Chapter 1

THE PROBLEM AND ITS BACKGROUND

Introduction

As the saying goes, experience is a great teacher. Some experiences may

be enjoyable and some may be challenging. Some undergo experiences that are

truly challenging and influencing just like the experiences of cancer survivors

which are really life-changing. Some are defeated in their fight against it while

others are lucky enough to have won the fight in the end. Those who have won

the fight are known in this study as cancer survivors or more specifically breast

cancer survivors. They have no apparent evidence of the active disease after at

least three years of being diagnosed with breast cancer.

There are vast sources of information regarding cancer and cancer

survivors experiences. Among the most popular of these cancer problems is

breast cancer which was the second leading cause of death in women, next to

lung cancer, according to the American Cancer Society (ACS, 2012). The

chance that breast cancer could cause death in women is about 1 in 36 (or about

3%) though death rates from breast cancer have been declining since about

1989, with larger decreases in women younger than 50. These decreases are

believed to be the result of earlier detection through screening and increased

awareness, as well as improved treatment.

 2

A few studies were conducted about breast cancer and how it affects

ones social, psychological, spiritual dimensions and role of the community. For

instance, the studies of Carter (2004), Guji (2005) and Gray et al. (2008) were all

about women who were breast cancer survivors. By using semi-structured

interviews, Carter arrived at the following findings: that many participants emerged

from the cancer experience with a clearer sense of self, gratitude for life, and

strength and confidence in their ability to manage life crises. These findings

suggest that care might best be provided by understanding the context of each

person's life. On the other hand, the findings of Guji suggest that one could

pursue higher levels of health and wellness beyond one's physical body, which

would continue to evolve in the mental, spiritual, and interpersonal levels while

that of Gray et al. revealed that there are emotional support benefits which

included connecting with other breast cancer survivors, feeling understood and

sharing experiences, providing hope, and sharing healing laughter. Informational

and practical support benefits included sharing of important information and

learning how to get what you want are more important in surviving breast cancer

experience.

Very few of the literature adequately tackled the experiences of breast

cancer survivors and none of them attempted to come-up with a program that

would raise the level of awareness of people concerned. This is the primary

reason for using the phenomenological research strategy in this study. What are

the experiences of these breast cancer survivors? What lessons and themes can

be derived from these experiences? These and more recapitulate the main intent
 3

of the researcher. He would like to draw out meanings from the experiences of

those who had survived breast cancer for those in the health care profession to be

better prepared in dealing with or managing these people. The survivors

significant others and the community at large may also gain deeper understanding

or insights regarding the survivors lives and in this way, the survivors and cancer

patients alike may be given the treatment that they deserve. This is through the

proper implementation of the Breast Cancer Awareness Program which is an

immediate output of this study.

Review of Related Literature

A few available literature / studies from books and from the internet

about the experiences and coping mechanisms of breast cancer survivors

were reviewed to properly situate this study and to find support for the

findings of this inquiry. These are presented thematically or by topics for

the readers convenience.

Social experience. Zabalequi (2005) states that cancer treatments

are not always curative; there are effective strategies for improving cancer

patients coping and quality of life, even in low resource. Social support is

one of these effective strategies. This was affirmed by Usta (2012) by

stating that social support is a complex construct which has direct and

buffering effects on patients wellbeing and emotional adjustment to cancer.

Cross-sectional and prospective studies show a positive association

between perceived social support and psychological adjustment following

 4

cancer treatment. Research findings suggest that the evidence for the

relationship between social support and cancer progression is sufficiently

strong. This report points out the importance of social support in cancer and

provides recommendations for health care professionals.

Psychological experience. A diagnosis of cancer is one of the most

devastating things a woman can have. A 2006 study conducted by researchers

at Dartmouth Medical School, revealed that nearly half of the 236 newly

diagnosed breast cancer patients in the study experienced emotional symptoms

and distress that were clinically significant (Preusse, 2012). This shows that

cancer is a feared disease by many because of the stigma attached to it.

In 2007, LIVESTRONG executed a global cancer research study intended

to give people affected by cancer a chance to share their cancer experiences

and their perspectives on the cancer problem a problem that is too often

shrouded by stigma and silence. Studies show that stigma may stem from

inaccurate perceptions of myths about cancer. In each of the five countries where

semi-structured interviews took place, there was evidence of myths associated

with cancer, such as the belief that cancer is contagious. Myths about cancer

treatment were also common: [Patients are] often reluctant to undergo surgery

because they believe if you cut into the cancer, it will spread immediately all over

the body (Beckjord, 2007).

Spiritual experience. Studies have shown that religious and spiritual

values are important to Americans. Most American adults say that they believe in

God and that their religious beliefs affect how they live their lives. However,
 5

people have different ideas about life after death, belief in miracles, and other

religious beliefs. Such beliefs may be based on gender, education, and ethnic

background (National Cancer Institute, 2012).

Many patients with cancer rely on spiritual or religious beliefs and

practices to help them cope with their disease. This is called spiritual coping.

Many caregivers also rely on spiritual coping. Each person may have different

spiritual needs, depending on cultural and religious traditions. For some seriously

ill patients, spiritual well-being may affect how much anxiety they feel about

death. For others, it may affect what they decide about end-of-life treatments.

Some patients and their family caregivers may want doctors to talk about spiritual

concerns, but may feel unsure about how to bring up the subject (NCI 2012).

As a nation, and individually as well, Filipinos are said to be survivors.

The Filipinos spiritual richness his/her great faith and hope in Gods plan for

his/her life, his/her attitude towards Gods providence and his/her often fatalistic

and deterministic attitude towards life have given substance to the physical

pain and the feelings of emptiness brought about by his/her diseased status.

They can metamorphise themselves from an existentially sick person to an

existentially well person. This same spiritual affluence has led the patients to

have a strong sense of hope, either imagined or real. In another study among

Filipino cancer patients, their relatives and doctors instilling a sense of hope

made the patients feel better. It helped them go through the initial stages of

anger, denial and grief until they finally learned to accept their health status

(Ngelangel, 2008).
 6

Most qualitative studies on breast cancer survivors used few number of

participants and semi-structured interview format for their studies. These studies

also revealed that surviving breast cancer is a multi-factorial experience.

Moreover, social, psychological, and spiritual factors are crucial in coping with

breast cancer. Information dissemination regarding such findings has been

inadequate, thus many people have little understanding on the multi-factorial

needs of breast cancer survivors and breast cancer patients. A Breast Cancer

Awareness Program is the key to information dissemination. If every oncologic

center has such Program, it will be able to optimize its services for the benefit not

only of the breast cancer survivors and breast cancer patients but of their

significant others as well.

Statement of the Problem

This is a study on the experiences of breast cancer survivors or persons

who have no apparent evidence of the active disease after at least three years of

being diagnosed with breast cancer.

Specifically, the study sought answers to the following questions;

1. How may the experiences of the breast cancer survivors be

described during and after the disease process in terms of:

1.1 social;

1.2 psychological and;

1.3 spiritual aspects?

 7

2. What meanings may be generated from the life experiences of

the breast cancer survivors which could be utilized as basis in crafting the

proposed Cancer Awareness Program?

Significance of the Study

The findings of the study are of benefit to the following:

Breast cancer survivors. The experiences of the breast cancer survivors

who participated in the study may be the source of inspiration to other breast

cancer survivors to continue with their lives in meaningful ways.

Significant others. The breast cancer survivors significant others (e.g.,

members of the family, friends, relatives, and the like) will have additional

knowledge and better understanding of the survivors experiences and may

enhance their relationship with the survivors.

Oncology centers. If the proposed Breast Cancer Awareness Program

will be properly implemented at least in the City of Cabanatuan, breast cancer

patients and survivors may live more meaningful lives.

Future researchers. This study may serve as a related literature for those

who want to venture into a similar study in the future.

The researcher. This may serve as the researchers reference material

for possible similar studies in the future.

 8

Definition of Terms

The following terms/phrases are defined operationally for ease in

understanding.

Breast cancer survivors. They are the female individuals with age 18-70

years old who have survived breast cancer for at least three years. They serve

as participants or informants of this study.

Lived experiences. These are the breast cancer survivors first-hand

knowledge of states, situations, emotions, or sensations of the breast cancer.

Psychological experiences. These are intangible manifestations

unobservable by others and specific to each of the cancer survivors. These may

include perceptions about cancer as a disease, outlook towards treatment

process and outlook in life.

Social experiences. These are the personal perceptions and knowledge

of the cancer survivors on other people they are in contact with. These may

include dependence on significant others during the cancer stage; cancer

survivors feeling when going to public places; verbal, moral and other support

received from people, and so forth.

Spiritual experiences. These are the cancer survivors degree of

connection toward their faith and belief in a higher Being. These may include

feelings of being tested by God, and atonement from her sins, and the like.

Themes. These are the central topic, subject or concept extracted from

the breast cancer survivors experiences during the course of having cancer.