Cancer diagnosis as discursive capture: Phenomenological repercussions of being positioned within dominant constructions of cancer

"I've had constant fears that I'll get cancer": the construction and experience of medical intervention on intersex bodies to reduce cancer risk

PURPOSE

This paper examines the subjective experience of medical interventions on intersex bodies to reduce cancer risk.

METHODS

Twenty-five individuals with intersex variations took part in semi-structured interviews, analysed through thematic discourse analysis.

RESULTS

Intersex bodies were positioned as inherently sick and in need of modification, with cancer risk legitimating surgical and hormonal intervention. This resulted in embodied shame, with negative impacts on fertility and sexual wellbeing. However, many participants resisted discourses of bio-pathologisation and embraced intersex status. Some medical interventions, such as HRT, were perceived to have increased the risk of cancer. Absence of informed consent, and lack of information about intersex status and the consequences of medical intervention, was positioned as a human rights violation. This was compounded by ongoing medical mismanagement, including health care professional lack of understanding of intersex variations, and the objectification or stigmatization of intersex people within healthcare. The consequence was non-disclosure of intersex status in health contexts and lack of trust in health care professionals.

CONCLUSIONS

The legitimacy of poorly-evidenced cancer risk discourses to justify medical intervention on intersex bodies needs to be challenged. Healthcare practitioners need to be provided with education and training about cultural safety practices for working with intersex people.

What enhances the quality of death and dying? A perspective from patients with terminal cancer

AIM

This study aimed to determine which factors improve the quality of dying and death from the point of view of patients with cancer who are nearing the end of their lives. The goal was to find out what they think are necessary conditions for a good death and how they would like to be cared for and supported at the end of their lives.

METHODS

This study used an exploratory research approach. Purposive sampling was used to select 21 participants from two hospices in Bengaluru and Hyderabad (Karunashraya and Sparsh), and Karnataka Cancer Hospital in Bangalore, India. Semi-structured interviews were undertaken to obtain data from the patients. Thematic analysis was used to examine the data.

RESULTS

Four themes were identified: 1) Spirituality and religiosity, 2) socioemotional support, 3) Breaking silence about the stage of the disease and 4) Preparation for and embracing death. There were distinct sub-themes within some of these that were highlighted using quotes from the participants.

CONCLUSIONS

The study provided a comprehensive understanding of end-of-life care, the criteria for a high-quality end of life, strategies for achieving it, and the quality of the dying process and death in advanced cancer patients. Studying patients' experiences will help inform a more robust intervention strategy and action plan to improve the quality of end-of-life care in the Indian community.

The Traces of Cancer: A Metaphorical Understanding of the Experiences of Women Living Beyond Breast Cancer

This study feeds into ongoing discussions on the metaphors used by cancer patients. Its aim is to explore how women living with a history of breast cancer use metaphors to express and interpret the experience of cancer remission. Data were collected in interviews designed to capture a rich and metaphorical description of participants' experiences with breast cancer and what these experiences mean to them. Ten participants were recruited. An interpretative phenomenological analysis of the participants' narratives highlighted a central metaphor: the cancer trace in one's life. The participants had to adapt to four specific traces of cancer: (1) the identity trace, (2) the existential trace, (3) the bodily trace, and (4) the narrative trace. We discuss how cancer challenges one's sense of biographical continuity and initiates a search for a new way of being. We also discuss how the metaphor of the trace differs from the metaphor of the cancer hero living without any trace of cancer.

"That bastard chose me": the use of metaphor in women's cancer blogs

Metaphors play a significant role in how cancer is experienced and discussed. This study delves into the utilization of metaphors by women bloggers grappling with colorectal and gynecological cancers. By focusing on cancer types less represented in mainstream media, we aim to shed light on cancer cultures associated with body areas often considered taboo. Our findings reveal that widely recognized expressions and stories about cancer, such as the metaphors of battle and narratives promoting optimism and heroism in the face of illness, are deeply ingrained. However, a notable discovery is the prevalence of personification alongside these conventional expressions. Personifying cancer endows it with human characteristics, providing an outlet for bloggers to express their fear and frustration, including articulating feelings of sadness and anger, diverging from narratives centered on heroism and positive thinking. Furthermore, our analysis reveals a significant emphasis on death, underscoring that despite advancements in treatment, bloggers still perceive cancer as highly lethal. Personification can serve both detrimental and therapeutic purposes for bloggers and for societal perceptions of cancer survivorship, both reinforcing and opposing dominant Western discourses surrounding the illness. These findings enrich our understanding of cognitive and cultural tools used to describe cancer within contemporary Western society.

Life after meningitis: a qualitative study exploring survivors' experience of living with sequelae

BACKGROUND

Around twenty percent of meningitis survivors experience after-effects. However, very little research on their psychological impact has been conducted. This report details a small explorative investigation into these psychological impacts.

OBJECTIVE

To explore the impact sequelae have on the meningitis survivors affected.

METHODS AND MEASURES

Thematic analysis of one-hundred individual user's blog posts, self-reporting one or more sequelae after a diagnosis of meningitis.

RESULTS

Blog posters' experiences varied greatly. Common trends in experience were mapped onto three themes. 'Struggling to Adjust to the New Normal' captures blog posters' struggles in returning to their lives post-hospitalization. 'Navigating Possibilities for Positivity' explores how blog posters either reported positive change due to their illness experience or felt a pressure, or inability, to do so. 'The Impact of Knowledge and Support' overarching two sub-themes; 'Lack of Awareness Causing Further Suffering' and 'Validation Leads to Narrative Shift'. These sub-themes contrast differences in experience blog posters reported, with and without knowledge, of the cause of their symptoms and support in dealing with the resulting difficulties.

CONCLUSIONS

Consistent and structured after-care would benefit patients experiencing sequelae. Suggestions of a possible format this could take are put forward. In addition, self-regulatory models of illness perception help explain some variations in blog posters experiences, with possible intervention plans based on these models also suggested. However, limitations, including the comparatively small and highly selected sample, mean that further research is necessary to validate the findings and assess their validity, widespread applicability, and financial feasibility.

A Discourse of Deviance: Blame, Shame, Stigma and the Social Construction of Head and Neck Cancer

Cancer of the head and neck is a confronting condition, as the disease and its treatments alter the appearance and function of body organs associated with physical appearance and identity. Many of the risk factors for head and neck cancers, including tobacco, alcohol, and human papilloma virus, can also have significant negative social and moral permutations. Language and action (discourse) plays an important role in constructing disease and illness and shape the way it is managed, both institutionally and socially. This research used a critical constructionist lens to investigate how the common discourses surrounding head and neck cancer are constructed within the healthcare context and how this influences patients and healthcare professionals' responses to the illness. Data were collected through semi-structured interviews, field noting, journaling and literature reviews. Analysis was guided by a three-dimensional approach to critical discourse analysis that investigated text, discursive practices, and social context. The overarching finding was that deviance dominates the common discourse and shapes head and neck cancer and responses to it. Deviance is channelled through metaphors, adjectives, descriptors, and collective nouns and is made overt through labelling, avoidance, blaming, shame, and categorization. Discourse is contextualized by a sociocultural understanding that when someone deviates from what is perceived as normal, they are devalued. Open dialogue and reflection on head and neck cancer discourse could enable better understanding of how people experience their condition and inform more supportive responses.

Love and lifestyle: how 'relational healthism' structures couples' talk of engagement with lifestyle advice associated with a new diagnosis of coronary heart disease

OBJECTIVES

Healthy lifestyle change improves outcomes in coronary heart disease (CHD), but is rarely sustained. To better understand barriers to lifestyle change, we examined couples' talk of engaging with lifestyle advice after one partner receives a diagnosis of CHD.

DESIGN

A longitudinal qualitative design, in which a poststructuralist discourse analysis was performed on 35 interviews, conducted with 22 heterosexual British people in a long term relationship. The interviews occurred over three months after one partner was referred to a cardiac rehabilitation programme designed to support lifestyle change.

RESULTS

Couples understood their health as a shared practice underpinned by an ideological framework of healthism, creating a form of 'relational healthism'. Practicing relational healthism was not straightforward because the practices of surveillance, control, and discipline related to healthism often contravened relationship norms of support, acceptance and respect for the other's autonomy. Couples struggled to resolve this tension, dynamically adopting, resisting, and occasionally transforming discourses of health and love in ways that worked for and against engagement in lifestyle change.

CONCLUSION

In foregrounding the discursive and relational contexts of behavioural change engagement, we show the considerable complexity for couples, including costs related to engagement with lifestyle advice.

« Le cancer, ce n’est pas juste une histoire de maladie » : l’expérience du cancer du sein à la lumière des métaphores des patientes

L’objectif de cette étude qualitative est de mieux comprendre l’expérience du cancer du sein à partir d’une analyse des métaphores présentes dans les récits de femmes atteintes d’un cancer du sein. Les blogs de deux femmes ont été sélectionnés puis analysés selon une approche phénoménologique interprétative. Notre analyse met de l’avant trois métaphores à la lumière desquelles ces femmes semblaient vivre et saisir leur expérience du cancer du sein : le corps comme champ de bataille médical, le corps morcelé et le chemin de la maladie. Ces résultats indiquent, d’une part, la violente atteinte des barrières du corps et du sujet dans la maladie cancéreuse, d’autre part, la nécessité pour le sujet d’effectuer un travail psychique pour intégrer cette expérience à son existence, au lieu de la combattre. L’étude apporte aussi des éléments de réflexions sur les métaphores en tant que vecteurs de sens de l’expérience du cancer.

The Health of Healthcare Professionals in Italian Oncology: An Analysis of Narrations through the M.A.D.I.T. Methodology

From the analysis of the scientific literature relating to the health of oncological patients, the need to consider the global dimension of health of individuals emerges, which subsumes the bodily dimension and involves all the actors who offer their contribution to it in different ways. In this direction, the state of the art of the health construct offered by healthcare professionals highlights a lack of scientific contributions to the specific subject although these professionals are fundamental figures in oncological diagnosis setups. Considering, therefore, the healthcare roles as an integral part of the interactive framework where the oncological patient is placed, this paper offers the results of an Italian study relating to the health of healthcare professionals who take charge of patients with a neoplasia diagnosis. In particular, through an analysis of the discursive productions of 61 participants (healthcare workers, oncological patients and citizens) by the M.A.D.I.T. methodology (Methodology for the Analysis of Computerized Textual Data), this study aimed at observing the discursive reality of health offered by healthcare workers. The collected data highlight a low degree of health expressed by the healthcare professionals, who are strongly typified by rhetoric such as “the one who is destined to suffer psychologically”. These narrations limit the possibilities of development of different narrations in depicting these professionals: critical repercussions in the interaction with the oncological patients emerged, as well as in their global health degree. In conclusion, the results show the need for deep investigation into the impact that the health degree of health professionals can have on the patients they take charge of.

The incurable metastatic breast cancer experience through metaphors: the fight and the unveiling

Purpose: War metaphors are omnipresent in public and medical discourse on cancer . If some studies suggest that cancer patients may view their experiences as afight, few studies focus on the metaphors that patients create from their subjective experiences. The aim was to better understand the experience of four women with incurabale metastatic breast cancer from the metaphors they used in personal cancer blogs.Methods: An interpretive phenomenological analysis (IPA) was used to analyze these women's experience and metaphors of cancer.Results: Two metaphors carried the meaning of metastatic breast cancer experience: the fight and the unveiling. The results show that the war metaphor had a unique meaning for the bloggers who lived with incurable breast cancer: they revealed the difficulty of fighting cancer and eventually collapsing in battle, although a renewed look at life had developed in parallel to their struggle. The bloggers thus tried to lift the veil on this complex experience.Conclusion: The results highlight the need for women with metastatic breast cancer to be able to tell and share their experience in a supportive context and to reinvest the war metaphor in order to express themselves in a more authentic way.

How to Intervene in the Health Management of the Oncological Patient and of Their Caregiver? A Narrative Review in the Psycho-Oncology Field

Starting from statistical data derived from the oncological field, some articles have highlighted the importance of communication in the patient-caregiver dyad and have considered the various roles involved in a cancer diagnosis situation. Thus, the question of how to intervene in terms of "quality of life" from the time of diagnosis to the recovery or death of a cancer patient, beyond the sanitary and physical dimensions, has become relevant. Therefore, the present narrative review aims to offer an overview of the state of the art in terms of the psychological treatment modalities of cancer patients, from the diagnosis to the post-surgery period. A total of 67 articles were collected and analyzed, in relation to (1) psychological constructs employed in the oncological field, (2) intervention models and (3) quality of life and well-being measurement and evaluation tools. We described these articles, differentiating between those focusing on the role of (1) the patient, (2) the caregiver, (3) the patient-caregiver dyad and (4) healthcare professional roles. The oncological diagnosis and its repercussions in the lives of the patient and caregiver were explored and critical aspects that emerged from the literature were highlighted. In conclusion, the analysis allowed some considerations about the need to define research protocols and useful management strategies for increasing the overall health of patients with cancer diagnoses and the people who surround them.

Women's experiences of advanced breast cancer in a resource-limited Arab context: A Stakian multi-case study

OBJECTIVE

Breast cancer is the most common cancer for women, globally. Women are more likely to present with more advanced cancer and palliative care needs in low-resource contexts. There is limited research on Arab, Muslim and African women's experiences of advanced breast cancer. The aim of this study was to explore and understand the experiences of advanced breast cancer in the Islamic Republic of Mauritania.

METHODS

Using a constructivist Stakian multi-case study approach, eight cases were constructed with women with advanced breast cancer (n = 8), family members (n = 10) and health professionals (n = 9). Data were collected longitudinally (up to nine months per case) and included semi-structured interviews and audio-journals. Data from 58 interviews and 31 journal entries were thematically analysed.

RESULTS

Three key themes were identified: 1. Destiny: Maure women appreciate that Allah is all powerful and maintains control over their destinies and their breast cancer. 2. Patience & Acceptance: a fear of causing offence to Allah influences how women express their experiences of breast cancer and its treatments. 3. Journeying in search of a cure: Maure women have limitled access to information around their cancer and its treatments. Women use their own observations and interpretations to understand their breast cancer and guide their pursuit of treatment and a cure.

CONCLUSION

Maure women feel reassured that life and cure remain possible because of Allah's sustenance; but are aware that the gift of life is fragile. They experience restricted power over how they express negative experiences, access to information, and healthcare decisions.

The social construction of multiple sclerosis in Israel: a cultural reading of illness narratives

PURPOSE

Illness narratives are cultural artifacts that reflect the ways through which a certain culture perceives and constructs a given illness. Against this backdrop, the study explored the social construction of MS in Israeli society.

MATERIALS AND METHODS

Thematic content analysis of all (70) illness narratives posted on the Israel MS Society's website between 2012-2018, was employed.

RESULTS

Five themes were identified in our analysis, according to chronological order: (1) "Becoming ill" - consisted of framing MS as a sudden affliction or constructing MS as a gradual development. (2) "Negative changes" depicted MS as inflicting negative bodily changes and a disruption to the social order. The "happy ending" of the narratives pertained to (3) "adjustments" to MS and, (4) "never giving up" to MS. These were facilitated by embracing (5) "positive thinking and optimism."

CONCLUSIONS

MS is perceived in Israel as a form of "deviance" and as a biomedical phenomenon. Rehabilitation and healthcare staff, therefore, need to actively engage in interventions that challenge and change the ways that MS is perceived, as well as to partner with people with MS, and disability advocates to reconstruct and design policies and services that reflect a more socio-political understanding of MS.Implications for rehabilitationIllness narratives by people with multiple sclerosis (MS) can teach us about the ways though which a given society perceives and constructs MS.This study analyzed online illness narratives by Israelis with MS; it shows that MS was predominantly constructed as a bio-medical phenomenon and as a form of social deviance.Rehabilitation and healthcare professionals need to actively engage in interventions that challenge and change the ways MS is perceived among the public, policy makers, and people with multiple sclerosis.Rehabilitation and healthcare professionals should collaborate with people with MS and disability advocates in order to reconstruct and shape policies and the planning of communities such that they address the socio-cultural barriers that people with MS face.

News Media Representations of Responsibility for Alcohol-Related Liver Disease Requiring Liver Transplantation

Alcohol-related liver disease (ARLD) is a common indication for liver transplantation yet it is considered ethically controversial in academic, clinical and public discourses. Various social groups consider people with ARLD as personally responsible for their condition and question whether they should have access to a scarce resource. How the news media constructs responsibility for ARLD may influence public opinions toward those who are ill as well as related healthcare policies. Since the organ transplantation system relies on the willingness of individuals to donate organs, understanding how the media portrays controversial issues is a matter of vital importance for public health and health policy. We investigated how responsibility for ARLD requiring liver transplantation is presented for public consumption in the news media. Using a keyword search of two online news databases, we selected 81 articles from the United Kingdom, Canada and the United States. We analyzed the articles using a discursive psychological approach. We found that the news media ascribed responsibility for ARLD to three main actors: individuals with ARLD, biological predisposition, and policy and industry representatives. How responsibility for ARLD requiring liver transplantation is presented in the news media may have implications for people diagnosed with other substance-related disorders who present for transplant candidacy or are on the transplant waiting list. Investigating how responsibility for ARLD is constructed in news media may provide insights into how responsibility is understood in other stigmatized health conditions and its potential implications for population health equity.

"I Wasn't Gonna Let It Stop Me": Exploring Women's Experiences of Getting Through Chemotherapy for Ovarian Cancer

BACKGROUND

Many women with ovarian cancer experience significant chemotherapy-related adverse effects during treatment and thus cannot complete it without dose reductions and/or delays. There is some indication that chemotherapy completion is associated with improved survival, although currently little is known about what helps women get through chemotherapy.

OBJECTIVE

The aim of this study was to explore women's accounts of the factors they believed were helpful during their ovarian cancer treatment.

METHODS

Using a qualitative approach within a critical realist framework, we conducted interviews with 18 women who had received chemotherapy for ovarian cancer and analyzed the data thematically.

RESULTS

We identified 3 main themes related to women's experiences of dealing with chemotherapy: "optimistic tenacity," which illustrates a specific stoic identity that women assumed during treatment; "self-care," which reflects the health behaviors and activities women engaged in and lifestyle adjustments they made; and "support systems," which emphasizes the importance of social, emotional, and medical support and the specific needs shared by women undergoing treatment for ovarian cancer.

CONCLUSIONS

Our findings contribute to a deeper understanding of women's unique experiences of treatment that may influence whether they complete chemotherapy for ovarian cancer.

IMPLICATIONS FOR PRACTICE

This study highlights the central role of women's optimistic determination within a wider self-caring and well-supported context of treatment; we aim to provide feedback and guidance to health professionals caring for women with ovarian cancer.

"To be healthy to me is to be free": how discourses of freedom are used to construct healthiness among young South African adults

PURPOSE

Healthiness is constructed, in Western culture, as a moral ideal or supervalue. This paper will interrogate the assumption that health and the pursuit of healthiness is always and unquestionably positive, by exploring how discourses of health and freedom interact to reinforce the current inequalities and detract from social transformation.

METHOD

Twenty young South African adults were interviewed about their understandings and experiences of health. These discussions were analysed using Foucauldian discourse analysis.

RESULTS

Participants constructed healthiness as facilitating the experience of freedom, while at the same time being dependent on a personal orientation towards freedom (as opposed to merely submitting to dominant health authorities). Freedom discourses also played a role in connecting health to neoliberal discourses idealizing economic productivity and hard work. Participants were able to construct a self that is active, productive, valuable, hopeful, and self-assured when talking about health using discourses of freedom. However, these discourses also functioned to moralise and idealise healthiness, which contributed to blaming poor health on its sufferers.

CONCLUSION

Health/freedom discourses can further reinforce the neoliberal value of individual responsibility by constructing self-improvement and self-work as the solution to ill-health, thereby contributing to victim-blaming and weakening support for public health interventions.

Living as a Cancer Survivor: A Qualitative Study on the Experiences of Belgian Adolescents and Young Adults (AYAs) after Childhood Cancer

PURPOSE

Insight was sought in how a childhood cancer experience plays a role in daily life of adolescents and young adults (AYA) survivors.

DESIGN AND METHODS

A qualitative research in which semi-structured interviews were held with 21 AYA survivors of childhood cancer between the ages of 14 and 25. The AYA survivors were recruited from two pediatric oncology departments of two university hospitals in Belgium.

RESULTS

The current situation and behavior of AYA-survivors who have been treated for childhood cancer are covered in 5 categories: The Feeling of Being Different while Aiming for Normalcy in Relationships, Living with Existential Uncertainty, The Conscious Protection of Health, The Attachment to the Parent(s) with Whom the Cancer Experience was Shared, and The Desire to Be Meaningful to Others.

CONCLUSIONS

The AYA survivors did not feel that their cancer experience dominated their current daily life, yet, the cancer experience had an important impact on their functioning.

PRACTICE IMPLICATIONS

The findings of the study can be used to optimize holistic psychosocial care of AYA survivors. By starting from the key elements in their current functioning, health care professionals can tailor their support to the way in which AYA survivors have integrated their cancer experience into their everyday lives.

The collective/affective practice of cancer survivorship

Whether within an atmosphere of hope, or amidst relations of fear, the emotions of cancer are unavoidably collectively produced. Yet persistent individualistic paradigms continue to obscure how the emotions of cancer operate relationally - between bodies, subjects, discourses, and practices - and are intertwined with circulating beliefs, cultural desires, and various forms of normativity. Drawing on interviews with 80 people living with cancer in Australia, this paper illustrates why recognition of the collective enterprise of survivorship - and the collective production of emotion, more generally - is important in light of persistent, culturally dominant conceptions of the individual patient as the primary 'afflicted', 'feeling', and 'treated' subject. Building on previous work on affective relations and moral framings, we posit that the collective affects of survivorship inflect what people living with cancer can, and should, feel. We highlight how such things as hope, resignation, optimism, and dread are 'products' of the collective affects of cancer, with implications for how survivorship is lived, felt, and done.

Feeling lucky: hierarchies of suffering and stories of endometrial cancer in a Danish context

Illness stories are a prime analytical way of understanding patient perspectives on cancer. Nevertheless, limited studies have focused on stories of endometrial cancer. An ethnographic study including participant observation and interviews among 18 Danish women with endometrial cancer was conducted to examine prevalent stories and the ways the women responded to them. In this article, the analysis focuses on two exemplary cases, which present a line of issues related to the kinds of experiences that suffering includes. Findings illustrate that feelings of luck were central to the experience of being diagnosed, treated and cured, which was related to the way health professionals framed endometrial cancer as favourable through notions of curable/incurable, trivial and gentle/invasive and brutal, and aggressive/non-aggressive. Drawing upon the concept of a 'hierarchy of suffering', we exemplify how women tended to scale own experiences of suffering against others', leading some to believe they were not in a legitimate position to draw attention to themselves nor seek help and support, despite adverse physical, psychosocial effects. Thus, feelings of being lucky were intertwined with a sense of ambivalence. We conclude by discussing how suffering arises within a moral context, suggesting that the ways we speak of cancer may make some experiences unspeakable. This calls for increased clinical attention to more diverse narratives of cancer.

Cancer survivorship and identity: what about the role of oncology social workers?

With cancer survival rates rapidly increasing over time, more people are living into the survivorship stage of their cancer experience. Furthermore, the experience of cancer may impact individuals long after treatment has ceased. This paper presents the results of a mapping review implemented to explore key themes in the literature related to issues with identity following the completion of cancer treatment. The review included 22 studies including quantitative, qualitative, mixed method, and review studies as well as conceptual papers. Findings revealed key descriptions post-cancer treatment identities, literature focused on dominant discourses and counter-discourses around cancer survivorship, and key themes focused on identity management and the roles of Oncology Social Workers in supporting identity issues in postcancer treatment. This review presents a 'map' of current research on identity and cancer survivorship, helping to identify major gaps in the literature, direct future research, and inform practice.

The Imperative for a Triumph-Over-Tragedy Story in Women's Accounts of Undergoing Chemotherapy for Ovarian Cancer

We aimed to examine how women construct their experiences of chemotherapy treatment for ovarian cancer. Through semistructured interviews, we explored the accounts of 18 Australian women about their experiences within a broader cultural imperative-or discourse-to "think positively." By applying a critical realist lens to the analysis, we identified two discursive themes that shaped women's accounts. The "feeling different and managing support" theme highlights the identity challenges women faced because of the lack of formal support for ovarian cancer. Conversely, the theme "women's reconstructions of difficult experiences" illustrates the imperative for women to present a positive story as a way of restoring their position of a lucky and stoic survivor. Such speaking served to mask some of the underlying difficulties that were part of these women's experiences. Health care professionals need to consider looking for the hidden stories of vulnerability that lie beneath the triumphant ones.

Representations of Young Cancer Survivorship: A Discourse Analysis of Online Presentations of Self

BACKGROUND

More young people are surviving treatment for cancer than ever before. Survival can have an adverse impact on their transition to adulthood. Discourses of cancer are applied to cancer survivors of all ages, but they manifest differently for young people.

OBJECTIVE

The aim of this study was to describe practices of self-representation in an online Web site that supports young Australian cancer survivors.

METHOD

We conducted a discourse analysis of images and text produced by young cancer survivors (aged 18-35 years) on a public cancer charity Web site.

RESULTS

The dominant subject position of participants published on this web site is one of empowered, beautiful cancer survivor. This applies to young people who have learned to embrace their cancer as providing a positive influence on their lives. However, this discourse can marginalize those whose cancer experience remains a source of distress or shame.

CONCLUSION

Web based media can provide a valuable forum for some young people to celebrate their cancer survival and to affirm the constructive influence that their cancer experience has had on their lives. However, we ponder the apparent unsuitability of some forums for young cancer survivors who have not yet found cause for celebration.

IMPLICATIONS FOR PRACTICE

Nurses have the opportunity to contribute to the development of supportive structures that meet the specific needs of different groups of young cancer survivors. This might mean assisting young cancer survivors who are struggling to find meaning in their cancer experience to negotiate the establishment of a new normal that they can embrace.

The sociology of cancer: a decade of research

Biomedicine is often presented as the driving force behind improvements in cancer care, with genomics the latest innovation poised to change the meaning, diagnosis, treatment, prevention and lived experience of cancer. Reviewing sociological analyses of a diversity of patient and practitioner experiences and accounts of cancer during the last decade (2007-17), we explore the experiences of, approaches to and understandings of cancer in this period. We identify three key areas of focus: (i) cancer patient experiences and identities; (ii) cancer risk and responsibilities and (iii) bioclinical collectives. We explore these sociological studies of societal and biomedical developments and how sociologists have sought to influence developments in cancer identities, care and research. We end by suggesting that we extend our understanding of innovations in the fields of cancer research to take better account of these wider social and cultural innovations, together with patients, activists' and sociologists' contributions therein.

The Social Reception of Women With Cancer

Experiences of cancer are enmeshed with cultural understandings and social discourses around responsibility and causation. A cancer diagnosis can raise questions about its causation-including the role of the individual-whereas the disease and its treatment provide various social markers of illness. We present a sociological study of 81 women's accounts of living with cancer, with a focus on how women interpret their illness, in light of their interpersonal interactions and accounts of social relations. Our analysis reveals women's experiences of cancer diagnosis and treatment, the varied sociocultural meanings of cancer and the responses it elicits, the presence of moral assessments within everyday interactions, and the implications for the support and care they receive. We argue that the experience of cancer should be seen as intimately interwoven with its social reception and cultural sense-making practices, including normative constructs which promote ideas about (in)justice, responsibilization, and shame.

Breast-cancer-isation explored: Social experiences of gynaecological cancer in a Norwegian context

This article's point of departure is recent claims that breast cancer survivorship displaying positivity and self-growth represents the gold standard for all forms of cancer survivorship in English-speaking Western cultures. An interview study of Norwegian women regarding gynaecological cancer followed by hysterectomy is used to explore whether this process is taking place beyond this setting. Results show that the women's experiences of having to display survivorship in this manner are not as notable as found in English-speaking Western countries, neither is their experience of social othering. Reasons for this may be strong norms of social egalitarianism marking Norwegian culture and breast cancer informational campaigns that have not yet totally defined Norwegian norms for how to survive cancer. At the clinic and in the public sphere, however, the women experience gynaecological cancer as clearly having lower status than breast cancer, leading to a strong sense that the bodily site of their disease is taboo. Hence, as found in English-speaking cultures, the complex embodied nature of having gynaecological cancer and life beyond treatment seems to be silenced by the media and medical institutions. Finally, implications for future research and health care related to cancer survivorship are also discussed.

The "Conflicted Dying": The Active Search for Life Extension in Advanced Cancer Through Biomedical Treatment

Using a poststructural perspective, we examine the subjectivities that are produced when advanced cancer patients seek life extension through biomedical treatments. Seven case studies were developed that included 20 interviews with patients, family, nurses, and physicians recruited from a tertiary hospital in Canada, 30 documents, and 5 hours of participant observation. We identify seven types of subjectivity: (a) the Desperate Subject, (b) the Cancer Expert Subject, (c) the Proactive Subject, (d) the Productive Subject, (e) the Mistrusting Subject, (f) the Model Patient Subject, and (g) the Suffering Subject. We characterize the "conflicted dying," a contemporary figure who holds multiple perspectives about seeking curative treatment despite the acknowledgment of death. Using active strategies to gain access to treatment, this figure resists traditional arrangements of power/knowledge established by health care providers. We suggest that the search for life extension is a process of shaping the self to fit certain aesthetical traits associated with surviving cancer.

Discursive constructions of youth cancer: findings from creative methods research with healthy young people

PURPOSE

As part of work to understand the experiences of young people who had cancer, we were keen to examine the perspectives of peers who share their social worlds. Our study aimed to examine how cancer in young people, young people with cancer and young cancer survivors are represented through language, metaphor and performance.

METHODS

We generated data using creative activities and focus group discussions with three high school drama classes and used Foucauldian discourse analysis to identify the discursive constructions of youth cancer.

RESULTS

Our analysis identified two prevailing discursive constructions: youth cancer as an inevitable decline towards death and as overwhelming personhood by reducing the young person with cancer to 'cancer victim'.

CONCLUSIONS

If we are to understand life after cancer treatment and how to support young people who have been treated for cancer, we need a sophisticated understanding of the social contexts they return to. Discourses shape the way young people talk and think about youth cancer; cancer as an inevitable decline towards death and as overwhelming personhood is a key discursive construction that young people draw on when a friend discloses cancer.

IMPLICATIONS FOR CANCER SURVIVORS

The way cancer is constructed shapes how friends react to and relate to a young person with cancer. These constructions are likely to shape challenging social dynamics, such as bullying, that many young cancer survivors experience. Awareness of these discursive constructions can better equip young cancer survivors, their family and health professionals negotiate life after cancer.

Beyond survivorship? A discursive analysis of how people with pancreatic cancer negotiate identity transitions in their health

We explored how people negotiate, and respond to, identity transitions following a diagnosis of pancreatic cancer. Interviews with 19 people with pancreatic cancer were analysed using thematic discourse analysis. While discursively negotiating two transitions, 'moving from healthy to ill' and 'moving from active treatment to end-of-life care', participants positioned themselves as 'in control', 'optimistic' and managing their health and illness. In the absence of other discourses or models of life post-cancer, many people draw on the promise of survival. Moving away from 'survivorship' may assist people with advanced cancer to make sense of their lives in a short timeframe.

Corporal diagnostic work and diagnostic spaces: clinicians' use of space and bodies during diagnosis

An emerging body of literature in sociology has demonstrated that diagnosis is a useful focal point for understanding the social dimensions of health and illness. This article contributes to this work by drawing attention to the relationship between diagnostic spaces and the way in which clinicians use their own bodies during the diagnostic process. As a case study, we draw upon fieldwork conducted with a multidisciplinary clinical team providing deep brain stimulation (DBS) to treat children with a movement disorder called dystonia. Interviews were conducted with team members and diagnostic examinations were observed. We illustrate that clinicians use communicative body work and verbal communication to transform a material terrain into diagnostic space, and we illustrate how this diagnostic space configures forms of embodied 'sensing-and-acting' within. We argue that a 'diagnosis' can be conceptualised as emerging from an interaction in which space, the clinician-body, and the patient-body (or body-part) mutually configure one another. By conceptualising diagnosis in this way, this article draws attention to the corporal bases of diagnostic power and counters Cartesian-like accounts of clinical work in which the patient-body is objectified by a disembodied medical discourse.

Avoiding genetically modified foods in GMO Ground Zero: A reflective self-narrative

I engage in a reflective self-narrative of my experience attempting to maintain a diet free of genetically modified organisms. Social tension over the genetically modified organism industry in Hawai‘i, United States, has led to public debates over jobs and social identities. Drawing on local media sources, grassroots organizations, and blog posts, I describe the way this tension has shaped my experience with food, eating, and being with others as a genetically modified organism avoider. I utilize discursive positioning to make sense of my experiences by locating them within the ongoing public conversations that give structure to the daily lives of Hawai‘i’s residents.

"Hell no, they'll think you're mad as a hatter": Illness discourses and their implications for patients in mental health practice

This article examines how discourses on mental illness are negotiated in mental health practice and their implications for the subjective experiences of psychiatric patients. Based on a Foucauldian analysis of ethnographic data from two mental health institutions in Denmark--an outpatient clinic and an inpatient ward--this article identifies three discourses in the institutions: the instability discourse, the discourse of "really ill," and the lack of insight discourse. This article indicates that patients were required to develop a finely tuned and precise sense of the discourses and ways to appear in front of professionals if they wished to have a say in their treatment. We suggest that the extent to which an individual patient was positioned as ill seemed to rely more on his or her ability to navigate the discourses and the psychiatric setting than on any objective diagnostic criteria. Thus, we argue that illness discourses in mental health practice are not just materialized as static biomedical understandings, but are complex and diverse--and have implications for patients' possibilities to understand themselves and become understandable to professionals.

'I've used the word cancer but it's actually good news': discursive performativity of cancer and the identity of urological cancer services

Drawing on the ethnographic study of urological cancer services, this article explores how a set of particular discourses embedded in the everyday clinical work in a large teaching hospital in the UK helps materialise particular configurations of cancer and related professional identities. Emerging on the intersection of specific socio-material arrangements (cancer survival rates, treatment regimens, cancer staging classifications, metaphors, clinical specialities) and operating across a number of differential relations (curable/incurable, treatable/untreatable, aggressive/nonaggressive), these configurations help constitute the categories of 'good' and 'bad' cancers as separate and contrasting entities. These categories help materialise particular distributions of power and are thus implicated in the making of specific claims about the identity of urological cancer services as unique and privileged. Exploring these issues in view of feminist and material-semiotic approaches to studying science, technology and medicine, this article seeks to move away from the understanding of cancer discourses as primarily linguistic performances, proposing to see them instead as arrangements of practices and relations simultaneously material and semiotic through which particular categories, entities and phenomena acquire their determinate nature. In doing so, it seeks to contribute to sociology's broader concern with discursive performativity of cancer.

When the treatment stops: A qualitative study of life post breast cancer treatment

Public attention focuses on breast cancer treatment and fundraising; however, there is limited discussion about life post-treatment. Once treatment is complete, there can be societal expectations of newfound wellness. To understand this phenomenon, the narratives of nine women post-treatment were explored. Analysis revealed the adoption of the sick role by the participants, the vulnerability experienced with the cessation of treatment, the disturbance of moving on from the security of the medical system and the patient and doctor relationship. Findings emphasised that survivorship can remain challenging and can present adverse psychosocial implications for women and those close to them.

‘If you grow them, know them’: Discursive constructions of the pink ribbon culture of breast cancer in the Australian context

The ‘pink ribbon culture’ dominates understandings of breast cancer in Western societies. We describe this as an ‘illness culture’, consisting of neoliberal discourses and practices, which construct the breast cancer experience. We take a feminist post-structuralist approach to review current breast cancer lay materials available to women in Australia, to examine how breast cancer is discursively constructed within this context. Further, we consider how women with breast cancer are positioned and what the implications are for women’s lives. We discuss neoliberal discourses of ‘individual responsibility and empowerment’ and ‘optimism’, and the central practices that focus on individual health behaviours and survivorship. This illness culture has productive and restrictive effects for women’s subjectivity. Whilst women are positioned as ‘empowered’ regarding their health, this comes at the price of self-regulation and responsibility. Support and information additionally reposition women in feminine, heteronormative ways, whilst excluding women who do not fit narrow cultural stereotypes.

An interpretative phenomenological analysis exploring the lived experience of individuals dying from terminal cancer in Ireland

Objective:

The experience of living with dying has attracted limited research. We utilized interpretive phenomenological analysis to explore the lived experience of individuals with terminal cancer receiving palliative care in Ireland.

Method:

Participants were purposely selected from public interviews that had been conducted between 2006 and 2011. The study included the accounts of eight participants (N = 8; six females and two males) with a diagnosis of terminal cancer. Participant ages ranged from 36 to 68 years.

Results:

Three master themes emerged from the analysis: the personal impact of diagnosis, the struggle in adjusting to change, and dying in context. The results revealed that participants were still living while simultaneously dying. Interestingly, participants did not ascribe new meaning to their lives. The terminal illness was understood within the framework of the life that had existed before diagnosis. They strove to maintain their normal routines and continued to undertake meaningful activities. Management of unfinished business and creation of a legacy were salient tasks. Social withdrawal was not present; rather, participants engaged in emotional labor to sustain valued roles. However, we found that within the public domain there is a paucity of education and discourse supporting individuals at the end of life. The hospice was noted as an important external resource. Each participant experienced a unique dying process that reflected their context.

Significance of Results:

Healthcare professionals need to recognize the subjectivity of the dying process. Dying individuals require support and options to maintain their personhood.

Resistance, agency, and liminality in women's accounts of symptom appraisal and help-seeking upon discovery of a breast irregularity

In the breast cancer literature, "delayed presentation" is defined as a period of 3 months or more between the self-detection of a new breast symptom and the decision to seek help for it. Delay studies have overlooked the relevance of dominant medical discourses such as those concerning "proper" health. In this paper we use a critical discursive method to analyze interviews with 14 women about their symptom appraisal process to demonstrate how many inhabited a liminal space comprised of both "knowing and not knowing" about the symptom, and "acting and not acting" on it (interviews took place from January 2006 to April 2007). We describe three discursive themes that arose in the transcripts including "Doing the right thing", "Deliberate ignorance", and "Passive resistance." These women's narratives are juxtaposed with two commonly accepted medical discourses in relation to self-detected breast symptoms: That of the woman who was unaware of her symptom, or interpreted it as being insignificant, and therefore, not requiring medical attention; or that of the woman who noticed the symptom, interpreted it as threatening, and immediately sought medical attention. We suggest that such discourses are constricting and fail to account for the sizeable number of women who do not fit this mold (i.e., those who are both aware of the concerning change and delay presentation). We conclude that these constricting medical discourses effectively have a role to play in the contradictory reasoning or perceived irrationality of women's delay behavior when it occurs.