Exploration of Symptoms and Psychological Experiences among Lung Cancer Patients during the First Year Following Day Surgery: A Qualitative Study

Exploration of Symptoms and Psychological Experiences among Lung Cancer Patients during the First Year Following Day Surgery: A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploration of Symptoms and Psychological Experiences among Lung Cancer Patients during the First Year Following Day Surgery: A Qualitative Study Xiaomin Hu, Hua di Yuan, Jie Zhang, Yaojuan Jin, Wang yang Tuo, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8485285/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: This study investigates the symptom experiences and psychological states of patients with lung cancer following day surgery the first year in China. Methods: A qualitative investigation was conducted utilizing face-to-face semi-structured interviews with lung cancer patients during the initial post-operative year. Interviews were audio-recorded, transcribed verbatim, and analyzed using Colaizzi's seven-step phenomenological methodology. Rigor was ensured through adherence to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Participants (n = 14) were recruited from a top-tier hospital in China using purposive sampling methodology between September 2024 and January 2025. The cohort exhibited a mean age of 57.1 ± 8.39 years, with the majority presenting with stage I disease. Thematic analysis of interview data yielded four principal themes characterizing the experiential dimensions: (1) Symptom manifestations and alterations, (2) Uncertainty regarding disease trajectory, (3) Confidence in treatment efficacy and therapeutic concerns, and (4) Support systems and unmet needs. Conclusion: Lung cancer patients exhibit a considerable symptom burden following day surgery. Heightened attention to post-discharge home care for this population is imperative. Clinicians should implement prompt and effective symptom assessments, followed by the integration of targeted symptom management strategies into discharge planning to alleviate post-discharge symptom burden. Lung cancer Symptom experiences Day surgery Qualitative research 1. Introduction Lung cancer (LC) represents a significant health burden in China, ranking among the top five chronic diseases [ 1 ] . Globally, it is the leading cause of cancer-related mortality and the most frequently diagnosed malignancy, with approximately 733,291 deaths reported in 2022 [ 2 ] . As the world's most populous nation, China exhibits the highest prevalence of daily smoking among males, raising concerns about a potential rapid increase in lung cancer incidence (projected at 41.5%) [ 3 ] . In most countries, the five-year survival rate for lung cancer remains below 20% [ 4 ] . Due to the widespread adoption of low-dose spiral computed tomography and advancements in therapeutic techniques, surgical intervention has emerged as the primary treatment modality for patients with early-stage non-small cell lung cancer [ 5 ] . With the continuous advancement of medical technology, day surgery has gradually emerged as a novel treatment option for lung cancer patients [ 6 ] . This model not only reduces hospital length of stay but also provides patients with a more convenient recovery experience [ 7 ] . However, this transition may increase the risk of inadequate medical support. In the context of day surgery, lung cancer patients are confronted with the challenge of achieving comprehensive postoperative rehabilitation and discharge within a limited timeframe, encompassing both discharge preparation and rehabilitation therapy [ 8 ] . As a malignant tumor with high global incidence and mortality rates, lung cancer often leaves patients facing numerous physical and psychological challenges following surgical treatment [ 9 ] . As a malignant tumor with high global incidence and mortality rates, lung cancer often leaves patients facing numerous physical and psychological challenges following surgical treatment. Effective symptom management is a critical strategy for alleviating patient burden and facilitating postoperative recovery [ 10 ] . Tang and colleagues documented a substantial symptom burden among lung cancer patients during the initial post-operative month, with pain, fatigue, dyspnea, and sleep disturbances being the most severe clinical manifestations. Tang and colleagues documented a substantial symptom burden among lung cancer patients during the initial post-operative month, with pain, fatigue, dyspnea, and sleep disturbances being the most severe clinical manifestations [ 11 ] . Therefore, an in-depth understanding of patients' symptom experiences and psychological states during this period holds important clinical value and practical significance. Existing studies on lung cancer patients have predominantly focused on the evaluation of physiological efficacy and the effects of medical interventions [ 12 , 13 ] . However, relatively insufficient attention has been paid to patients' subjective experiences. As an approach to gain in-depth insights into individuals' experiences and perceptions, qualitative research can provide us with richer and more nuanced patient perspectives, assisting medical teams in developing targeted intervention strategies. Through qualitative research, we can explore patients' perceptions of their own symptoms following day surgery, the impacts on their quality of life, as well as their emotional needs and expectations for nursing support [ 14 ] . Therefore, this study will adopt a qualitative research approach from the perspective of Chinese patients to conduct an in-depth exploration of the symptomatic and psychological experiences of lung cancer patients within one year after day surgery. This research is anticipated to fill the existing gap in the current literature regarding the exploration of patients' subjective experiences, thereby providing data support and a theoretical basis for the development of personalized nursing interventions tailored to patients' needs in the future. It will not only focus on patients' physical health but also emphasize the significance of psychological support and emotional care. Through this study, we aim to provide clinical insights that assist healthcare teams in more comprehensively understanding and responding to the complex experiences of lung cancer patients during postoperative rehabilitation. In turn, this will facilitate improvements in the overall quality of patient care, enhance their quality of life, and promote the recovery of their mental health. Ultimately, this research seeks to advance the application of day surgery in lung cancer treatment, ensuring that patients not only receive effective physical treatment but also obtain better support and improvements in psychological adjustment and social adaptation. 2. Methods 2.1 Study Design This qualitative study employed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to investigate the symptoms and psychological experiences of lung cancer patients during the first year following day surgery [ 15 ] . Ethical approval was obtained from the Ethics Committee of The Second Affiliated Hospital, Zhejiang University School of Medicine (Approval Number: (2024) Ethical Review No. 0145). Written informed consent was obtained from all participants. 2.2 Participants and Recruitment Participants were recruited during follow-up outpatient clinic visits between September 2024 and January 2025. Eligibility criteria comprised: (1) age ≥ 18 years; (2) confirmed diagnosis of lung cancer; and (3) history of day surgery within the preceding year. Exclusion criteria were: (1) impaired verbal communication, and (2) diagnosed mental disorders. Purposive sampling was employed for participant selection until data saturation was attained. Researcher Wangyang Tuo conducted all semi-structured interviews. Of the seventeen individuals invited, three declined participation due to a lack of interest. Consequently, fourteen patients were enrolled in the study. All participants voluntarily agreed to participate in this study and signed the informed consent form. 2.3Determination of the interview outline In light of the research objectives, current status of relevant domestic and international studies, and recommendations from expert discussions, a preliminary version of the interview outline was formulated for this study. Subsequently, a pilot interview was conducted with three patients (the results of which were excluded from data analysis), and the content of the outline was revised accordingly. The final interview outline is as follows:(1) How long have you been suffering from this disease since its onset?(2) What symptoms have you experienced after the onset of the disease? What are the specific manifestations of these symptoms (e.g., onset time, frequency, and affected site)?(3)Which symptom has been the most distressing to you?(4)What impacts have these symptoms exerted on your daily life?(5)What are your perceptions of these symptoms?(6)What measures do you take to alleviate your condition when these symptoms occur?(7)Do you need assistance from medical staff? If yes, could you give some specific examples? 2.4Data Collection and Quality Assurance Measures Interviews will be conducted in an independent, quiet, and private room, by a nursing postgraduate with professional training in qualitative research. Prior to the formal interview, researchers should gain a thorough understanding of the participants’ basic information and establish a sound trusting relationship through adequate communication, so as to reduce potential psychological defensiveness among participants during the interview. Before the interview commences, researchers must provide a detailed explanation of the study objectives, procedures, and content to participants, and explicitly commit to the strict confidentiality of all interview data and audio recordings, which will be used exclusively for this research project. The formal interview will be initiated only after participants have voluntarily signed the informed consent form. Throughout the interview, data will be documented via a combination of audio recording and on-site note-taking to ensure the completeness of data and the scientific rigor of the study. During the interview, researchers are required to maintain attentive listening, flexibly adjust questioning strategies based on participants’ responses, and simultaneously record key content, emotional reactions, and non-verbal behaviors. Each interview will be controlled within a duration of 20–30 minutes and concluded when data saturation is achieved—that is, when no new themes or perspectives emerge. All transcripts were systematically assigned unique identifiers (01, 02, 03, ..., 14). Within 24 hours following the interview, two nursing postgraduates will complete verbatim transcription of the audio recordings in accordance with the principle of verbatim presentation. Upon completion of transcription, researchers shall submit the textual transcripts to participants for verification, so as to ensure the accuracy of records and consistency with the participants’ genuine intentions. 2.5 Data Analysis Two nursing postgraduates analyzed the same set of textual data using Colaizzi’s seven-step phenomenological analysis method and NVivo 12.0 software. Specifically, Colaizzi’s seven-step approach involves the following procedures [ 16 ] : (1) Repeatedly reading all interview transcripts to gain a holistic understanding of the content; (2) Extracting all meaningful statements related to the postoperative symptoms and psychological experiences of lung cancer patients; (3) Conducting an in-depth interpretation of the extracted statements to refine their implicit meanings; (4) Categorizing similar units of meaning to form preliminary themes; (5) Repeatedly comparing the preliminary themes with the original data to ensure accuracy; (6) Integrating related themes to construct a concise thematic framework; (7) Synthesizing all themes to form a comprehensive description of the essence of the phenomenon. During this process, the researchers systematically coded the meaningful statements regarding the postoperative symptoms and psychological experiences of lung cancer patients and conducted thematic synthesis. Ultimately, the collation and analysis of the data were guided by experts with extensive qualitative research experience, who evaluated the rationality of the transcribed content and the summarized themes. Any discrepancies arising during the analysis process were collectively discussed and resolved by the research team. 3. Results A cohort of 14 patients with lung cancer who underwent day surgery participated in this study. The cohort consisted of 4 males and 10 females, with a mean age of 57.1 ± 8.39 years (range, 40–70 years). All participants were married and possessed medical insurance coverage. Professional status, educational attainment, and disease stage are detailed in Table 1 . Educational levels varied among participants, although the majority had completed junior high school. Household incomes were predominantly reported to range from 10,000 to over 20,000 Yuan monthly. The histological subtypes of lung cancer were diverse, with the largest proportion of patients diagnosed with minimally invasive adenocarcinoma. The post-operative duration exhibited considerable heterogeneity among patients, ranging from 14 days to 10 months (Table 1 ). The key theme was emerged from the data related to lung cancer patients' symptom experiences after day surgery during the first year: symptoms and changes, uncertainty, confidence and concerns, and supports and needs. Table 1 Demographic information and clinical characteristics of the participants (N = 14) # Age Sex Marital status Educational level Employment Household income, Yuan/month Time after surgery Types of lung cancer Disease stage 1 67 Female Married Primary school Unemployed 20,000 9 months Minimally Invasive Adenocarcinoma T1miN0M0 3 70 Male Married Primary school Retired < 10,000 3 months Invasive Adenocarcinoma T2N1M1 4 55 Male Married University Company clerk 10,000–20,000 1 month Minimally Invasive Adenocarcinoma T1miN0M0 5 60 Female Married Junior high Farmer < 10,000 4 months Invasive Adenocarcinoma T1bN0M0 6 52 Male Married Primary school Farmer < 10,000 1 month Invasive Adenocarcinoma T1bN0M0 7 59 Female Married Junior high Retired < 10,000 5 months Minimally Invasive Adenocarcinoma T1miN0M0 8 59 Female Married Junior high Farmer < 10,000 16 days Minimally Invasive Adenocarcinoma T1miN0M0 9 62 Female Married Primary school Farmer < 10,000 3 months Minimally Invasive Adenocarcinoma T1miN0M0 10 55 Female Married University Retired < 10,000 3 months Invasive Adenocarcinoma T1bN0M0 11 40 Female Married University Company clerk 10,000–20,000 6 months Minimally Invasive Adenocarcinoma T1miN0M0 12 67 Female Married Senior high Retired < 10,000 18 days Minimally Invasive Adenocarcinoma T1miN0M0 13 48 Female Married University Teacher 10,000–20,000 10 months Minimally Invasive Adenocarcinoma T1miN0M0 14 47 Female Married University Teacher 10,000–20,000 15 days Invasive Adenocarcinoma T1aN0M0 3.1 Theme 1: Symptom manifestations and alterations Most patients were discharged within two days, consequently impeding the timely management of post-operative symptoms. Several participants retained distinct recollections of symptomatic manifestations owing to persistent discomfort. The predominant symptoms reported by participants during the first year following discharge from day surgery were pain (78.6%), shortness of breath (78.6%), and sleep disturbances (50%). Fatigue was additionally reported by five participants (35.7%). The wound was intensely painful and persisted for approximately one month. (Participant 3) I continue to experience difficulty with deep inspiration to the present day. Upon deep inhalation, a sensation of obstruction is perceived in my left lung, whereas my right lung demonstrates unimpaired and effortless airflow. (Participant 13) My sleep quality was significantly compromised; I experienced frequent nocturnal awakenings. On occasions when sleep was achieved, it was limited to approximately one hour. This phenomenon persisted for nearly two months, resulting in pronounced daytime fatigue. (Participant 5) Following day surgery procedures, the majority of participants reported alterations in their daily routines. Dietary modifications represented the most prevalent and readily adopted change. Subsequently, shifts in attitudes and behaviors concerning smoking were noted. Furthermore, smoking and alcohol abstinence contributed to improved post-operative appetite. I presently prioritize maintaining a well-balanced diet. (Participant 4) I have abstained from consuming alcohol and cigarettes, a behavioral shift that has enabled me to consume two additional bowls of rice per meal—a practice previously unattainable. Previously, I would typically prefer a glass of wine to consuming a meal. (Participant 3) My food intake has marginally increased compared to the past since I ceased alcohol consumption. Previously, when I consumed wine, my appetite for food was relatively diminished. (Participant 6) Participants often experience increased fatigue during the post-operative period. The majority remain at home for approximately two weeks or longer following hospital discharge. Despite the absence of occupational or domestic responsibilities, they report significantly increased fatigue compared to their preoperative state. This scenario occasionally results in spouses expressing dissatisfaction, with some taking the initiative to assume household duties proactively. Family support is essential for patients to sustain a positive emotional state. It is plausible that my physical state has not fully recovered. Currently, I am aware that I am prone to fatigue. What strategies can be employed to tackle this problem? Previously, fatigue was not a frequent phenomenon. In the past, participating in physical workouts or traveling did not lead to fatigue; however, currently, I encounter tiredness under such conditions. (Participant 7) Due to a lack of energy to undertake household chores, I have chosen to discontinue this task. Consequently, it falls upon my husband to handle the housework (laugh). However, he shows reluctance in fulfilling this responsibility. Perhaps he should adapt to this situation! (Participant 8) Similarly, I tend to sleep for prolonged periods. I slept for approximately 12 hours yesterday. Even following a midday nap, I continue to experience significant afternoon somnolence. (Participant 8) Following the surgical procedure, the majority of participants recognized the significance of adopting healthy lifestyles and discontinued detrimental habits, including smoking, alcohol consumption, and mahjong playing. They also demonstrated heightened attention to physical well-being and cultivated new interests. Compared to Western medicine, participants exhibited a preference for traditional Chinese medicine for post-surgical rehabilitation. Taiji, Ba Duan Jin, and the Five Animal Exercises gained increased popularity among these participants, appearing to facilitate their physical and psychological recovery from surgery. Mahjong, a prominent traditional Chinese recreational activity, presented comparable challenges for participants to abstain from as quitting smoking and alcohol. Consequently, participants opted to play mahjong exclusively with women due to the latter's non-smoking behavior. The frequency of mask usage also rose during outdoor activities or cooking. Some participants abandoned self-cooking or opted for steamed food to minimize inhalation of cooking fumes. Recently, I initiated the study of Huangdi Neijing, a pursuit scheduled initially for six years later. Additionally, engagement with traditional Chinese medicine facilitated interactions with new colleagues. (Participant 13) I will cease playing mahjong and terminate my engagement in this activity. Currently, I participate in card games with female counterparts. (Participant 5) The practice of Baduanjin has recently been initiated. (Participant 14) Following the surgical procedure, I adopted the practice of wearing a mask during cooking activities and activated the kitchen ventilation system. Furthermore, I enhanced my vigilance concerning this issue. (Participant 11) Recently, I have consciously abstained from employing deep-frying culinary techniques. Conversely, I prioritize preparing stewed soups and stir-frying individual vegetable dishes. (Participant 14) 3.2 Theme 2: Uncertainty regarding disease trajectory Considerable uncertainty pervades patients' daily lives following surgery. Participants reported refraining from bathing for approximately half a month postoperatively until their scheduled clinic revisit. Uncertainties were also expressed regarding appropriate dietary practices, physical activity levels, and resumption of household chores. Notably, some experienced dental pain persisting for several days yet refrained from seeking professional treatment. May I present to the clinic for the extraction of a tooth that has been causing pain for several days? Additionally, what is the recommendation regarding the dyeing of my hair? (Participant 7) After the stitches were removed, I have felt a little itchy for the past two days. Maybe it is because I am afraid to take a shower and wipe it? (Participant 10) However, a persistent issue remains: I experience significant apprehension regarding bathing. For the past two weeks, bathing avoidance has led me to rely solely on sponge bathing for personal hygiene. Furthermore, I seek clarification: might performing basic household chores also be feasible? (Participant 1) Dietary practices constitute the primary source of uncertainty for participants. Despite explicit clinical advice indicating no post-operative dietary restrictions, participants persisted in avoiding red meat and seafood. Furthermore, select individuals abstained from tofu consumption and exhibited a preference for white-colored vegetables. Within the Chinese context, traditional dietary regimens incorporating components such as Hongzao, Longyanrou, and Gouqi are prevalent. These nutritional supplements are perceived to confer therapeutic effects; however, adverse gastrointestinal reactions, including diarrhea, were documented among some participants consequent to excessive intake. My friends cautioned against consuming certain food items; consequently, I refrain from consuming my favorite tofu as well as beef. (Participant 3) However, when seafood originates from Japanese waters, I am neither willing nor inclined to consume fish at present. (Participant 1) Due to compromised pulmonary function, I predominantly consume foods characterized by their white coloration. For example, these include white rice, white rice porridge, white cabbage, and radish. Additionally, I ingest steamed apples, jujubes, dried longan, goji berries, and ophiopogon. (Participant 13) I consumed various substances, including Dendrobium and Cordyceps, as well as other conceivable materials. Subsequently, I suspected this practice might be erroneous due to the development of diarrhea. (Participant 14) During my post-operative recovery period, I consumed stewed loach with tofu. It is generally recommended that patients should increase their intake of fish and shrimp protein following surgical procedures. (Participant 10) It is the yellow eel, loach, and turtle, which I typically avoid consuming due to a generalized weakness. Do these foods possess significant protein content in dietary contexts? Potential intolerance may be associated with the diarrhea I experienced. (Participant 8) 3.3 Theme 3:Confidence in treatment efficacy and therapeutic concerns We observed that participants exhibited comparable levels of confidence and concerns regarding rehabilitation. Numerous participants reported a firm belief in the efficacy of post-operative rehabilitation, perceiving themselves to be as healthy as typical healthy individuals. However, they concurrently expressed apprehension regarding disease recurrence and discomfort when cancer-related topics were raised. Notably, while some individuals derived unexpected benefits from their illness experience, others associated it with feelings of stigma. We have now acquired a certain level of medical expertise and have gained substantial knowledge from this experience. (Participant 9) Presently, I intend to bid farewell to the past. Having undergone the surgery, which proved to be successful, I am now a normal individual, and this is a fact. (Participant 13) Over the past fortnight, I have experienced a progressive improvement in my well-being and currently perceive my physical state to be commensurate with baseline levels, without any discernible discomfort. (Participant 1) At times, I reassured myself that I was clinically cured, which was indeed the case. However, persistent concerns regarding potential recurrence remained. Frankly, I maintain significant apprehension due to prevailing cultural stigmas. Given the proximity of the Lunar New Year and my planned return to my hometown, I explicitly requested my husband to limit disclosure of my diagnosis. As is widely recognized, strong cultural taboos surround public discussion of cancer within Chinese society. (Participant 13) Under the day surgery model, wherein patients are discharged promptly, several participants expressed reservations regarding this approach, while others indicated a desire for enhanced post-operative care from the hospital. Within 24 hours post-discharge, patients recuperating at home frequently reported concerns about potential complications, including wound dehiscence, hemorrhage, and limitations in physical mobility, such as arm elevation or positional changes. Furthermore, despite satisfactory post-operative recovery, apprehension persisted among some patients regarding long-term oncological outcomes, specifically cancer prognosis and recurrence risk. Post-operative care did not involve any therapeutic intervention on the subsequent day. The surgical procedure was performed on Monday. On Tuesday, the medical team advised that discharge was permissible and pharmacological treatment was no longer indicated. I asked the rationale for discontinuing medication. The clinician clarified that the absence of inflammatory indicators rendered further treatment unnecessary. (Participant 14) The surgeon informed us about this model (day surgery) on the day of the operation. Consequently, the biopsy was not performed; instead, the procedure proceeded directly to surgery that same day. This abrupt transition caused considerable apprehension. Although this may represent your standard protocol, we nevertheless perceived the timeline as excessively compressed. Discharge followed shortly thereafter. (Participant 3) 3.4 Theme 4:Support systems and unmet needs Perceived support played a crucial role in patients' post-operative recovery, with the majority of participants reporting receipt of such support from spouses or children. During illness, family members provided heightened attention and comprehensive care throughout the perioperative period. Some participants noted this heightened attention was limited to approximately one or two months. Older participants expressed pride that their children covered the surgical expenses. Others self-funded the procedure to alleviate financial pressure on their offspring. The geographical location of their children's employment constituted the primary factor influencing most elderly patients' decision to undergo surgery at this facility. During the perioperative phase, elderly patients typically resided at their children's homes, subsequently returning to their residences postoperatively. It was essential for family members to provide emotional support; however, this supportive engagement persisted for merely one month. Subsequently, circumstances reverted entirely to the pre-intervention state, with my husband resuming daily social engagements involving dining out. (Participant 14) This individual is my son-in-law, who accompanies me consistently. He arose at 5:30 this morning. His character is exemplary, akin to that of a son to me. My family members exhibit heightened concern regarding my cancer diagnosis, significantly more so than prior to my surgery. This worry manifests as frequent reminders to dress warmly to avoid contracting a cold. (Participant 6) In the post-operative period, my husband assumed responsibility for all domestic tasks and demonstrated increased tolerance towards me. For instance, during occasional episodes of irritability, he would provide comfort. He also accompanied me to follow-up medical appointments. However, I considered his attendance at these appointments unnecessary, as it required him to take leave from work. Believing I was fully capable of attending independently, I accepted his accompaniment for the initial appointments but subsequently attended alone. (Participant 11) The financial burden is evident, as my prior savings had been entirely depleted. I independently shouldered all treatment expenses, reasoning that funds intended for posthumous distribution to my family were essentially allocated in advance for cancer intervention. Furthermore, I underwent genetic testing in Shanghai for CNY 18,000, which represented a relatively costly expenditure. (Participant 6) Several patients reported receiving attentive care and support from the medical staff during this period, which enhanced their confidence in overcoming the disease. They indicated that healthcare professionals demonstrated warmth and made every effort to meet patients' needs. Prior to the surgical procedure, the hospital provided brief pre-operative education, including instructional videos, which was perceived as beneficial. (Participant 13) It was stated in the pre-operative lectures that patients should cough as vigorously as possible. Following these instructions, I performed daily post-operative deep-breathing exercises to facilitate coughing. (Participant 1) The nurse advised me to initiate early ambulation as soon as possible after surgery, along with several other precautions. I found this professional guidance crucial, particularly during the initial hospitalization period. (Participant 14) Attending the consultation proved advantageous, as listening to my doctor's brief remarks provided psychological comfort. (Participant 2) 4. Discussion This qualitative study explored the physical symptoms and psychological experiences of lung cancer patients during the first year following day surgery, revealing a complex and dynamic recovery trajectory shaped by both bodily changes and emotional challenges. A total of 14 participants—predominantly female, married, with low to moderate educational attainment (mainly junior high school or below), and household incomes mostly below 20,000 Yuan per month—shared their lived experiences, offering rich insights into the postoperative reality beyond clinical metrics. One of the key findings was the persistence and fluctuation of physical symptoms over time. Participants reported ongoing issues such as pain at the surgical site, fatigue, dyspnea on exertion, shoulder stiffness, and persistent coughing, which often interfered with daily activities and sleep quality. Notably, while these symptoms were expected to diminish after discharge, many patients experienced unexpected prolongation—particularly fatigue and respiratory discomfort—that lasted for several months. This aligns with previous studies indicating that even minimally invasive procedures like video-assisted thoracoscopic surgery (VATS) can lead to prolonged symptom burden due to nerve injury, musculoskeletal strain, or reduced pulmonary reserve [ 17 ] . The current findings underscore that "day surgery" does not equate to rapid or uncomplicated recovery; rather, it necessitates sustained symptom monitoring and support during the critical first year. Therefore, the whole-process nursing service system can be implemented to manage patients undergoing day surgery, with particular emphasis on monitoring symptoms during the post-discharge recovery period, enabling timely assessment of both physical and psychological symptomatology [ 18 ] . A recent study by Chinese scholars using factor analysis to examine the longitudinal changes in symptoms among lung cancer patients after day surgery revealed dynamic fluctuations in individual symptoms and symptom clusters over time [ 19 , 20 ] . These findings suggest that clinicians, particularly nurses, should adopt targeted, phase-specific interventions tailored to the evolving symptom profiles of patients at different stages of recovery, thereby reducing overall symptom burden and improving patient outcomes. Beyond physical discomfort, psychological distress emerged as a central theme across narratives. Anxiety about cancer recurrence was nearly universal [ 21 ] , often triggered by minor bodily sensations such as chest tightness or coughing. These somatic cues were frequently interpreted through a catastrophic lens, leading to heightened vigilance and fear [ 22 ] . Some participants described feeling emotionally isolated, especially when family members minimized their concerns or urged them to “just move on.” This echoes findings from Guo et al [ 23 ] , who identified emotional suppression and lack of resilient coping strategies among preoperative non-small cell lung cancer patients in China. In our sample, limited health literacy and low awareness of psychosocial resources further exacerbated distress. Many participants did not recognize their emotional struggles as legitimate or treatable conditions, and few proactively sought professional psychological help. The findings indicate that the majority of patients appear reluctant to seek professional support, which may be closely linked to the cultural context in China. Lung cancer is often perceived as a stigmatized illness, leading patients to conceal their diagnosis and avoid disclosing their psychological distress [ 23 ] . This stigma, coupled with concerns about high medical costs, further discourages proactive help-seeking behavior, resulting in unmet psychosocial needs. To prevent the worsening of this issue, we recommend implementing preoperative psychological interventions and health education to help patients develop a positive mindset and enhance their readiness to adapt to disease-related physical changes. Such proactive support may improve psychological preparedness, promote adaptive coping strategies, and facilitate better adjustment during the postoperative recovery period [ 24 ] . Importantly, this study revealed a significant gap in patient education and transitional care. Despite being discharged within 24 hours—a hallmark of day surgery—most participants felt unprepared for managing symptoms at home. They expressed uncertainty about distinguishing between normal postoperative changes and warning signs requiring medical attention. For instance, some delayed seeking care for worsening pain or new-onset shortness of breath out of fear of being perceived as “overreacting”. Others relied heavily on informal sources of information, such as online forums or peer advice from fellow patients, which sometimes led to misinformation or increased anxiety. This finding further underscores the need for healthcare professionals to provide health education not only preoperatively but even during the screening or physical examination stage, equipping patients with essential knowledge to facilitate early symptom recognition and prompt medical consultation. Moreover, promoting the use of digital health platforms is recommended to enhance patients’ motivation and capacity for proactive health information seeking [ 25 ] . Such an approach not only empowers individuals in managing their health but also supports the broader dissemination and adoption of digital health technologies in oncology care [ 26 ] . The sociocultural context also played a crucial role in shaping recovery experiences [ 27 ] . Most participants came from rural or semi-urban backgrounds and had limited access to rehabilitation services or follow-up support. Their roles as caregivers or breadwinners added pressure to return to normalcy quickly, even when physically or emotionally unready. Women, in particular, reported suppressing their own needs to maintain family stability, reflecting broader gendered expectations in Chinese society. Our findings are consistent with those of a 14-year cohort study [ 28 ] , which also demonstrated a progressive increase in lung cancer mortality among women with advancing age. This suggests that not only should greater attention be directed toward female populations in rural areas—who often face compounded disadvantages due to limited access to care—but also that differential medical and nursing interventions should be tailored according to age-specific patient subgroups. Personalized approaches that account for the biological, psychosocial, and healthcare utilization differences across age strata are essential to improving outcomes in this high-risk population. These findings highlight the need for a more holistic, patient-centered approach to post-day-surgery care. Healthcare providers should move beyond a purely biomedical model and integrate routine screening for both physical symptoms and psychological well-being throughout the first postoperative year. Structured discharge planning that includes personalized symptom management guides, clear referral pathways for mental health support, and accessible follow-up mechanisms (e.g., telehealth consultations or mobile health applications) could significantly improve patient outcomes [ 29 ] . Furthermore, educational interventions tailored to patients’ literacy levels and cultural beliefs may enhance self-efficacy and promote timely help-seeking behaviors. In conclusion, this study provides valuable firsthand accounts of the multifaceted challenges faced by lung cancer patients after day surgery. Recovery is not merely a physiological process but an intricate interplay of bodily sensations, emotional responses, social roles, and healthcare system interactions. By listening to patients’ voices, clinicians can develop more compassionate, responsive, and effective support systems that truly meet the needs of individuals navigating life after lung cancer surgery. 5. Limitations and Future Research Directions The limitations of this study lie in the small sample size and the restriction of participants to Zhejiang Province. Future research should expand the sample size and include patients from more diverse geographical regions to enhance the generalizability of the findings. Meanwhile, considering the cultural disparities across different regions, subsequent studies should also focus on comparing postoperative symptom experiences and psychological states of lung cancer patients against varied cultural backgrounds. In addition, the adoption of quantitative methods to assess explicit changes in symptoms and psychological states will facilitate the comparability of data and the generalizability of results. 6. Conclusion Our study revealed that lung cancer patients experience significant symptom burden following day surgery. Although the day surgery model enhances healthcare resource utilization, prioritizing home care for these patients post-discharge is crucial. For patients with lung cancer undergoing day surgery, healthcare professionals should conduct timely and comprehensive clinical assessments. Subsequently, evidence-based, individualized symptom management plans must be incorporated into discharge protocols to alleviate post-operative symptom burden at home. Furthermore, we observed that a substantial proportion of participants tended to minimize or endure post-surgical discomfort. Therefore, structured educational interventions should be implemented to empower patients to proactively report their symptom experiences and promptly consult healthcare providers when necessary. Declarations CONFLICT OF INTEREST STATEMENT This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Zhejiang University School of Medicine(Approval No. 2024-0012). Informed consent was obtained from all individual participants included in the study. FUNDING INFORMATION This study was supported by the General Project of Zhejiang Medical and Health Science and Technology Plan (grant number 2024KY084). Author Contribution Xiaomin Hu: Data curation; writing, review, and editing.Yaojuan Jin: Data curation.Huadi Yuan: Conceptualization; formal analysis; investigation.Jie Zhang: Conceptualization; formal analysis; investigation.Hong He: project administration; supervision.Wangyang Tuo:writing – review and editing. ACKNOWLEDGMENTS The authors thank all the participants who contributed to this study for their support and participation. Data Availability The data underlying this article will be shared on reasonable request to the corresponding author. References Liu X, Zhou H, Yi X, et al. 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Chinese Expert Consensus on Day Surgery Management of Lung Cancer (2024 Edition)[J]. Chinese Journal of Lung Cancer, 2024, 27(6): 405-414. Gonfiotti A, Viggiano D, Voltolini L, et al. Enhanced recovery after surgery and video-assisted thoracic surgery lobectomy: the Italian VATS Group surgical protocol[J]. J Thorac Dis, 2018, 10(Suppl 4): S564-s570. Yang J, Ge L, Ju X X, et al. Status and Influencing Factors of Discharge Readiness in Day Surgery Lung Cancer Patients Under a Fast-Track Rehabilitation Pathway[J]. J Clin Nurs, 2025, 34(11): 4779-4787. Saab M M, Fitzgerald S, Noonan B, et al. Promoting lung cancer awareness, help-seeking and early detection: a systematic review of interventions[J]. Health Promot Int, 2021, 36(6): 1656-1671. Tang L, Yu H, Dai W, et al. Symptom Trajectories Informing Patient Care After Lung Cancer Surgery: A Longitudinal Patient-Reported Outcome Study[J]. Ann Surg Oncol, 2023, 30(5): 2607-2617. Obeagu E I, Parray A R. Lung cancer and the eroded self: identity challenges and mental well-being - a narrative review[J]. Ann Med Surg (Lond), 2025, 87(12): 8604-8609. Teng L, Zhou Z, Yang Y, et al. Developing and Validating a Prediction Model for the Severe Pain-Fatigue-Sleep Disturbance Symptom Cluster in Patients with Lung Cancer Following Chemotherapy: A Machine Learning Analysis[J]. Semin Oncol Nurs, 2025: 152063. Gao Y, Guo M. Impact of Oncology Nursing Interventions on Chemotherapy-Induced Toxicities in Lung Cancer Patients[J]. Ther Clin Risk Manag, 2025, 21: 1549-1558. Wang J, Ma S, Li C, et al. A qualitative study of the discharge planning needs of lung cancer patients and their caregivers[J]. Support Care Cancer, 2025, 33(10): 885. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups[J]. Int J Qual Health Care, 2007, 19(6): 349-57. Liu M. Using an Example to Illustrate Colaizzi’s Phenomenological Data Analysis Method[J]. Journal of Nursing Science, 2019, 34: 90-92. Lv C, Lu F, Zhou X, et al. Efficacy of a smartphone application assisting home-based rehabilitation and symptom management for patients with lung cancer undergoing video-assisted thoracoscopic lobectomy: a prospective, single-blinded, randomised control trial (POPPER study)[J]. Int J Surg, 2025, 111(1): 597-608. Sun W, Wu F, Du Y, et al. Construction of the whole-process nursing service system for day surgery patient based on the Kano model: A pilot cluster randomized controlled trial[J]. Digit Health, 2024, 10: 20552076241286799. Nafei H, Hong H, Huadi Y, et al. Longitudinal changes of symptoms and nursing strategies of patientsunder daytime lung cancer surgery after discharge[J]. Chinese Journal of Nursing, 2025, 60(04): 432-438. Nafei H, Chuanbo A, Huadi Y, et al. Study on the longitudinal change trajectory and influencing factors of symptoms in patients undergoing daytime lung cancer surgery after discharge[J]. Chinese Journal of Emergency and Critical Care, 2025, 6(11): 1335-1341. Derry-Vick H, Prigerson H G, Hahne J, et al. "You Always Worry": Scan-Related Anxiety Among Patients With Metastatic Lung Cancer[J]. J Am Coll Radiol, 2025, 22(12): 1572-1577. Mahapatra S S, Gupta N, Mishra S, et al. Psychological distress and quality of life during chemotherapy for non-small cell lung cancer: prospective observational study[J]. BMJ Support Palliat Care, 2025. Guo J, Zhu J, Li X, et al. Exploring barriers to resilience among preoperative non-small cell lung cancer patients: a qualitative study in China[J]. BMC Nurs, 2025, 24(1): 575. Yamazaki-Tan J, Harrison N J, Marshall H, et al. Interventions to Reduce Lung Cancer and COPD-Related Stigma: A Systematic Review[J]. Ann Behav Med, 2024, 58(11): 729-740. Klooster I T, Kip H, Van Gemert-Pijnen L, et al. A systematic review on eHealth technology personalization approaches[J]. iScience, 2024, 27(9): 110771. Mueller J, Davies A, Jay C, et al. Evaluation of a web-based, tailored intervention to encourage help-seeking for lung cancer symptoms: a randomised controlled trial[J]. Digit Health, 2020, 6: 2055207620922381. Yang J, Bao R, Chen Z, et al. Mediating roles of social connection and stress-coping self-efficacy in the association between physical activity and emotional distress among lung cancer survivors: a cross-sectional study[J]. BMJ Open, 2025, 15(11): e102071. Liu H, Shi Y, Zhao L, et al. The mortality and trends of lung cancer among females in urban and rural China, 2004 to 2018: A cohort study[J]. Medicine (Baltimore), 2025, 104(49): e46440. Weber M, Raab A M, Schmitt K U, et al. Efficacy of a digital lifestyle intervention on health-related QUAlity of life in non-small cell LUng CAncer survivors following inpatient rehabilitation: protocol of the QUALUCA Swiss multicentre randomised controlled trial[J]. BMJ Open, 2024, 14(3): e081397. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8485285","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":595045303,"identity":"41db4ab4-0731-4531-81b1-6bab54ebfc33","order_by":0,"name":"Xiaomin Hu","email":"","orcid":"","institution":"浙江大学医学院附属第二医院","correspondingAuthor":false,"prefix":"","firstName":"Xiaomin","middleName":"","lastName":"Hu","suffix":""},{"id":595045305,"identity":"f32ef75f-b685-4cbf-888a-bc2832acd98b","order_by":1,"name":"Hua di Yuan","email":"","orcid":"","institution":"浙江大学医学院附属第二医院","correspondingAuthor":false,"prefix":"","firstName":"Hua","middleName":"di","lastName":"Yuan","suffix":""},{"id":595045312,"identity":"8619b445-0c4d-4e86-8294-0829ed940adc","order_by":2,"name":"Jie Zhang","email":"","orcid":"","institution":"浙江大学医学院附属第二医院","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Zhang","suffix":""},{"id":595045318,"identity":"02148fc1-db35-4a6d-bad4-f8f7a9a69c96","order_by":3,"name":"Yaojuan Jin","email":"","orcid":"","institution":"浙江大学医学院附属第二医院","correspondingAuthor":false,"prefix":"","firstName":"Yaojuan","middleName":"","lastName":"Jin","suffix":""},{"id":595045329,"identity":"a2264edf-c242-4602-aa09-9a930aab0b54","order_by":4,"name":"Wang yang Tuo","email":"","orcid":"","institution":"浙江大学医学院附属第二医院","correspondingAuthor":false,"prefix":"","firstName":"Wang","middleName":"yang","lastName":"Tuo","suffix":""},{"id":595045340,"identity":"60b15218-1b76-467e-b2f4-6828e0f3967d","order_by":5,"name":"Hong He","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsElEQVRIiWNgGAWjYFACHjaGDwxsIJYB8VoYZ5CshZkHwiJSi/zss8ce2/zhS2xgb94mwVBzh7AWxr68dOMcHrbEBp5jZRIMx54R1sLMw2MmnSMB1CKRYybB2HCYsBY2kBYLA6AW+TdEauEBaWFIANnCQ6QWCaAWyZ4DbMZtPGnFFgnHiNAi3wM0/MefY7L97Ic33vhQQ4QWKDgGicwEojUwMNSQoHYUjIJRMApGHAAAxocsU4mB9HAAAAAASUVORK5CYII=","orcid":"","institution":"浙江大学医学院附属第二医院","correspondingAuthor":true,"prefix":"","firstName":"Hong","middleName":"","lastName":"He","suffix":""}],"badges":[],"createdAt":"2025-12-31 03:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8485285/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8485285/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106185697,"identity":"7c419820-79e8-4723-bb6d-0078e91f0714","added_by":"auto","created_at":"2026-04-05 15:24:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":755224,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8485285/v1/6334ba2b-fedb-4d44-bce4-675fdba95968.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploration of Symptoms and Psychological Experiences among Lung Cancer Patients during the First Year Following Day Surgery: A Qualitative Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eLung cancer (LC) represents a significant health burden in China, ranking among the top five chronic diseases\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Globally, it is the leading cause of cancer-related mortality and the most frequently diagnosed malignancy, with approximately 733,291 deaths reported in 2022\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. As the world's most populous nation, China exhibits the highest prevalence of daily smoking among males, raising concerns about a potential rapid increase in lung cancer incidence (projected at 41.5%)\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. In most countries, the five-year survival rate for lung cancer remains below 20%\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Due to the widespread adoption of low-dose spiral computed tomography and advancements in therapeutic techniques, surgical intervention has emerged as the primary treatment modality for patients with early-stage non-small cell lung cancer \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWith the continuous advancement of medical technology, day surgery has gradually emerged as a novel treatment option for lung cancer patients\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. This model not only reduces hospital length of stay but also provides patients with a more convenient recovery experience\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. However, this transition may increase the risk of inadequate medical support. In the context of day surgery, lung cancer patients are confronted with the challenge of achieving comprehensive postoperative rehabilitation and discharge within a limited timeframe, encompassing both discharge preparation and rehabilitation therapy\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. As a malignant tumor with high global incidence and mortality rates, lung cancer often leaves patients facing numerous physical and psychological challenges following surgical treatment\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. As a malignant tumor with high global incidence and mortality rates, lung cancer often leaves patients facing numerous physical and psychological challenges following surgical treatment.\u003c/p\u003e \u003cp\u003eEffective symptom management is a critical strategy for alleviating patient burden and facilitating postoperative recovery\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Tang and colleagues documented a substantial symptom burden among lung cancer patients during the initial post-operative month, with pain, fatigue, dyspnea, and sleep disturbances being the most severe clinical manifestations. Tang and colleagues documented a substantial symptom burden among lung cancer patients during the initial post-operative month, with pain, fatigue, dyspnea, and sleep disturbances being the most severe clinical manifestations\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Therefore, an in-depth understanding of patients' symptom experiences and psychological states during this period holds important clinical value and practical significance.\u003c/p\u003e \u003cp\u003eExisting studies on lung cancer patients have predominantly focused on the evaluation of physiological efficacy and the effects of medical interventions\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. However, relatively insufficient attention has been paid to patients' subjective experiences. As an approach to gain in-depth insights into individuals' experiences and perceptions, qualitative research can provide us with richer and more nuanced patient perspectives, assisting medical teams in developing targeted intervention strategies. Through qualitative research, we can explore patients' perceptions of their own symptoms following day surgery, the impacts on their quality of life, as well as their emotional needs and expectations for nursing support\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTherefore, this study will adopt a qualitative research approach from the perspective of Chinese patients to conduct an in-depth exploration of the symptomatic and psychological experiences of lung cancer patients within one year after day surgery. This research is anticipated to fill the existing gap in the current literature regarding the exploration of patients' subjective experiences, thereby providing data support and a theoretical basis for the development of personalized nursing interventions tailored to patients' needs in the future. It will not only focus on patients' physical health but also emphasize the significance of psychological support and emotional care. Through this study, we aim to provide clinical insights that assist healthcare teams in more comprehensively understanding and responding to the complex experiences of lung cancer patients during postoperative rehabilitation. In turn, this will facilitate improvements in the overall quality of patient care, enhance their quality of life, and promote the recovery of their mental health. Ultimately, this research seeks to advance the application of day surgery in lung cancer treatment, ensuring that patients not only receive effective physical treatment but also obtain better support and improvements in psychological adjustment and social adaptation.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design\u003c/h2\u003e \u003cp\u003eThis qualitative study employed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to investigate the symptoms and psychological experiences of lung cancer patients during the first year following day surgery\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Ethical approval was obtained from the Ethics Committee of The Second Affiliated Hospital, Zhejiang University School of Medicine (Approval Number: (2024) Ethical Review No. 0145). Written informed consent was obtained from all participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Participants and Recruitment\u003c/h2\u003e \u003cp\u003eParticipants were recruited during follow-up outpatient clinic visits between September 2024 and January 2025. Eligibility criteria comprised: (1) age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; (2) confirmed diagnosis of lung cancer; and (3) history of day surgery within the preceding year. Exclusion criteria were: (1) impaired verbal communication, and (2) diagnosed mental disorders. Purposive sampling was employed for participant selection until data saturation was attained. Researcher Wangyang Tuo conducted all semi-structured interviews. Of the seventeen individuals invited, three declined participation due to a lack of interest. Consequently, fourteen patients were enrolled in the study. All participants voluntarily agreed to participate in this study and signed the informed consent form.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3Determination of the interview outline\u003c/h2\u003e \u003cp\u003eIn light of the research objectives, current status of relevant domestic and international studies, and recommendations from expert discussions, a preliminary version of the interview outline was formulated for this study. Subsequently, a pilot interview was conducted with three patients (the results of which were excluded from data analysis), and the content of the outline was revised accordingly. The final interview outline is as follows:(1) How long have you been suffering from this disease since its onset?(2) What symptoms have you experienced after the onset of the disease? What are the specific manifestations of these symptoms (e.g., onset time, frequency, and affected site)?(3)Which symptom has been the most distressing to you?(4)What impacts have these symptoms exerted on your daily life?(5)What are your perceptions of these symptoms?(6)What measures do you take to alleviate your condition when these symptoms occur?(7)Do you need assistance from medical staff? If yes, could you give some specific examples?\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4Data Collection and Quality Assurance Measures\u003c/h2\u003e \u003cp\u003eInterviews will be conducted in an independent, quiet, and private room, by a nursing postgraduate with professional training in qualitative research. Prior to the formal interview, researchers should gain a thorough understanding of the participants\u0026rsquo; basic information and establish a sound trusting relationship through adequate communication, so as to reduce potential psychological defensiveness among participants during the interview. Before the interview commences, researchers must provide a detailed explanation of the study objectives, procedures, and content to participants, and explicitly commit to the strict confidentiality of all interview data and audio recordings, which will be used exclusively for this research project. The formal interview will be initiated only after participants have voluntarily signed the informed consent form. Throughout the interview, data will be documented via a combination of audio recording and on-site note-taking to ensure the completeness of data and the scientific rigor of the study.\u003c/p\u003e \u003cp\u003e During the interview, researchers are required to maintain attentive listening, flexibly adjust questioning strategies based on participants\u0026rsquo; responses, and simultaneously record key content, emotional reactions, and non-verbal behaviors. Each interview will be controlled within a duration of 20\u0026ndash;30 minutes and concluded when data saturation is achieved\u0026mdash;that is, when no new themes or perspectives emerge. All transcripts were systematically assigned unique identifiers (01, 02, 03, ..., 14). Within 24 hours following the interview, two nursing postgraduates will complete verbatim transcription of the audio recordings in accordance with the principle of verbatim presentation. Upon completion of transcription, researchers shall submit the textual transcripts to participants for verification, so as to ensure the accuracy of records and consistency with the participants\u0026rsquo; genuine intentions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data Analysis\u003c/h2\u003e \u003cp\u003eTwo nursing postgraduates analyzed the same set of textual data using Colaizzi\u0026rsquo;s seven-step phenomenological analysis method and NVivo 12.0 software. Specifically, Colaizzi\u0026rsquo;s seven-step approach involves the following procedures\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e: (1) Repeatedly reading all interview transcripts to gain a holistic understanding of the content; (2) Extracting all meaningful statements related to the postoperative symptoms and psychological experiences of lung cancer patients; (3) Conducting an in-depth interpretation of the extracted statements to refine their implicit meanings; (4) Categorizing similar units of meaning to form preliminary themes; (5) Repeatedly comparing the preliminary themes with the original data to ensure accuracy; (6) Integrating related themes to construct a concise thematic framework; (7) Synthesizing all themes to form a comprehensive description of the essence of the phenomenon. During this process, the researchers systematically coded the meaningful statements regarding the postoperative symptoms and psychological experiences of lung cancer patients and conducted thematic synthesis. Ultimately, the collation and analysis of the data were guided by experts with extensive qualitative research experience, who evaluated the rationality of the transcribed content and the summarized themes. Any discrepancies arising during the analysis process were collectively discussed and resolved by the research team.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eA cohort of 14 patients with lung cancer who underwent day surgery participated in this study. The cohort consisted of 4 males and 10 females, with a mean age of 57.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.39 years (range, 40\u0026ndash;70 years). All participants were married and possessed medical insurance coverage. Professional status, educational attainment, and disease stage are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Educational levels varied among participants, although the majority had completed junior high school. Household incomes were predominantly reported to range from 10,000 to over 20,000 Yuan monthly. The histological subtypes of lung cancer were diverse, with the largest proportion of patients diagnosed with minimally invasive adenocarcinoma. The post-operative duration exhibited considerable heterogeneity among patients, ranging from 14 days to 10 months (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe key theme was emerged from the data related to lung cancer patients' symptom experiences after day surgery during the first year: symptoms and changes, uncertainty, confidence and concerns, and supports and needs.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic information and clinical characteristics of the participants (N\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEducational level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEmployment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHousehold income, Yuan/month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTime after surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTypes of lung cancer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eDisease stage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMetastatic clear cell renal cell carcinoma (renal primary with lung metastasis)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT1N0M0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSenior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMerchant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMinimally Invasive Adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT1miN0M0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eInvasive Adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT2N1M1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCompany clerk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10,000\u0026ndash;20,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMinimally Invasive Adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT1miN0M0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eJunior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eInvasive Adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT1bN0M0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eInvasive Adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT1bN0M0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eJunior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMinimally Invasive Adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT1miN0M0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eJunior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMinimally Invasive Adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT1miN0M0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMinimally Invasive Adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT1miN0M0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eInvasive Adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT1bN0M0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCompany clerk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10,000\u0026ndash;20,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMinimally Invasive Adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT1miN0M0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSenior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e18 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMinimally Invasive Adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT1miN0M0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTeacher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10,000\u0026ndash;20,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMinimally Invasive Adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT1miN0M0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTeacher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10,000\u0026ndash;20,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eInvasive Adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT1aN0M0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Theme 1: Symptom manifestations and alterations\u003c/h2\u003e \u003cp\u003eMost patients were discharged within two days, consequently impeding the timely management of post-operative symptoms. Several participants retained distinct recollections of symptomatic manifestations owing to persistent discomfort. The predominant symptoms reported by participants during the first year following discharge from day surgery were pain (78.6%), shortness of breath (78.6%), and sleep disturbances (50%). Fatigue was additionally reported by five participants (35.7%).\u003c/p\u003e \u003cp\u003eThe wound was intensely painful and persisted for approximately one month.\u003c/p\u003e \u003cp\u003e(Participant 3)\u003c/p\u003e \u003cp\u003eI continue to experience difficulty with deep inspiration to the present day. Upon deep inhalation, a sensation of obstruction is perceived in my left lung, whereas my right lung demonstrates unimpaired and effortless airflow.\u003c/p\u003e \u003cp\u003e(Participant 13)\u003c/p\u003e \u003cp\u003eMy sleep quality was significantly compromised; I experienced frequent nocturnal awakenings. On occasions when sleep was achieved, it was limited to approximately one hour. This phenomenon persisted for nearly two months, resulting in pronounced daytime fatigue.\u003c/p\u003e \u003cp\u003e(Participant 5)\u003c/p\u003e \u003cp\u003eFollowing day surgery procedures, the majority of participants reported alterations in their daily routines. Dietary modifications represented the most prevalent and readily adopted change. Subsequently, shifts in attitudes and behaviors concerning smoking were noted. Furthermore, smoking and alcohol abstinence contributed to improved post-operative appetite.\u003c/p\u003e \u003cp\u003eI presently prioritize maintaining a well-balanced diet.\u003c/p\u003e \u003cp\u003e(Participant 4)\u003c/p\u003e \u003cp\u003eI have abstained from consuming alcohol and cigarettes, a behavioral shift that has enabled me to consume two additional bowls of rice per meal\u0026mdash;a practice previously unattainable. Previously, I would typically prefer a glass of wine to consuming a meal.\u003c/p\u003e \u003cp\u003e(Participant 3)\u003c/p\u003e \u003cp\u003eMy food intake has marginally increased compared to the past since I ceased alcohol consumption. Previously, when I consumed wine, my appetite for food was relatively diminished.\u003c/p\u003e \u003cp\u003e(Participant 6)\u003c/p\u003e \u003cp\u003eParticipants often experience increased fatigue during the post-operative period. The majority remain at home for approximately two weeks or longer following hospital discharge. Despite the absence of occupational or domestic responsibilities, they report significantly increased fatigue compared to their preoperative state. This scenario occasionally results in spouses expressing dissatisfaction, with some taking the initiative to assume household duties proactively. Family support is essential for patients to sustain a positive emotional state.\u003c/p\u003e \u003cp\u003eIt is plausible that my physical state has not fully recovered. Currently, I am aware that I am prone to fatigue. What strategies can be employed to tackle this problem? Previously, fatigue was not a frequent phenomenon. In the past, participating in physical workouts or traveling did not lead to fatigue; however, currently, I encounter tiredness under such conditions.\u003c/p\u003e \u003cp\u003e(Participant 7)\u003c/p\u003e \u003cp\u003eDue to a lack of energy to undertake household chores, I have chosen to discontinue this task. Consequently, it falls upon my husband to handle the housework (laugh). However, he shows reluctance in fulfilling this responsibility. Perhaps he should adapt to this situation!\u003c/p\u003e \u003cp\u003e(Participant 8)\u003c/p\u003e \u003cp\u003eSimilarly, I tend to sleep for prolonged periods. I slept for approximately 12 hours yesterday. Even following a midday nap, I continue to experience significant afternoon somnolence.\u003c/p\u003e \u003cp\u003e(Participant 8)\u003c/p\u003e \u003cp\u003eFollowing the surgical procedure, the majority of participants recognized the significance of adopting healthy lifestyles and discontinued detrimental habits, including smoking, alcohol consumption, and mahjong playing. They also demonstrated heightened attention to physical well-being and cultivated new interests. Compared to Western medicine, participants exhibited a preference for traditional Chinese medicine for post-surgical rehabilitation. Taiji, Ba Duan Jin, and the Five Animal Exercises gained increased popularity among these participants, appearing to facilitate their physical and psychological recovery from surgery. Mahjong, a prominent traditional Chinese recreational activity, presented comparable challenges for participants to abstain from as quitting smoking and alcohol. Consequently, participants opted to play mahjong exclusively with women due to the latter's non-smoking behavior. The frequency of mask usage also rose during outdoor activities or cooking. Some participants abandoned self-cooking or opted for steamed food to minimize inhalation of cooking fumes.\u003c/p\u003e \u003cp\u003eRecently, I initiated the study of Huangdi Neijing, a pursuit scheduled initially for six years later. Additionally, engagement with traditional Chinese medicine facilitated interactions with new colleagues.\u003c/p\u003e \u003cp\u003e(Participant 13)\u003c/p\u003e \u003cp\u003eI will cease playing mahjong and terminate my engagement in this activity. Currently, I participate in card games with female counterparts.\u003c/p\u003e \u003cp\u003e(Participant 5)\u003c/p\u003e \u003cp\u003eThe practice of Baduanjin has recently been initiated.\u003c/p\u003e \u003cp\u003e(Participant 14)\u003c/p\u003e \u003cp\u003eFollowing the surgical procedure, I adopted the practice of wearing a mask during cooking activities and activated the kitchen ventilation system. Furthermore, I enhanced my vigilance concerning this issue.\u003c/p\u003e \u003cp\u003e(Participant 11)\u003c/p\u003e \u003cp\u003eRecently, I have consciously abstained from employing deep-frying culinary techniques. Conversely, I prioritize preparing stewed soups and stir-frying individual vegetable dishes.\u003c/p\u003e \u003cp\u003e(Participant 14)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Theme 2: Uncertainty regarding disease trajectory\u003c/h2\u003e \u003cp\u003eConsiderable uncertainty pervades patients' daily lives following surgery. Participants reported refraining from bathing for approximately half a month postoperatively until their scheduled clinic revisit. Uncertainties were also expressed regarding appropriate dietary practices, physical activity levels, and resumption of household chores. Notably, some experienced dental pain persisting for several days yet refrained from seeking professional treatment.\u003c/p\u003e \u003cp\u003eMay I present to the clinic for the extraction of a tooth that has been causing pain for several days? Additionally, what is the recommendation regarding the dyeing of my hair?\u003c/p\u003e \u003cp\u003e(Participant 7)\u003c/p\u003e \u003cp\u003eAfter the stitches were removed, I have felt a little itchy for the past two days. Maybe it is because I am afraid to take a shower and wipe it?\u003c/p\u003e \u003cp\u003e(Participant 10)\u003c/p\u003e \u003cp\u003eHowever, a persistent issue remains: I experience significant apprehension regarding bathing. For the past two weeks, bathing avoidance has led me to rely solely on sponge bathing for personal hygiene. Furthermore, I seek clarification: might performing basic household chores also be feasible?\u003c/p\u003e \u003cp\u003e(Participant 1)\u003c/p\u003e \u003cp\u003eDietary practices constitute the primary source of uncertainty for participants. Despite explicit clinical advice indicating no post-operative dietary restrictions, participants persisted in avoiding red meat and seafood. Furthermore, select individuals abstained from tofu consumption and exhibited a preference for white-colored vegetables. Within the Chinese context, traditional dietary regimens incorporating components such as Hongzao, Longyanrou, and Gouqi are prevalent. These nutritional supplements are perceived to confer therapeutic effects; however, adverse gastrointestinal reactions, including diarrhea, were documented among some participants consequent to excessive intake.\u003c/p\u003e \u003cp\u003eMy friends cautioned against consuming certain food items; consequently, I refrain from consuming my favorite tofu as well as beef.\u003c/p\u003e \u003cp\u003e(Participant 3)\u003c/p\u003e \u003cp\u003eHowever, when seafood originates from Japanese waters, I am neither willing nor inclined to consume fish at present.\u003c/p\u003e \u003cp\u003e(Participant 1)\u003c/p\u003e \u003cp\u003eDue to compromised pulmonary function, I predominantly consume foods characterized by their white coloration. For example, these include white rice, white rice porridge, white cabbage, and radish. Additionally, I ingest steamed apples, jujubes, dried longan, goji berries, and ophiopogon.\u003c/p\u003e \u003cp\u003e(Participant 13)\u003c/p\u003e \u003cp\u003eI consumed various substances, including Dendrobium and Cordyceps, as well as other conceivable materials. Subsequently, I suspected this practice might be erroneous due to the development of diarrhea.\u003c/p\u003e \u003cp\u003e(Participant 14)\u003c/p\u003e \u003cp\u003eDuring my post-operative recovery period, I consumed stewed loach with tofu. It is generally recommended that patients should increase their intake of fish and shrimp protein following surgical procedures.\u003c/p\u003e \u003cp\u003e(Participant 10)\u003c/p\u003e \u003cp\u003eIt is the yellow eel, loach, and turtle, which I typically avoid consuming due to a generalized weakness. Do these foods possess significant protein content in dietary contexts? Potential intolerance may be associated with the diarrhea I experienced.\u003c/p\u003e \u003cp\u003e(Participant 8)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Theme 3:Confidence in treatment efficacy and therapeutic concerns\u003c/h2\u003e \u003cp\u003eWe observed that participants exhibited comparable levels of confidence and concerns regarding rehabilitation. Numerous participants reported a firm belief in the efficacy of post-operative rehabilitation, perceiving themselves to be as healthy as typical healthy individuals. However, they concurrently expressed apprehension regarding disease recurrence and discomfort when cancer-related topics were raised. Notably, while some individuals derived unexpected benefits from their illness experience, others associated it with feelings of stigma.\u003c/p\u003e \u003cp\u003eWe have now acquired a certain level of medical expertise and have gained substantial knowledge from this experience.\u003c/p\u003e \u003cp\u003e(Participant 9)\u003c/p\u003e \u003cp\u003ePresently, I intend to bid farewell to the past. Having undergone the surgery, which proved to be successful, I am now a normal individual, and this is a fact.\u003c/p\u003e \u003cp\u003e(Participant 13)\u003c/p\u003e \u003cp\u003eOver the past fortnight, I have experienced a progressive improvement in my well-being and currently perceive my physical state to be commensurate with baseline levels, without any discernible discomfort.\u003c/p\u003e \u003cp\u003e(Participant 1)\u003c/p\u003e \u003cp\u003eAt times, I reassured myself that I was clinically cured, which was indeed the case. However, persistent concerns regarding potential recurrence remained. Frankly, I maintain significant apprehension due to prevailing cultural stigmas. Given the proximity of the Lunar New Year and my planned return to my hometown, I explicitly requested my husband to limit disclosure of my diagnosis. As is widely recognized, strong cultural taboos surround public discussion of cancer within Chinese society.\u003c/p\u003e \u003cp\u003e(Participant 13)\u003c/p\u003e \u003cp\u003eUnder the day surgery model, wherein patients are discharged promptly, several participants expressed reservations regarding this approach, while others indicated a desire for enhanced post-operative care from the hospital. Within 24 hours post-discharge, patients recuperating at home frequently reported concerns about potential complications, including wound dehiscence, hemorrhage, and limitations in physical mobility, such as arm elevation or positional changes. Furthermore, despite satisfactory post-operative recovery, apprehension persisted among some patients regarding long-term oncological outcomes, specifically cancer prognosis and recurrence risk.\u003c/p\u003e \u003cp\u003ePost-operative care did not involve any therapeutic intervention on the subsequent day. The surgical procedure was performed on Monday. On Tuesday, the medical team advised that discharge was permissible and pharmacological treatment was no longer indicated. I asked the rationale for discontinuing medication. The clinician clarified that the absence of inflammatory indicators rendered further treatment unnecessary.\u003c/p\u003e \u003cp\u003e(Participant 14)\u003c/p\u003e \u003cp\u003eThe surgeon informed us about this model (day surgery) on the day of the operation. Consequently, the biopsy was not performed; instead, the procedure proceeded directly to surgery that same day. This abrupt transition caused considerable apprehension. Although this may represent your standard protocol, we nevertheless perceived the timeline as excessively compressed. Discharge followed shortly thereafter.\u003c/p\u003e \u003cp\u003e(Participant 3)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Theme 4:Support systems and unmet needs\u003c/h2\u003e \u003cp\u003ePerceived support played a crucial role in patients' post-operative recovery, with the majority of participants reporting receipt of such support from spouses or children. During illness, family members provided heightened attention and comprehensive care throughout the perioperative period. Some participants noted this heightened attention was limited to approximately one or two months. Older participants expressed pride that their children covered the surgical expenses. Others self-funded the procedure to alleviate financial pressure on their offspring. The geographical location of their children's employment constituted the primary factor influencing most elderly patients' decision to undergo surgery at this facility. During the perioperative phase, elderly patients typically resided at their children's homes, subsequently returning to their residences postoperatively.\u003c/p\u003e \u003cp\u003eIt was essential for family members to provide emotional support; however, this supportive engagement persisted for merely one month. Subsequently, circumstances reverted entirely to the pre-intervention state, with my husband resuming daily social engagements involving dining out.\u003c/p\u003e \u003cp\u003e(Participant 14)\u003c/p\u003e \u003cp\u003eThis individual is my son-in-law, who accompanies me consistently. He arose at 5:30 this morning. His character is exemplary, akin to that of a son to me. My family members exhibit heightened concern regarding my cancer diagnosis, significantly more so than prior to my surgery. This worry manifests as frequent reminders to dress warmly to avoid contracting a cold.\u003c/p\u003e \u003cp\u003e(Participant 6)\u003c/p\u003e \u003cp\u003eIn the post-operative period, my husband assumed responsibility for all domestic tasks and demonstrated increased tolerance towards me. For instance, during occasional episodes of irritability, he would provide comfort. He also accompanied me to follow-up medical appointments. However, I considered his attendance at these appointments unnecessary, as it required him to take leave from work. Believing I was fully capable of attending independently, I accepted his accompaniment for the initial appointments but subsequently attended alone.\u003c/p\u003e \u003cp\u003e(Participant 11)\u003c/p\u003e \u003cp\u003eThe financial burden is evident, as my prior savings had been entirely depleted. I independently shouldered all treatment expenses, reasoning that funds intended for posthumous distribution to my family were essentially allocated in advance for cancer intervention. Furthermore, I underwent genetic testing in Shanghai for CNY 18,000, which represented a relatively costly expenditure.\u003c/p\u003e \u003cp\u003e(Participant 6)\u003c/p\u003e \u003cp\u003eSeveral patients reported receiving attentive care and support from the medical staff during this period, which enhanced their confidence in overcoming the disease. They indicated that healthcare professionals demonstrated warmth and made every effort to meet patients' needs.\u003c/p\u003e \u003cp\u003ePrior to the surgical procedure, the hospital provided brief pre-operative education, including instructional videos, which was perceived as beneficial.\u003c/p\u003e \u003cp\u003e(Participant 13)\u003c/p\u003e \u003cp\u003eIt was stated in the pre-operative lectures that patients should cough as vigorously as possible. Following these instructions, I performed daily post-operative deep-breathing exercises to facilitate coughing.\u003c/p\u003e \u003cp\u003e(Participant 1)\u003c/p\u003e \u003cp\u003eThe nurse advised me to initiate early ambulation as soon as possible after surgery, along with several other precautions. I found this professional guidance crucial, particularly during the initial hospitalization period.\u003c/p\u003e \u003cp\u003e(Participant 14)\u003c/p\u003e \u003cp\u003eAttending the consultation proved advantageous, as listening to my doctor's brief remarks provided psychological comfort.\u003c/p\u003e \u003cp\u003e(Participant 2)\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis qualitative study explored the physical symptoms and psychological experiences of lung cancer patients during the first year following day surgery, revealing a complex and dynamic recovery trajectory shaped by both bodily changes and emotional challenges. A total of 14 participants\u0026mdash;predominantly female, married, with low to moderate educational attainment (mainly junior high school or below), and household incomes mostly below 20,000 Yuan per month\u0026mdash;shared their lived experiences, offering rich insights into the postoperative reality beyond clinical metrics.\u003c/p\u003e \u003cp\u003eOne of the key findings was the persistence and fluctuation of physical symptoms over time. Participants reported ongoing issues such as pain at the surgical site, fatigue, dyspnea on exertion, shoulder stiffness, and persistent coughing, which often interfered with daily activities and sleep quality. Notably, while these symptoms were expected to diminish after discharge, many patients experienced unexpected prolongation\u0026mdash;particularly fatigue and respiratory discomfort\u0026mdash;that lasted for several months. This aligns with previous studies indicating that even minimally invasive procedures like video-assisted thoracoscopic surgery (VATS) can lead to prolonged symptom burden due to nerve injury, musculoskeletal strain, or reduced pulmonary reserve\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. The current findings underscore that \"day surgery\" does not equate to rapid or uncomplicated recovery; rather, it necessitates sustained symptom monitoring and support during the critical first year. Therefore, the whole-process nursing service system can be implemented to manage patients undergoing day surgery, with particular emphasis on monitoring symptoms during the post-discharge recovery period, enabling timely assessment of both physical and psychological symptomatology\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. A recent study by Chinese scholars using factor analysis to examine the longitudinal changes in symptoms among lung cancer patients after day surgery revealed dynamic fluctuations in individual symptoms and symptom clusters over time\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. These findings suggest that clinicians, particularly nurses, should adopt targeted, phase-specific interventions tailored to the evolving symptom profiles of patients at different stages of recovery, thereby reducing overall symptom burden and improving patient outcomes.\u003c/p\u003e \u003cp\u003eBeyond physical discomfort, psychological distress emerged as a central theme across narratives. Anxiety about cancer recurrence was nearly universal\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, often triggered by minor bodily sensations such as chest tightness or coughing. These somatic cues were frequently interpreted through a catastrophic lens, leading to heightened vigilance and fear\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Some participants described feeling emotionally isolated, especially when family members minimized their concerns or urged them to \u0026ldquo;just move on.\u0026rdquo; This echoes findings from Guo et al\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, who identified emotional suppression and lack of resilient coping strategies among preoperative non-small cell lung cancer patients in China. In our sample, limited health literacy and low awareness of psychosocial resources further exacerbated distress. Many participants did not recognize their emotional struggles as legitimate or treatable conditions, and few proactively sought professional psychological help. The findings indicate that the majority of patients appear reluctant to seek professional support, which may be closely linked to the cultural context in China. Lung cancer is often perceived as a stigmatized illness, leading patients to conceal their diagnosis and avoid disclosing their psychological distress\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. This stigma, coupled with concerns about high medical costs, further discourages proactive help-seeking behavior, resulting in unmet psychosocial needs. To prevent the worsening of this issue, we recommend implementing preoperative psychological interventions and health education to help patients develop a positive mindset and enhance their readiness to adapt to disease-related physical changes. Such proactive support may improve psychological preparedness, promote adaptive coping strategies, and facilitate better adjustment during the postoperative recovery period\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eImportantly, this study revealed a significant gap in patient education and transitional care. Despite being discharged within 24 hours\u0026mdash;a hallmark of day surgery\u0026mdash;most participants felt unprepared for managing symptoms at home. They expressed uncertainty about distinguishing between normal postoperative changes and warning signs requiring medical attention. For instance, some delayed seeking care for worsening pain or new-onset shortness of breath out of fear of being perceived as \u0026ldquo;overreacting\u0026rdquo;. Others relied heavily on informal sources of information, such as online forums or peer advice from fellow patients, which sometimes led to misinformation or increased anxiety. This finding further underscores the need for healthcare professionals to provide health education not only preoperatively but even during the screening or physical examination stage, equipping patients with essential knowledge to facilitate early symptom recognition and prompt medical consultation. Moreover, promoting the use of digital health platforms is recommended to enhance patients\u0026rsquo; motivation and capacity for proactive health information seeking\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Such an approach not only empowers individuals in managing their health but also supports the broader dissemination and adoption of digital health technologies in oncology care\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe sociocultural context also played a crucial role in shaping recovery experiences\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Most participants came from rural or semi-urban backgrounds and had limited access to rehabilitation services or follow-up support. Their roles as caregivers or breadwinners added pressure to return to normalcy quickly, even when physically or emotionally unready. Women, in particular, reported suppressing their own needs to maintain family stability, reflecting broader gendered expectations in Chinese society. Our findings are consistent with those of a 14-year cohort study\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e, which also demonstrated a progressive increase in lung cancer mortality among women with advancing age. This suggests that not only should greater attention be directed toward female populations in rural areas\u0026mdash;who often face compounded disadvantages due to limited access to care\u0026mdash;but also that differential medical and nursing interventions should be tailored according to age-specific patient subgroups. Personalized approaches that account for the biological, psychosocial, and healthcare utilization differences across age strata are essential to improving outcomes in this high-risk population.\u003c/p\u003e \u003cp\u003eThese findings highlight the need for a more holistic, patient-centered approach to post-day-surgery care. Healthcare providers should move beyond a purely biomedical model and integrate routine screening for both physical symptoms and psychological well-being throughout the first postoperative year. Structured discharge planning that includes personalized symptom management guides, clear referral pathways for mental health support, and accessible follow-up mechanisms (e.g., telehealth consultations or mobile health applications) could significantly improve patient outcomes\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Furthermore, educational interventions tailored to patients\u0026rsquo; literacy levels and cultural beliefs may enhance self-efficacy and promote timely help-seeking behaviors.\u003c/p\u003e \u003cp\u003eIn conclusion, this study provides valuable firsthand accounts of the multifaceted challenges faced by lung cancer patients after day surgery. Recovery is not merely a physiological process but an intricate interplay of bodily sensations, emotional responses, social roles, and healthcare system interactions. By listening to patients\u0026rsquo; voices, clinicians can develop more compassionate, responsive, and effective support systems that truly meet the needs of individuals navigating life after lung cancer surgery.\u003c/p\u003e"},{"header":"5. Limitations and Future Research Directions","content":"\u003cp\u003eThe limitations of this study lie in the small sample size and the restriction of participants to Zhejiang Province. Future research should expand the sample size and include patients from more diverse geographical regions to enhance the generalizability of the findings. Meanwhile, considering the cultural disparities across different regions, subsequent studies should also focus on comparing postoperative symptom experiences and psychological states of lung cancer patients against varied cultural backgrounds. In addition, the adoption of quantitative methods to assess explicit changes in symptoms and psychological states will facilitate the comparability of data and the generalizability of results.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eOur study revealed that lung cancer patients experience significant symptom burden following day surgery. Although the day surgery model enhances healthcare resource utilization, prioritizing home care for these patients post-discharge is crucial. For patients with lung cancer undergoing day surgery, healthcare professionals should conduct timely and comprehensive clinical assessments. Subsequently, evidence-based, individualized symptom management plans must be incorporated into discharge protocols to alleviate post-operative symptom burden at home. Furthermore, we observed that a substantial proportion of participants tended to minimize or endure post-surgical discomfort. Therefore, structured educational interventions should be implemented to empower patients to proactively report their symptom experiences and promptly consult healthcare providers when necessary.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCONFLICT OF INTEREST STATEMENT\u003c/h2\u003e \u003cp\u003e This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Zhejiang University School of Medicine(Approval No. 2024-0012). Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFUNDING INFORMATION\u003c/h2\u003e \u003cp\u003eThis study was supported by the General Project of Zhejiang Medical and Health Science and Technology Plan (grant number 2024KY084).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eXiaomin Hu: Data curation; writing, review, and editing.Yaojuan Jin: Data curation.Huadi Yuan: Conceptualization; formal analysis; investigation.Jie Zhang: Conceptualization; formal analysis; investigation.Hong He: project administration; supervision.Wangyang Tuo:writing \u0026ndash; review and editing.\u003c/p\u003e\u003ch2\u003eACKNOWLEDGMENTS\u003c/h2\u003e \u003cp\u003eThe authors thank all the participants who contributed to this study for their support and participation.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data underlying this article will be shared on reasonable request to the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLiu X, Zhou H, Yi X, et al. 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Ann Behav Med, 2024, 58(11): 729-740.\u003c/li\u003e\n\u003cli\u003eKlooster I T, Kip H, Van Gemert-Pijnen L, et al. A systematic review on eHealth technology personalization approaches[J]. iScience, 2024, 27(9): 110771.\u003c/li\u003e\n\u003cli\u003eMueller J, Davies A, Jay C, et al. Evaluation of a web-based, tailored intervention to encourage help-seeking for lung cancer symptoms: a randomised controlled trial[J]. Digit Health, 2020, 6: 2055207620922381.\u003c/li\u003e\n\u003cli\u003eYang J, Bao R, Chen Z, et al. Mediating roles of social connection and stress-coping self-efficacy in the association between physical activity and emotional distress among lung cancer survivors: a cross-sectional study[J]. BMJ Open, 2025, 15(11): e102071.\u003c/li\u003e\n\u003cli\u003eLiu H, Shi Y, Zhao L, et al. The mortality and trends of lung cancer among females in urban and rural China, 2004 to 2018: A cohort study[J]. Medicine (Baltimore), 2025, 104(49): e46440.\u003c/li\u003e\n\u003cli\u003eWeber M, Raab A M, Schmitt K U, et al. Efficacy of a digital lifestyle intervention on health-related QUAlity of life in non-small cell LUng CAncer survivors following inpatient rehabilitation: protocol of the QUALUCA Swiss multicentre randomised controlled trial[J]. BMJ Open, 2024, 14(3): e081397. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lung cancer, Symptom experiences, Day surgery, Qualitative research","lastPublishedDoi":"10.21203/rs.3.rs-8485285/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8485285/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This study investigates the symptom experiences and psychological states of patients with lung cancer following day surgery the first year in China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A qualitative investigation was conducted utilizing face-to-face semi-structured interviews with lung cancer patients during the initial post-operative year. Interviews were audio-recorded, transcribed verbatim, and analyzed using Colaizzi's seven-step phenomenological methodology. Rigor was ensured through adherence to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eParticipants (n = 14) were recruited from a top-tier hospital in China using purposive sampling methodology between September 2024 and January 2025. The cohort exhibited a mean age of 57.1 ± 8.39 years, with the majority presenting with stage I disease. Thematic analysis of interview data yielded four principal themes characterizing the experiential dimensions: (1) Symptom manifestations and alterations, (2) Uncertainty regarding disease trajectory, (3) Confidence in treatment efficacy and therapeutic concerns, and (4) Support systems and unmet needs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Lung cancer patients exhibit a considerable symptom burden following day surgery. Heightened attention to post-discharge home care for this population is imperative. Clinicians should implement prompt and effective symptom assessments, followed by the integration of targeted symptom management strategies into discharge planning to alleviate post-discharge symptom burden.\u003c/p\u003e","manuscriptTitle":"Exploration of Symptoms and Psychological Experiences among Lung Cancer Patients during the First Year Following Day Surgery: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-23 09:11:46","doi":"10.21203/rs.3.rs-8485285/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"416fd013-fd7c-462c-8999-d317667de3b0","owner":[],"postedDate":"February 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-05T15:24:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-23 09:11:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8485285","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8485285","identity":"rs-8485285","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}