Reconciling susceptibility: A grounded theory study of the experience of neutropenia for older adults with non-Hodgkin's lymphoma in the first cycle of R-CHOP

Neutrapenia is a common and dangerous side effect of chemotherapy associated with infection, prolonged hospitalization and death, particularly among older adults in beginning stages of treatment for hematologic malignancies such as non-hodgkin's lymphoma (NHL). Although much is known about neutropenia and its management, its personal impact on older adults remains hidden by the received view of neutropenia as a state of potential and actual infection, defined by the absolute neutrophil count (ANC). A greater understanding of the older adult's experience of neutropenia is necessary for a broader and more useful framework that could guide research aimed at interventions more attuned to the individual needs of neutropenic older adults with cancer.; The purpose of this study was to develop a grounded theory to describe and explain the experience of neutropenia for older adults with NHL during the first cycle of chemotherapy. Five participants aged 57--71 participated in 18 interviews. Interview, field note and document review data underwent constant comparative analysis and resulted in Reconciling Susceptibility, the theory which explicates the experience of neutropenia for older adults in the first cycle of chemotherapy. Reconciling susceptibility is an intrapersonal process constituting a remarkable counternarrative to the received view of neutropenia. Reconciling Susceptibility unfolded within the context of experiential incongruity and in response to a triggering event that left participants feeling caught off guard. Reflection enabled the realization of constructed expectations, and during week two, when participants were most susceptible to infection, they established reconstructed expectations based on their individually interpreted index of susceptibility to infection. Reflection mediated the process and took participants to a point of tempered resignation. Participants began their first cycle of chemotherapy thinking about susceptibility to infection but by the start of Cycle II they came to realize that they were susceptible to any side effect, including death. Findings of this grounded theory illuminate the disutility of absolute neutrophil counts and fevers as sole indicators of infection among older adults with cancer and offer new insights to research and its application to the clinical care of this population.