether it is safe. The massage therapist even \nwarned me that improper massage could make it worse.” (Participant 9)\n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\nPronounced fatigue and functional limitations\nFatigue was a common and distressing problem reported by most interviewees, undermining their \nindependence and work capacity. Some participants also mentioned that fatigue reduced their \nmotivation to go out and engage in social activities.\n“I feel tired so easily… my legs are sore even when sitting. I used to manage some \nhousework, but now I always feel weak. Even a little activity makes me exhausted. \nEven when resting, my legs feel sore and swollen, and I cannot get relief.” \n(Participant 2)\n“I can’t do anything… my sleep is poor, and I often suffer from insomnia. It takes a \nlong time to fall asleep at night, and I wake up frequently. During the day I already \nfeel weak, and the poor sleep makes it worse. Sometimes I want to do things, but I \nhave no energy, and my body doesn’t cooperate. It makes me feel completely \nuseless.” (Participant 7)\nTheme 2: Insufficient understanding of the role of nursing follow-up\nFrom the interview data, two subthemes were identified regarding patients’ perceptions of \nnursing follow-up: Limited knowledge of nursing follow-up content and Recognition of the \nvalue of follow-up. Overall, although most patients had a preliminary understanding of the \nterm “follow-up,” their comprehension remained limited to the notion of “regular check-ups.” \nThey lacked awareness of the proactive, diverse, and supportive functions of nursing \nfollow-up.\nLimited knowledge of nursing follow-up content\nWhen asked about the meaning of “follow-up,” most participants equated it with “returning \non time for examinations.” Many only came back when instructed by physicians and rarely \ntook the initiative to contact nursing staff. Some reported that they had never received a \nfollow-up call from nurses and were uncertain whether they could actively seek consultation. \nInstead, they mainly relied on medical advice or second-hand experiences shared by others. \nSuch limited understanding of follow-up contrasted with existing clinical guidelines.\n“I thought it just meant coming back on time when the doctor asked me to. When I \nheard the word ‘follow-up,’ I felt it was simply a task assigned by the doctor—come \nback to the hospital for a check-up on schedule. I never thought it meant anything \nelse.” (Participant 1)\n“I always thought that once radiotherapy was finished, everything was done. Later \nthey told me that I still needed several follow-up visits, and that was the first time I \nrealized it. Actually, I never figured out what follow-up really meant—I only knew I \nhad to come back to the hospital.” (Participant 10)\nRecognition of the value of follow-up\n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\nSome participants gradually realized that follow-up was not merely a routine examination \nbut also played a key role in the recovery process. They acknowledged that follow-up could \nhelp detect potential problems, remind patients to pay attention to abnormal symptoms, \nand even allow for timely intervention before conditions worsened.\n“If you detect some warning signs, you can stop it in time. Follow-up is about finding \nproblems earlier, not waiting until the disease becomes serious before dealing with \nit.” (Participant 3)\n“If it hadn’t been for this follow-up discovering the adhesion problem, I might have \njust kept ignoring it. The nurse asked me some questions and reminded me to get \nchecked, and that was when I realized how serious it was.” (Participant 12)\nTheme 3: Psychological stress and need for support\nFrom the interview data, three subthemes were identified regarding psychological stress and the \nneed for support after radiotherapy: Anxiety and depressive emotions, Low participation in \npsychological counseling services, and Family and self-adjustment. Overall, the uncertainty associated \nwith the disease and the physical symptoms following treatment placed a psychological burden on \nmost patients. However, their coping strategies varied: some relied on self-adjustment and family \nsupport, while others expressed potential needs for professional psychological assistance.\nAnxiety and depressive emotions\nAlmost all participants mentioned experiencing anxiety, depression, or fear due to the illness and its \ntreatment. These emotional reactions appeared to be stage-specific, with symptoms being \nparticularly prominent in the early period after radiotherapy.\n“Right after completing radiotherapy, I indeed felt anxious, though now I take things \nmore calmly. At that time, I constantly felt fragile, worried about recurrence, and \nfeared that my future life would be heavily affected. At night, lying in bed alone, I \nfelt uneasy and often had racing thoughts. Later, as time passed, I realized my \ncondition was not as bad as I had imagined. I still worry occasionally, but it is not as \nsevere as before, and I can now face it more calmly.” (Participant 8)\n“Sometimes I feel scared when I think about this disease, especially when I cannot \nsleep at night.” (Participant 14)\nLow participation in psychological counseling services\nDespite such psychological distress, most participants did not actively seek professional counseling. \nSome believed they could “think it through” on their own or relied on conversations with family and \nfriends to relieve negative emotions. Only a few joined patient support groups or expressed a desire \nfor regular conversations with nurses.\n“If there were a doctor or nurse who could talk with me regularly, I would feel more \nreassured.” (Participant 8)\n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\nCurrently, participation in psychological counseling services remains low, but potential needs do exist. \nMeanwhile, some patients (such as Participants 4, 10, 11, and 15) reported that their current mental \nstate was stable and that they did not require additional support.\nFamily and self-adjustment\nIn the absence of professional psychological counseling, most patients relied heavily on family \nmembers, friends, and self-adjustment strategies to cope with psychological stress.\n“I have support from my family—I have many siblings. They often come to see me, \ncook for me, and accompany me to follow-up visits. When I am in a bad mood, they \ncomfort me. Although I sometimes worry about my illness, seeing my family around \ngives me a sense of security, and I do not feel alone.” (Participant 1)\nTheme 4: Sexual health concerns\nFrom the interview data, three subthemes were identified regarding sexual health problems and \ncoping: Decline in sexual desire and intercourse difficulties, Severe lack of sexual health guidance, and \nSensitivity and avoidance psychology. Overall, patients commonly experienced diminished sexual \nfunction and related physiological problems after radiotherapy. However, due to cultural factors and \npsychological barriers, sexual health concerns were rarely openly discussed, and systematic \nprofessional guidance was lacking.\nDecline in sexual desire and intercourse difficulties\nMost participants reported a marked decline in sexual desire after radiotherapy, with sexual activity \nsignificantly reduced or even completely discontinued.\n“It’s not that it hurts, but I just don’t feel interested anymore. Life pressures are \nhigh, and since the illness and radiotherapy, all my energy has gone into recovery \nand family matters. Every day I just think about how to get through life. I really have \nno motivation to think about sex. It’s not that my body is in pain, but I feel it has no \nmeaning, unlike before when I still had desire.” (Participant 1)\n“At our age we definitely don’t want it anymore. Besides, I am a patient—I never \nthink about it. And when it’s dry inside, it burns like fire, so painful that I cannot \neven have the thought of sex.” (Participant 6)\nSevere lack of sexual health guidance\nRadiotherapy-related vaginal changes caused clear physical symptoms, especially pain during \nintercourse. However, most patients did not receive relevant guidance or support. Nearly all \nemphasized that they had not been given any explanation or instructions on sexual health during \nfollow-up.\n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\n“It definitely hurts when inserted. Without lubricant, it’s impossible. I don’t know \nthe exact time when intercourse is safe. I saw the health education sheet, which \nsaid three months, right? But in reality, I didn’t follow it. My ward mate had surgery, \nand even after more than half a year, she still hasn’t resumed.” (Participant 3)\n“I asked the doctor, and he said sexual activity is important—it must be maintained, \notherwise the endocrine condition gets worse. But regarding how long after \nradiotherapy it is safe, I am still not sure. I don’t know. We have to wait until the \nchief physician tells us before we dare.” (Participant 14)\nSensitivity and avoidance psychology\nParticipants often expressed feelings of shame, rejection, and self-denial when it came to sexual \nhealth, which contributed to these needs being overlooked.\n“I feel that because I am ill, I just don’t think about it anymore.” (Participant 8)\n“I feel that since I got sick, I am no longer a normal person.” (Participant 12)\n“I feel incomplete now, and psychologically I am somewhat resistant.” (Participant \n14)\nTheme 5: Help and conflicts in family support\nFamily played an important role in the recovery process of patients, but the quality and stability of \nsuch support varied considerably. From the interview data, three subthemes were identified: \nVariations in quality of family support, Recovery of daily functioning and social adaptation, and Coping \nstrategies for economic pressure.\nVariations in quality of family support\nMost participants reported receiving care and emotional support from family members, and \nacknowledged the important role families played in their recovery.\n“My relatives, everyone treats me very well. My husband’s two older sisters care \nabout me, and my son is really considerate. Whenever I need something, he finds a \nway to help, which makes me feel very warm inside.” (Participant 1)\nSome participants, however, noted that although family members were willing to help, they lacked \nsufficient understanding of post-radiotherapy complications and rehabilitation needs.\n“I feel they may not fully understand my needs. They don’t really know how to help \nwith the aftereffects of radiotherapy.” (Participant 4)\nOthers described the support as inconsistent, influenced by family members’ own responsibilities and \ncircumstances.\n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\n“My children take turns taking care of me, but they also have their jobs, and I live \nalone.” (Participant 7)\n“My son is tired after work, so he doesn’t pay much attention to me.” (Participant 9)\nRecovery of daily functioning and social adaptation\nSome participants reported regaining basic self-care abilities after radiotherapy, such as cooking, \nsweeping, or light walking. While functional recovery was gradually improving, social adaptation and \nphysical endurance remained limited, highlighting the need for ongoing support and encouragement. \nA few participants expressed a desire to engage in social activities, but family members’ concerns or \ntheir own physical discomfort restricted participation.\n“I don’t go out. Actually, I would really like to, but my family won’t let me. They are \nafraid I will get too tired.” (Participant 4)\n“Now I mainly take care of myself, but when I feel unwell, there are many things I \ncannot do, and I often need help from others.” (Participant 7)\nCoping strategies for economic pressure\nEconomic burden was a common concern, with treatment and recovery costs placing significant strain \non families. Many participants explicitly mentioned that financial stress was a persistent challenge.\n“Neither of us is working, so of course there is pressure. We rely only on savings and \nour children’s support, and life always feels tight.” (Participant 5)\n“Treatment cost a lot, and I even borrowed money from relatives. Every time I think \nabout repaying the debt, I feel uneasy.” (Participant 7)\nTheme 6: Information needs and preferences\nPatients of different ages and levels of information literacy demonstrated distinct preferences in \nobtaining health information. Their needs varied across information channels, knowledge content, \nand follow-up models, reflecting the necessity for more individualized and flexible approaches in \nnursing follow-up. From the interview data, three subthemes were identified: Preferences in \ninformation acquisition methods, Knowledge gaps, and Views on follow-up format and frequency.\nPreferences in information acquisition methods\nClear generational and ability-related differences were observed in patients’ preferences for receiving \ninformation, indicating that communication strategies should be tailored to patients’ stages and life \nrhythms. Older patients tended to rely on face-to-face communication, highlighting barriers to using \nwritten or electronic media, whereas younger or more digitally literate patients preferred electronic \nchannels.\n“WeChat reminders are very useful. I can check them anytime without making a \nspecial trip to the hospital.” (Participant 12)\n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\n“Face-to-face communication is better for understanding. Elderly people like me \ncannot even read. It is best to explain things in person. I cannot use a mobile phone, \nand I cannot understand phone calls clearly either.” (Participant 15)\nKnowledge gaps\nMany participants reported a lack of professional guidance after discharge regarding rehabilitation \ncare, nutrition, and daily management. They not only lacked basic rehabilitation knowledge but also \nrequired personalized guidance tailored to their individual conditions.\n“I don’t know much about rehabilitation knowledge. I hope they can teach us some \nnursing methods, like massage or how to relieve leg swelling.” (Participant 5)\n“I am never sure about what I can and cannot eat, especially since I also have \ndiabetes. I need to supplement nutrition but at the same time worry about high \nblood sugar.” (Participant 2)\nViews on follow-up format and frequency\nParticipants’ opinions about the frequency and format of follow-up varied depending on their \nrecovery stage and physical condition. Some preferred more flexible and convenient approaches. \nWhile a few considered follow-up every three to six months reasonable, others emphasized aligning \nfollow-up with scheduled examinations or using remote methods such as phone or WeChat to reduce \nunnecessary hospital visits.\n“Right after discharge, I think follow-up should be more frequent. But now, longer \nintervals are fine.” (Participant 10)\n“It’s best to complete follow-up along with examinations, without making an extra \ntrip to the hospital.” (Participant 13)\n“Contact by phone or WeChat is also fine—it saves the trouble of going back and \nforth.” (Participant 16)\nDiscussion\nThis study explored the follow-up experiences and needs of cervical cancer patients after \nradiotherapy in a tertiary oncology hospital in Guangzhou, and analyzed the gaps in current continuity \nof care. Participants faced multiple challenges in the physical, psychological, social, and economic \ndomains after treatment. However, variations in functional recovery, psychological adaptation, family \nsupport, and economic coping strategies highlighted the necessity of developing individualized \nnursing follow-up strategies.\nMost participants reported persistent physical symptoms after completing radiotherapy for cervical \ncancer. Lymphedema, urinary and gastrointestinal dysfunction, skin irritation, and pain interfered \nwith daily activities such as household tasks and social participation. These experiences are consistent \nwith previous reports indicating that radiotherapy-induced damage often results in sexual dysfunction, \nlymphedema, menopausal symptoms, osteoporosis, urogenital and gastrointestinal dysfunction, \n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\nchronic pain, and fatigue [7]. Although some studies have reported that the overall long-term quality \nof life among cervical cancer survivors remains acceptable, chronic symptoms and lymphedema \nsignificantly compromise quality of life and warrant further attention [19]. In the Chinese context, \nwhere patients often return to family and work roles after treatment, these persistent symptoms may \nfurther exacerbate limitations in daily living and social engagement. Clinical teams should implement \nstandardized management strategies for common symptoms such as fatigue, including rehabilitation \nexercises, pain control, and lymphedema care, to improve survivors’ quality of life [20,21].\nThe findings also revealed that many patients had insufficient awareness of the importance of \nstructured follow-up and showed low adherence. Studies have demonstrated that cervical cancer \nsurvivors often struggle to maintain long-term compliance with regular follow-up visits [22]. On the one \nhand, some patients mistakenly perceived themselves as “cured” once symptoms were relieved, \nthereby neglecting the necessity of follow-up. On the other hand, economic burdens, transportation \ndifficulties, and limited access to medical resources further reduced adherence. In this study, some \nparticipants explicitly mentioned delays in follow-up due to distance or financial constraints. Within \nthe Chinese cultural context, patients often rely heavily on face-to-face guidance from physicians [23], \nand many survivors fail to fully understand the necessity of follow-up plans. Consequently, some only \nseek medical help when symptoms occur, increasing the risk of delayed detection of recurrence [22]. \nThe latest Chinese clinical guidelines for cervical cancer emphasize the importance of follow-up, \nrequiring regular examinations after radiotherapy [24]. Therefore, clinical practice should strengthen \npatient education and interventions by providing clear follow-up schedules and content explanations, \nusing reminder systems (e.g., telephone, WeChat), and reducing the burden for patients with financial \ndifficulties.\nThis study also highlighted that most participants experienced fear of recurrence, emotional distress, \nand even anxiety or depression during recovery. In China, the prevalence of anxiety and depression \namong cervical cancer patients has been reported to be as high as 65.6% and 52.2%, respectively [25]. \nDue to cultural norms, patients often suppress negative emotions to avoid burdening their families, \nleaving many psychological needs unmet. Previous research showed that approximately 43% of \ncervical cancer survivors experience clinically significant anxiety or depression during the first three \nyears after treatment, yet fewer than one-quarter of medical centers conduct routine psychological \nscreening [22]. Evidence supports that psychological interventions for cancer survivors, such as \ncognitive-behavioral therapy and mindfulness-based stress reduction, can significantly reduce fear of \nrecurrence and psychological distress [26]. It is therefore recommended that psychological assessment \nbe integrated into China’s follow-up system, extending mental health services into the community to \nmeet survivors’ long-term emotional and supportive needs.\nThe impact of cervical cancer treatment on sexual health was profound. Many participants reported \ndecreased sexual desire, vaginal dryness, and dyspareunia, yet often felt too embarrassed to bring up \nthese concerns or received little support[27]. More aggressive treatment regimens, such as concurrent \nchemoradiotherapy with brachytherapy, can cause greater structural and functional damage to the \nvagina [19]. In this study, some women described feeling distant from their partners. Communication \nbarriers regarding sexual health were striking. Influenced by traditional Chinese values, patients often \nrefrained from discussing sexual issues with physicians, while healthcare providers seldom took the \ninitiative to inquire [28,29]. Clinical follow-up should recognize the importance of sexual health, \n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\nincorporate it as a regular agenda item, create a private and trusting environment, and encourage \npatients to express their concerns. Evidence-based interventions should also be provided, such as \nvaginal dilators, local hormonal therapy, and sexual counseling [30].\nFamily played an important role in patient recovery, with many participants describing care and \nemotional support from spouses, children, and relatives as vital to coping. However, some patients \nalso reported experiencing guilt over imposing financial and emotional burdens on their families. \nStudies have shown that 65.2% of gynecologic cancer patients have unmet social needs, with family \nsupport serving as a key resource for cervical cancer survivors [31,32]. Healthcare professionals should \nprovide regular updates to family members on the patient’s recovery to foster a sense of involvement \nand sustained motivation for support. Globally, cervical cancer has shown an increasing trend among \nyounger women [33,34], and in this study, some participants had already returned to work. Therefore, \nworkplace support should also be considered. At the policy level, financial and caregiving assistance \nfor low-income families should be strengthened to reduce social and economic burdens.\nThe interviews further revealed differing preferences for acquiring health information. Some patients \npreferred direct face-to-face guidance from physicians, while others actively sought information via \nthe internet and social media. However, patients faced two major challenges in self-directed searches: \nthe complexity of medical terminology and the unreliability of online information [23]. Without \nsimplified patient-friendly materials or guidance toward high-quality sources, survivors are prone to \nconfusion and anxiety, which may undermine adherence and recovery experiences [35]. It is \nrecommended to develop educational materials tailored for cervical cancer survivors (e.g., concise \nbooklets, WeChat articles, online courses) covering follow-up schedules, side-effect management, \nnutrition and exercise, and fertility concerns. Hospitals could also leverage multimedia platforms, \nsuch as official WeChat accounts, to regularly disseminate rehabilitation knowledge and incorporate \nQ&A sessions into remote follow-up [36].\nLimitations\nThis study was a single-center qualitative study with a relatively small sample size, including only 16 \ncervical cancer patients after radiotherapy from a specialized oncology hospital in Guangzhou. \nTherefore, the generalizability and representativeness of the findings are limited. As semi-structured \ninterviews and interpretative phenomenological analysis were employed, data interpretation may \nhave been influenced by the researchers’ subjectivity, and bias could not be completely avoided. \nFurthermore, this study did not conduct in-depth stratified analyses based on patients’ treatment \nstages or social backgrounds. Future research should expand sample sources and incorporate \nquantitative methods to further validate the present findings.\nConclusion\nThis study provided an in-depth exploration of the subjective experiences of cervical cancer patients \nduring post-radiotherapy nursing follow-up. It revealed their real challenges and needs regarding \nphysical symptoms, perceptions of follow-up, psychological status, sexual health, family support, and \ninformation acquisition. The findings suggest that patients generally expect more continuous, \nindividualized, and empathetic follow-up support to enhance rehabilitation quality and social \n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\nadaptation. Nursing staff should strengthen the proactivity and professionalism of follow-up services, \nwith particular attention to sexual health guidance, psychological support, and health education. \nFuture multi-center and mixed-methods studies are needed to provide evidence for the development \nof a more comprehensive and effective follow-up system for cervical cancer survivors.\nAcknowledgments\nWe sincerely thank the patients who participated in this study and the clinical staff who \nsupported data collection.\nReferences\n[1] Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. 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J Cancer Educ. \n2023;38(5):1710–1718. doi:10.1007/s13187-023-02325-5\n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\nAppendix 1. Semi-Structured Interview Guide\n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\nTable 1 Sociodemographic and Clinical Characteristics of the Participants\nVariables Frequencies(n) %\nParticipants age\n31–50 4 25\n51–70 10 62.5\n71–90 2 12.5\nMarital status\nUnmarried 3 18.75\nMarried 11 68.75\nWidowed 1 6.25\nInterview Questions\nAfter completing radiotherapy, have you experienced any physical discomfort? How have \nthese symptoms affected your daily life? Are there any issues that remain unresolved at \npresent?\nAre you familiar with the concept of “follow-up care”? If yes, how do you understand it?\nHave healthcare professionals ever conducted nursing follow-up with you? Are you aware \nof your post-radiotherapy follow-up plan? What are your views on follow-up care? Has the \ncurrent follow-up been helpful? What problems have you noticed? What additional \ncontent do you think should be included?\nAre you satisfied with the current form of follow-up care? Do you think the timing of \nfollow-up appointments is reasonable? Are there any adjustments needed? What \nfrequency and form of follow-up would you prefer?\nUnder what circumstances would you be unwilling to participate in follow-up care? Under \nwhat circumstances would you be willing to attend?\nAfter radiotherapy, have you experienced anxiety, depression, or other emotional \nproblems? How have these emotions affected your daily life? Have you received \npsychological counseling or participated in a support group? If yes, how effective was it? \nWould you like to receive more mental health support? If so, in what form?\nAfter radiotherapy, have you experienced any sexual health problems? Have these issues \naffected your quality of life? Have you received sexual health guidance? If yes, how \neffective was it? What kind of support would you like in relation to sexual health?\nAfter radiotherapy, have you received adequate family support? Do your family members \nunderstand your needs? Have you experienced financial difficulties?\nAre you familiar with rehabilitation knowledge for cervical cancer patients after \nradiotherapy? Would you like to receive more guidance about follow-up care? What is \nyour preferred method for obtaining health information? How do you think the healthcare \nteam could improve the provision of such information?\n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\nDivorced 1 6.25\nEducation level\nPrimary school 2 12.5\nMiddle school 6 37.5\nHigh school 1 6.25\nCollege and above 7 43.75\nOccupation\nEmployed 5 31.25\nRetired 3 18.75\nUnemployed 8 50\nTime since radiotherapy ended\n≤1 year 8 50\n1–3 years 4 25\n>3 years 4 25\nCancer stage\nStage I 4 25\nStage II 2 12.5\nStage III 10 62.5\nTreatment method received\nSurgery + Radiotherapy 2 12.5\nChemotherapy + Radiotherapy 1 6.25\nSurgery + Chemotherapy + Radiotherapy 13 81.25\nTable 2. Summary of themes and categories\nThemes Categories\nOngoing physical symptoms and interference(i) Persistent discomfort and daily life \nimpact Pronounced fatigue and functional limitations\nLimited knowledge of nursing follow-up content(ii) Insufficient understanding of the role of \nnursing follow-up Recognition of the value of follow-up\nAnxiety and depressive emotions(iii) Psychological stress and need for \nsupport Low participation in psychological counseling \nservices\n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint \n\nFamily and self-adjustment\nDecline in sexual desire and intercourse \ndifficulties\nSevere lack of sexual health guidance(iv) Sexual health concerns\nSensitivity and avoidance psychology\nVariations in quality of family support\nRecovery of daily functioning and social \nadaptation(v) Help and conflicts in family support\nCoping strategies for economic pressure\nPreferences in information acquisition methods\nKnowledge gaps(vi) Information needs and preferences\nViews on follow-up format and frequency\n . CC-BY 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted October 15, 2025. ; https://doi.org/10.1101/2025.10.13.25337929doi: medRxiv preprint","source_license":"CC-BY-4.0","license_restricted":false}