The purpose of this study was to explore the emotional and psychosocial experiences of Ghanaian women living with advanced breast cancer in the Kumasi metropolis. The study employed a qualitative exploratory descriptive design. Purposive sampling approach was used and data was saturated with 10 participants aged between 32 and 65 years. All interviews were audio-taped and transcribed. Data was analyzed concurrently based on the techniques of content analysis. Anonymity and confidentiality were ensured. Women experienced emotional reactions such as sadness, fear, and anxiety. Pain was severe and led to suicidal ideations. Women experienced lost hopes regarding their marriage, parenting, and work. They received support from their families, spouses, colleagues, health professionals, and spiritual leaders. Women coped by accepting the disease and surrendering to God and having the will to live. Five major themes described were emotional reactions, pain, lost hope, support, and coping. It was recommended that health care providers involved in breast cancer management should be trained to enhance effective and holistic care of women and their families. Also, patients with advanced disease should be given effective pain management and a multidisciplinary palliative care team should be instituted to care for the women. 1. Introduction Breast cancer is a devastating disease among women and it is known to be associated with severe emotional and psychosocial consequences. The emotional and psychosocial experiences of breast cancer patients are well documented in many countries [1]. Early diagnosis of breast cancer leads to a better chance of cure. However, late diagnosis of the disease provides avenue for palliative care because of minimal chances of cure [2]. In many developing countries including Ghana, breast cancer is diagnosed at an advanced stage due to late reporting [3]. Factors that contribute to late reporting include fear of death associated with removal of the breast (mastectomy), seeking alternative treatment, and inadequate knowledge of breast cancer [4]. Research on breast cancer in Ghana confirms that the majority of breast cancer patients (47%–75%) report at the late stage of disease [3, 5] and this implies that many women have advanced breast cancer (ABC). However, previous research on breast cancer in Ghana [3, 4, 6, 7] has not explored the experiences of women with advanced breast cancer although the incidence is high. It is observed that the majority of women find the diagnosis of advanced disease more stressful than that of early stage breast
References
[1]
S. Aranda, P. Schofield, L. Weih et al., “Mapping the quality of life and unmet needs of urban women with metastatic breast cancer,” European Journal of Cancer Care, vol. 14, no. 3, pp. 211–222, 2005.
[2]
M. A. A. Doumit, H. Abu-Saad Huijer, and J. H. Kelley, “The lived experience of Lebanese oncology patients receiving palliative care,” European Journal of Oncology Nursing, vol. 11, no. 4, pp. 309–319, 2007.
[3]
J. N. A. Clegg-Lamptey and W. M. Hodasi, “A study of breast cancer in Korle-Bu teaching hospital: assessing the impact of health education,” Ghana Medical Journal, vol. 41, pp. 72–77, 2007.
[4]
L. Aziato and J. N. Clegg-Lamptey, “Breast cancer diagnosis and factors influencing treatment decisions in Ghana,” Health Care for Women International, 2014.
[5]
M. Ohene-Yeboah and E. Adjei, “Breast cancer in Kumasi, Ghana,” Ghana Medical Journal, vol. 46, no. 1, pp. 8–13, 2012.
[6]
L. Aziato, “Post-mastectomy experiences of women with breast cancer in the Accra metropolis,” West African Journal of Nursing, vol. 20, pp. 51–57, 2009.
[7]
. Opoku S, M. Benwell, and J. Yarney, “Knowledge, attitudes, beliefs, behaviour and breast cancer screening practices in Ghana,” European Journal of Cancer Supplements, vol. 8, article 16, 2010.
[8]
R. P. Vilhauer, “A qualitative study of the experiences of women with metastatic breast cancer,” Palliative & Supportive Care, vol. 6, no. 3, pp. 249–258, 2008.
[9]
J. E. Price, “Concepts and mechanisms of breast cancer metastasis,” in The Breast: Comprehensive Management of Benign and Malignant Disorders, K. I. Bland and E. M. Copeland, Eds., Elsevier, St. Louis, Miss, USA, 2004.
[10]
L. Aziato, “Post-mastectomy experiences of women with breast cancer in the Accra metropolis,” in Nursing, University of Ghana, Accra, Ghana, 2006.
[11]
E. Reed, P. Simmonds, J. Haviland, and J. Corner, “Quality of life and experience of care in women with metastatic breast cancer: a cross-sectional survey,” Journal of Pain and Symptom Management, vol. 43, no. 4, pp. 747–758, 2012.
[12]
M. Warren, “Uncertainty, lack of control and emotional functioning in women with metastatic breast cancer: a review and secondary analysis of the literature using the critical appraisal technique,” European Journal of Cancer Care, vol. 19, no. 5, pp. 564–574, 2010.
[13]
A. K. Conlin and A. D. Seidman, “Beyond cytotoxic chemotherapy for the first-line treatment of HER2-negative, hormone-insensitive metastatic breast cancer: current status and future opportunities,” Clinical Breast Cancer, vol. 8, no. 3, pp. 215–223, 2008.
[14]
M. J. Mayan, An Introduction to Qualitative Methods: Training Modulation for Students and Professionals, International Institute for Qualitative Methodology, University of Alberta, Alberta, Canada, 2001.
[15]
M. J. Mayan, Essentials of Qualitative Inquiry, Left Coast Press, Walnut Creek, Calif, USA, 2009.
[16]
A. S. de Vos, H. Strydom, C. B. Fouché, and Delport C. S. L., Research at Grass Roots: For the Social Sciences and Human Service Professions, Van Schaik, Pretoria, South Africa, 4th edition, 2011.
[17]
Ghana Health Service, 2011 Population and Housing Census Summary Report of Final Report, Kumasi, Ghana, 2011.
[18]
D. F. Polit and C. T. Beck, Nursing Research: Generating and Assessing Evidence for Nursing Practice, Lippincott Williams & Wilkins, 8th edition, 2008.
[19]
M. B. Miles and A. M. Huberman, Qualitative Data Analysis: An Expanded Sourcebook, Sage, Newberg Park, Calif, USA, 2nd edition, 1994.
[20]
E. G. Guba and Y. S. Lincoln, Effective Evaluation: Improving the Usefulness of Evaluation Results through Responsive and Naturalistic Approaches, Jossey-Bass, San Francisco, Calif, USA, 1981.
[21]
B. M. Sackey, “Faith healing and women’s reproductive health,” Institute of African Studies Research Review, vol. 18, no. 1, pp. 5–12, 2002.
[22]
P. Sarpong, Ghana in Retrospect, Ghana Publishing Corporation, Tema, Ghana, 1975.
[23]
L. R. Gauthier, G. Rodin, C. Zimmermann et al., “Acceptance of pain: a study in patients with advanced cancer,” Pain, vol. 143, no. 1-2, pp. 147–154, 2009.
[24]
E. J. Shim and B. J. Hahm, “Anxiety, helplessness/hopelessness and 'desire for hastened death' in Korean cancer patients,” European Journal of Cancer Care, vol. 20, no. 3, pp. 395–402, 2011.
[25]
G. Rodin, C. Zimmermann, A. Rydall et al., “The desire for hastened death in patients with metastatic cancer,” Journal of Pain and Symptom Management, vol. 33, no. 6, pp. 661–675, 2007.
[26]
L. Aziato and O. Adejumo, “The ghanaian surgical nurse and postoperative pain management: a clinical ethnographic insight,” Pain Management Nursing, vol. 15, no. 1, pp. 265–272, 2013.
[27]
L. A. Menefee and D. A. Monti, “Nonpharmacologic and complementary approaches to cancer pain management,” The Journal of the American Osteopathic Association, vol. 105, no. 11, supplement 5, pp. S15–S20, 2005.
[28]
B. Knobel and A. Mikhlin, “Severe accidental hypothermia in an elderly woman,” Harefuah, vol. 140, no. 11, pp. 1014–1119, 2001.
[29]
G. K. Nukunya, Tradition and Change: An Introduction to Sociology, Ghana Universities Press, Accra, Ghana, 2nd edition, 2003.
[30]
C. Fisher and M. O'Connor, “‘motherhood’ in the context of living with breast cancer,” Cancer Nursing, vol. 35, no. 2, pp. 157–163, 2012.
[31]
H. J. Campbell-Enns and R. L. Woodgate, “Decision making for mothers with cancer: maintaining the mother-child bond,” European Journal of Oncology Nursing, vol. 17, no. 3, pp. 261–268, 2013.
[32]
D. M. Rasmussen and B. Elverdam, “The meaning of work and working life after cancer: an interview study,” Psycho-Oncology, vol. 17, no. 12, pp. 1232–1238, 2008.
[33]
L. M. Frazier, V. A. Miller, D. V. Horbelt, J. E. Delmore, B. E. Miller, and E. P. Averett, “Employment and quality of survivorship among women with cancer: domains not captured by quality of life instruments,” Cancer Control, vol. 16, no. 1, pp. 57–65, 2009.
[34]
C. J. Bradley, D. Neumark, Z. Luo, and M. Schenk, “Employment and cancer: findings from a longitudinal study of breast and prostate cancer survivors,” Cancer Investigation, vol. 25, no. 1, pp. 47–54, 2007.
[35]
P. F. Short, J. J. Vasey, and R. BeLue, “Work disability associated with cancer survivorship and other chronic conditions,” Psycho-Oncology, vol. 17, no. 1, pp. 91–97, 2008.
[36]
J. Julkunen, M. Gustavsson-Lilius, and P. Hietanen, “Anger expression, partner support, and quality of life in cancer patients,” Journal of Psychosomatic Research, vol. 66, no. 3, pp. 235–244, 2009.
[37]
F. Kennedy, C. Haslam, F. Munir, and J. Pryce, “Returning to work following cancer: a qualitative exploratory study into the experience of returning to work following cancer,” European Journal of Cancer Care, vol. 16, no. 1, pp. 17–25, 2007.
[38]
A. Johnsson, T. Fornander, L. E. Rutqvist, and M. Olsson, “Factors influencing return to work: a narrative study of women treated for breast cancer,” European Journal of Cancer Care, vol. 19, no. 3, pp. 317–323, 2010.
[39]
F. Cebeci, H. B. Yangin, and A. Tekeli, “Life experiences of women with breast cancer in south western Turkey: a qualitative study,” European Journal of Oncology Nursing, vol. 16, no. 4, pp. 406–412, 2012.
[40]
F. R. Nedjat-Haiem, K. A. Lorenz, K. Ell, A. Hamilton, and L. Palinkas, “Experiences with advanced cancer among latinas in a public health care system,” Journal of Pain and Symptom Management, vol. 43, no. 6, pp. 1013–1024, 2012.
[41]
H. Svensson, Y. Brandberg, Z. Einbeigi, T. Hatschek, and K. Ahlberg, “Psychological reactions to progression of metastatic breast cancer—an interview study,” Cancer Nursing, vol. 32, no. 1, pp. 55–63, 2009.
[42]
M. A. A. Doumit, N. El Saghir, H. Abu-Saad Huijer, J. H. Kelley, and N. Nassar, “Living with breast cancer, a Lebanese experience,” European Journal of Oncology Nursing, vol. 14, no. 1, pp. 42–48, 2010.
