INTRODUCTION:

Cancer is increasingly viewed as a curable disease for many and a chronic illness for others (Aziz and Rowland, 2003; Hewitt, Greenfield, and Stovall, 2006).

A large number of studies have investigated the survivorship experience of women with breast cancer which is studied more often than other types of cancers, with a particular focus on the psychological and emotional impact on the women (Terry Tien Cheng, 2010). Breast cancer is a growing problem in India, with estimates as high as 1 in 22 women predicted to develop the disease. For instance, the five-year survival rate for Indian women is about 60 percent; in developed countries, it is 79-85 percent. Additionally, studies have shown that Indian women develop breast cancer roughly a decade earlier than women in Western countries (Laura Bailey 2013).

The experience of breast cancer survivorship includes plaguing thoughts about cancer recurrence, changes in family relationships, alterations in self-image and femininity, thoughts about mortality, changes in life priorities and a strong commitment to help other women with breast cancer (Cope, Diane Grace, 1993). Understanding the lived experience of women with breast cancer can help nursing and medical practitioners to provide proficient care that meets the continual needs of their patients (Maggi Banning, 2007).

The quality of relationships rather than the size of the network matters to survival and the study found an association between patients' social support networks and survival rates but it did not prove a cause-and-effect relationship (Kaiser Permanente, 2012).

METHODS

The objective of this study was to understand the lived experience of a woman and their family member particularly social strain which primarily focuses three themes on quantity and quality of relationships, involvement in groups and maintaining relationships as part of the breast cancer survivorship experience based on hermeneutic circle, a phenomenological emergent qualitative design. The paper had undertaken sources, ancestry and descendancy approach through electronic data base literature search strategy; free standing literature reviews and grey literature on lived experience of breast cancer survivorship. Research work is based on substantive theory and conceptualization for integrating theoretical naivete. This study was approved with waiver consent by expedited review under Institutional Review Board. After obtaining process consent a woman aged 55 years with stage II breast cancer and the family members including husband and two children were enrolled in the study at Erode Cancer Centre, Erode through gain entree. Risk Benefit ratio commensurate maximize benefits for the participants. Typical case purposive sampling technique was undertaken to recruit the participants by conducting joint interviews. Initially content specific vignettes were used to develop rapport. Trustworthiness was obtained through authenticity rigor. Investigator triangulation strategy was used for collecting the data, coding and making analytic decisions. After developing category scheme, data was coded with Nvivo 2.0 qualitative software and reflexivity analysis of the data was done by adhering Van Manen’s thematic analytic method which comprises of three approaches such as the holistic approach, the selective approach and the detailed approach.

RESULTS:

Social support is regarded as a complex construct which has long been suggested to have direct and buffering effects on patients’ wellbeing and emotional adjustment to cancer (Yasemin Yildirim Usta, 2012). (Caplan and Killelea, 1976) consider social support to be significant when dealing with a crisis situation. A great deal of research (Katz and Bender 1976; Taylor et al., 1986; Sarason et al., 1987; Samarel et al., 1997) reports that social network is an important source of emotional support that facilitates the psychological adjustment to cancer. Social relationships both quantity and quality affect mental health, health behavior, physical health and mortality risk. (Debra Umberson1 and Jennifer Karas Montez, 2011).

Demographic profile of the woman depicted with the age 55 years, completed high school educational status, employed timely homemaker, Hinduism as religious practice, household income of Rs.10,000 and type of treatment comprises chemotherapy with radiation therapy. Husband’s demographic data elicited 60 years old, who completed college and retired from the post of teacher. Elder daughter aged 28 years, postgraduate, working as case manager in the field of marketing and unmarried. Younger daughter with 25 years, postgraduate, working as software proprater, single.

The results are organized into themes that emerged from the data to illustrate the commonalities among the Breast cancer survivorship experiences in relation to their social strain with three themes namely quantity and quality of relationships, involvement in groups and maintaining relationships.

Following are the themes illuminated through the rich quotations of the informant lived experience on social strain.

Theme 1: Quantity and Quality of relationships:

The social problems and relationships exist on woman with breast cancer survivorship and the family members who are directly involved in the social network. The following direct quote by the woman with breast cancer survivorship illustrates the lived experience on quantity and quality of relationships.

“After the diagnosis of breast cancer I was very much disappointed. I started to worry about my husband and two children [pause], Doctor said I am with initial stage of breast cancer and can survive by taking treatment. I maintained stable social relationship with my husband, children and father in law. They supported lot and never viewed me as a patient. I couldn’t even talk with my relatives, friends and neighbors [sighing], but they liked my presence and consoled me a lot to adopt the situation”

Some of the discourse quotes by the husband reflecting the social relationship.

“My wife, I and two daughters talked openly about the future settlements. I never permitted the relatives to involve in our personal family matters. I and my wife use to share the feelings [silent]. I think I will become empty without her presence in this world [with emphasis]”.

Elder daughter as the participant explained the experiences in the following texts.

“I cared for my mother in a diplomatic way [voice softening]. We both shared much on the treatment process for breast cancer. I use to keep in touch with my brother [uncle’s son] who is working as a Nurse to clarify the doubts based on treatment for breast cancer”.

Younger daughter addressing the following social strain as part of relationship.

“Honestly speaking I faced the situation [appearing distressed] very challenging immediately after hearing the NEWS from my father saying that mother is having breast cancer [ crying softly]. I was left out of station due to official work with my boss. I am not in a situation to see my mother’s health condition [continuing to cry softly]. I quit the job, came back home and took care of my mother. I use to share feelings with my father as mother will not accept and agree with continues treatment for breast cancer”.

From theme 1 the interviewees shared their positive and negative experiences about the social relationship. Quantity of social relationships seems to be within the family context. Quality of relationships includes positive aspects of social relationships, such as emotional support provided by significant family members and strained aspects of relationships such as distress due to the diagnosis of breast cancer for the woman. Social relationships have significant effects on woman’s health and affect behavioral, psychosocial and physiological pathways. Quantity and Quality of social relationships shape health outcomes throughout the life course and have a cumulative impact on health over time which helps in the prognosis of breast cancer. On other hand relationship provokes supportive social network system within and outside the family.

Theme 2: Involvement in Groups:

Addressing involvement in social groups acknowledge friends and spiritual clubs.

Rich quotes by the woman who explores involvement in social groups.

“Usually I will not speak with anybody I am little reserved from childhood period [smiling softly]. Only school friend and I will share the personal and family matters. She helped me financially for the treatment”

“I am much spiritual and do believe in God. I could remember the days when I was left aloof during the treatment; I opened the mind to God and expressed the bitter feelings”.

Quotes by the husband expressing the involvement in groups.

“I am having many friends. I spend more time with them, at times my wife use to abuse verbally because of friends. One of my friend helped a lot for the treatment. From the day onwards she [wife] never reflected any negative attitude towards the friends”.

“I believe in God, but I am not pious. I help all poor and needy people and I see God through them”

Quotes by the Elder daughter as follows:

“Making and selecting friends is the easiest approach within me. I talk and share all the personal matters. Friends directed and helped me in transportation and purchasing drugs for her [mother] during the treatment process”.

Younger daughter elicited the following quotes

“I am very religious oriented I take most of the friends to the temple. Pooja and Mantra only helps my mother against the breast cancer [sighing]”.

The transcript in the interview indicates that friends play a vital role in the treatment process of cancer. High involvement in spiritual clubs helps the family for the total regain. The spectrum of social engagement comprises activity, interaction and social exchange between woman and friends circle. Friends and Spirituality act as a core point in the involvement group for husband, elder and younger daughter within the context.

Theme 3: Maintaining relationships:

Woman as the interviewee acknowledged experience in maintaining relationship as follows:

“Very often my school friend and I will speak through cell phone. Nowadays I share more on the treatment process for cancer. Week end movie always makes me to relax and refresh [smiling softly]. Reading adventures and novel creates interest”

Husband quoted the following texts:

“I relax myself by watching television. Office stress and personal distress are always shared with my friends”

Daughters jointly revealed that they call and receive messages frequently through cell phones with their friends and watch cinema by visiting theaters.

As illustrated the theme of maintaining valuable relationship depicts that constant relationship with friends and personal relaxation through watching television and reading books on regular basis keeps working on developing the relationship. Impact of maintaining social ties can have an experience and fit with other work emphasizing the importance of social support for physical and mental health for both woman and the family members. A strong relationship can help through the stress tough time of diagnosis with breast cancer. Maintaining cordial relationship with friends made the woman and the family members to have the sense of belonging, increased sense of self-worth and feeling of security.

DISCUSSION:

The multitude women living with breast cancer in an economically constrained environment necessitates consideration of the way existing services are utilized and delivered. Of greater importance is the need to understand how woman and the family members interpret their lived experience as a crucial component for oncology nurses committed to assist woman in the recovery phase. The findings from this study brings insights to aid oncology nurses to assess the women’s actual problem and anticipate potential problem and also facilitate their frame of coping strategies to maximize adaptation and recovery. Significant to all women, these findings also challenge the universal application of survivor identity as part of the lived survivorship experience of a breast cancer woman.

Social strain itself implies the three interrelated areas in which the participant expresses the relationship, involvement in groups and its maintenance. From transcribed the generalizability of findings may extrapolate to other women with breast cancer survivorship. As a researcher, I identified sharing resources are very much constrained within the family context interrelated to the external social environment.

Recommendation for future research focuses the cross cultural area on the lived survivorship experience. Key note to be added for further research on lived experience with advanced metastatic breast cancer. On turning back few pages, a personal note with new perspective of my culture, its weakness and strengths, raising questions and generating hypothesis could be a journey of self-discovery.

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Received on 24.02.2015 Modified on 20.03.2015

Asian J. Nur. Edu. and Research 5(3): July- Sept.2015; Page 439-442

DOI: 10.5958/2349-2996.2015.00088.9