Background: The experience of cancer and its treatments frequently generates psychological, physical, and social difficulties that may persist after treatment completion and affect daily life. Three trajectories emerge: the first is marked by persistent vulnerability and accumulation of difficulties; the second characterizes individuals who regain a satisfactory quality of life; the third trajectory represents an oscillation between periods of vulnerability and moments of well-being. Current research does not yet enable understanding of the reasons for these differences. The first objective is therefore to examine their experience, which has received limited attention in Switzerland. To understand these transitions, a theoretical framework appears necessary. While no model is proposed in the literature, one concept—liminality—is regularly cited. Originally developed to describe the passage from one social state to another, it is used in psycho-oncology to explain different trajectories and variations in experience. However, liminality remains poorly defined. The second objective is therefore to conceptualize it.
Method: Three qualitative studies were conducted: 9 individuals with colostomies following colorectal cancer; 11 women aged 40-50 years treated for breast cancer 5-7 years previously; 19 individuals who had completed treatment for colorectal, breast, or prostate cancer 2-5 years previously. Semi-structured interviews were conducted, transcribed, and analyzed using thematic content analysis. A scoping review was performed to define liminality.
Results: Psychological, physical, and social difficulties persist well beyond treatment completion. Three trajectories were identified: a negative trajectory, where encountered difficulties prevent adaptation and generate anxiety and vulnerability; a positive trajectory, where individuals successfully adapt and regain satisfactory quality of life; an intermediate trajectory, where individuals alternate between feelings of improvement and vulnerability. This latter trajectory can be conceptualized through liminality, defined as a state of vulnerability and uncertainty linked to psychological, physical, and social changes resulting from the cancer experience, or fear of cancer recurrence and death. This state persists as long as the individual cannot accept or redefine their identity. Until this occurs, the individual may experience marginalization and inability to project into the future.
Conclusion: Post-treatment experiences vary considerably across individuals. Those in a negative trajectory should be rapidly identified and supported. Those in a positive trajectory require minimal support. The needs of individuals in an intermediate trajectory risk going undetected and unmet given their oscillations between well-being and vulnerability. Person-centered medical and psychological care appears essential. The definition of liminality should enable its operationalization to more effectively identify and support individuals facing difficulties.
