Ethnicity and cultural models of recovery from breast cancer

[Oncology in French Guiana: A challenge to win]

French Guiana is an equatorial, multicultural, overseas territory in South America. The region is unique: a wealthy country with a universal healthcare system, but significant poverty, which bears little resemblance to its neighbors Brazil and Suriname. Cancer is the second leading cause of death. The incidence of cancer is lower than in France, stages are generally more advanced and the prognosis worse. To date, oncology has been organized through a joint venture between local institutions and healthcare professionals and a cancer center in mainland France, in line with the recommendations of the Institut National du Cancer. The implementation of a medical project and a complete medical studies curriculum in French Guiana is a tremendous opportunity for the development of oncology. The main challenges are consolidating medical care for patients, quality control, genetic oncology, molecular biology, implementation of radiotherapy and nuclear medicine, clinical and translational research, and teaching programs. Working in oncology in French Guiana is exciting because of the scientific interest (particular characteristics of cancers, notably the role of viral or micro-organism-induced carcinogenesis, genetic factors in these populations with African and Asian roots, and the importance of a public health policy) and human interest (patients from different cultures; all of them bring original approaches to health and illness that need to be deciphered in order to offer quality care). This requires the support of healthcare professionals who are enthusiastic about this unique adventure.

A Transformative Journey Through Support Group Participation: Narratives of the Wives of Individuals With Alcohol Use Disorder

The issue of alcohol use disorder (AUD) has received significant attention, with a primary focus on individuals directly afflicted by the disorder. This extensive focus, while necessary, often overlooks the profound impact that AUD has on the family unit, particularly on spouses who play a crucial role in the dynamics of coping and recovery. However, the psychosocial and emotional challenges encountered by wives of those with AUD have been largely neglected in both research and therapeutic interventions. This oversight not only minimizes their suffering but also overlooks their potential contribution to the recovery process, underscoring the need for a more inclusive approach to understanding and addressing AUD. Building upon this foundation, the current study delves into the less explored terrain of the psychosocial and emotional ramifications borne by wives of individuals suffering from AUD. By highlighting the pivotal role that these women fulfil in family dynamics, it seeks to shed light on the transformative effects of their engagement in support groups, aiming to demonstrate how these networks promote resilience, empowerment, and healing for both the women and their families, thus offering a more comprehensive perspective on AUD's impact on society. Employing a qualitative narrative research design, the study utilized purposive sampling to select 36 participants from the northern, southern, and central regions of Kerala, India. Data collection was conducted through in-depth interviews using a semi-structured interview guide. The interviews, conducted initially in the local language, were transcribed into English and analyzed using the constant comparative method, ensuring that ethical considerations were upheld throughout the research process. The results of the study illuminate the multifaceted challenges faced by wives of individuals with AUD, including financial burdens, domestic violence, marital discord, and psychosocial issues. Notably, the participants reported a significant positive shift in their lives following their involvement in support groups, experiencing enhanced mental peace and tranquillity. This transformation enabled some participants to resume their education, engage with the community as role models and leaders, and reconstruct their lives. Most participants viewed their support group participation as a pivotal moment of hope restoration in their lives. The study reveals the necessity for integrating culturally sensitive support mechanisms into rehabilitation programs for families affected by AUD, advocating for broader adoption of support groups that cater to the specific sociocultural dynamics of affected communities.

Conceptualising the separation from an abusive partner as a multifactorial, non-linear, dynamic process: A parallel with Newton’s laws of motion

The present study focused on the dynamics and factors underpinning domestic abuse (DA) survivors’ decisions to end the abusive relationship. The experiences and opinions of 12 female DA survivors and 18 support workers were examined through in-depth, one-to-one, semi-structured interviews. Hybrid thematic analysis was conducted to retrieve semantic themes and explore relationships among the themes identified and the differences in survivors’ and professionals’ narratives of the separation process. The findings highlighted that separation decisions derived from the joint action of two sets of factors, the “promoters” and the “accelerators.” Whilst the “promoters” are factors leading to the separation from the abuser over time, the “accelerators” bear a stronger and more direct connection with survivors’ decision to end the abusive relationship. Despite their differences, both these factors acted as propelling forces, leading survivors to actively pursue the separation from the perpetrator. To portray the dynamic links among these factors, we propose a conceptualisation drawn from Newton’s laws of motion. Our findings also highlighted important differences in the views of survivors and support workers, as the former conceived themselves as proactive in ending the abuse, whereas the latter described the leaving process as mainly led by authorities and services supporting survivors. This study has potential implications for research, policy and clinical practice, as it suggests that far from being a linear sequence of multiple stages, leaving an abusive relationship results from a complex interplay of factors that facilitate (“promoters”) or drastically accelerate (“accelerators”) the separation process. We argue that future research should aim at improving our current understanding of the subjective and situational factors that can act as “accelerators” or “promoters” for women’s leaving decisions. Moreover, clinicians and policymakers should invest in creating interventions that aid victims to recognise and leverage promoters and accelerators, thus increasing their readiness to end the abuse.

A qualitative exploration of physical and psychosocial well-being in the short and long term after treatments for cervical cancer

OBJECTIVE

Cervical cancer is predominantly a cancer of younger women, and improvements in oncological outcomes have led to an increase in cervical cancer survivors living with the long-term effects of treatment. Understanding the recovery process after treatment is essential to increase awareness of the short- and long-term needs of survivors. The aim of this study was to qualitatively explore the recovery process and return to daily activity of cervical cancers survivors from a biopsychosocial perspective.

METHODS

Participants were 21 women treated for cervical cancer between the ages of 18 and 60 years, living in the United Kingdom. Interviews were undertaken face to face and via the telephone using a semi-structured interview schedule.

RESULTS

Data analysis revealed themes which represented participants' experience and perceptions of treatment as a paradox; emotional needs after treatment; and a journey of adversarial growth. A key finding from this analysis was the nuanced experiences between treatment modalities, with physical changes perceived to be more disruptive following radical treatments, whilst psychological repercussions were significant regardless of treatment type.

CONCLUSION

This study provides novel insight into the varied recovery experiences of those treated with surgery and/or chemoradiotherapy for cervical cancer, which can be used to improve the survivorship experience.

Spiritual Well-Being, Depression, and Quality of Life Among Latina Breast Cancer Survivors

This study explores the relationship between spiritual well-being (SWB) (meaning/peace & faith), depression, and quality of life (QOL). Cancer survivors often use their spirituality as a way of coping. Among a sample of 97 Latina breast cancer survivors (LBCS), SWB was assessed with the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale, QOL was measured using the Functional Assessment of Cancer Therapy-General (FACT-G), and depression was measured with the Patient Health Questionnaire. Study findings revealed that SWB, specifically the meaning/peace factor, is the main predictor of an increase in QOL and a reduction in depression among LBCS.

Praying to win this battle: Cancer Metaphors in Latina and Spanish Women's Narratives

This study closely examines 51 breast cancer narratives Latina and Spanish women wrote for other patients to illuminate how they conceptualize their health, with insights for addressing health disparities. Using discourse analysis of the role of language and culture in health care communication, this study focuses on the use of metaphors in the narratives. This provides revelations about the cultural and linguistic aspects of how the writers conceptualize their disease. Building on past research on metaphor use in cancer discourse in the English language, this study reveals the prevalence of metaphors comparing cancer to combat, or more generally, violence (e.g., "my battle against cancer"), or a journey (e.g., "my path with cancer"). Writers used this metaphorical language to offer advice to others with cancer and to mark their membership in a larger community of people with cancer. We also find that Spanish women use metaphors more frequently than Latinas and that they differed in their metaphorical portrayals of cancer. This research uncovers culturally embedded themes that are central to how women with cancer think about the disease, such as the prominence of spirituality in Latinas' metaphorical constructions, a pattern not evident in Spanish women's narratives.

Oncologists, oncology nurses and oncology social workers experiences with suicide: impact on patient care

OBJECTIVE

To explore how oncology healthcare workers' (HCPs) personal experiences with suicide impacts their practice with cancer patients.

DESIGN

The study was designed using Grounded Theory strategies in data collection and analysis.

PARTICIPANTS

Eighteen social workers, 23 oncologists, and 20 nurses, participated in the research.

METHODS

Themes emerged from systematic line-by-line coding of the interview transcripts.

FINDINGS

HCPs reported that personal experiences with suicide: impacted the way they communicated with patients about suicide; made them vigilant about signs of suicidality; and made them aware of specific indicators of this distress.

CONCLUSIONS

HCPs drew a direct line between their experiences with suicide to the ways in which they care for their patients.

IMPLICATIONS

Increasing HCP awareness of these issues alongside training using evidence-based guidelines for identifying and responding to suicide risk in patients will ensure providing the best quality of care for patients.

Patient pathways as social drama: a qualitative study of cancer trajectories from the patient's perspective

PURPOSE

The number of persons living with and beyond cancer is increasing. Such persons often have complex needs that last, and change, over time. The aim of this study is to get insights of lived experience of person diagnosed with colorectal cancer and to create an understanding of cancer trajectories as a dynamic process. This study thus explores Victor Turner's model of social drama in a cancer care context.

METHOD

Turner suggests that crisis is a dynamic process structured by four phases: 1) breach of norm 2) crisis 3) redressive actions 4) reintegration or schism. The research team employed content analysis to explore material gathered through a series of qualitative interviews with nine Norwegian cancer patients over a period of one year.

RESULTS

To the authors' knowledge, Turner's model has not earlier been applied to such materials. The results show that Turner's model of social drama is useful in achieving new and possibly important knowledge on illness trajectories from a lived experience perspective.

CONCLUSIONS

The model of social drama may contribute to a deeper understanding of the processes patients are going through in long-term illness trajectories, demonstrating that illness is not a static matter.

Cancer Patients' Mental Health Distress and Suicidality

Abstract. Background: A substantial number of people with cancer endorse suicidality when compared with the general population. Thus, oncology healthcare workers may experience the death of a patient to suicide over their careers. Aims: To explore the impact of patients' mental health distress and suicidality on oncology personnel with a secondary aim of exploring how personnel cope with these types of events. Method: We interviewed 61 healthcare professionals (HCPs) at two cancer centers. The grounded theory method (GT) was used. Results: The impact of patients' mental health distress and suicidal ideation on oncology HCPs included sadness, depression, worry and concern, and feeling emotionally overwhelmed. The impact of patient suicide on HCPs included trauma, guilt, and surprise. Oncology personnel reported a change in practice, including communication style, being attuned to patient cues, and changing the physical environment. Coping strategies included colleague support, seeking professional help, and setting boundaries between their work and home life. Limitations: It is likely that HCPs who participated in the study represent those who are more willing to discuss issues related to suicide. Thus, the impact of patient suicide on healthcare providers may be even more pronounced among the general oncology HCP community. Conclusion: Given the higher risk of suicide among cancer patients, it is necessary to increase awareness about the impact these events may have on HCPs. Professional guidelines can highlight the need for a balance between ensuring the availability of informal support and more formal methods of help.

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 impact of cancer and quality of life among long-term survivors of breast cancer in Austria

PURPOSE

This study explores the relationship between the perceived impact of cancer among long-term breast cancer survivors, sociodemographic and clinical variables, and mental and physical health-related quality of life outcomes in Austria.

METHODS

One hundred and fifty-two long-term survivors of breast cancer (on average 13 years after initial diagnosis) completed three mailed surveys, including the Short Form-36 (SF-36), the Impact of Cancer (version 2) to assess the perceived positive and negative aspects of cancer survivorship, and a general sociodemographic and clinical questionnaire. Linear regression models were constructed to determine the effects of the perceived positive and negative impact of cancer on mental and physical health-related quality of life.

RESULTS

Respondents reported a physical health status that centered on population norms for Austria, but scored lower on mental health status. After controlling for age, chemotherapy, exercise, and BMI, the positive impact of cancer was associated with improved physical functioning (p = 0.0014) and the negative impact of cancer was associated with poorer physical functioning (p < 0.0001). After controlling for age, marital status, the belief in emotional distress as a cause of cancer, and high stress levels, the negative impact of cancer was associated with poorer mental functioning (p < 0.0001). Higher perceived positive impact of cancer was not associated with improved mental functioning.

CONCLUSIONS

Long-term survivors of breast cancer in Austria perceive both positive and negative impacts of breast cancer. These perceptions, in particular the negative impact of cancer, appear to influence, or are potentially influenced by, physical and mental health-related quality of life.

Psychosocial correlates of benefit finding in breast cancer survivors in China

Breast cancer is number one in incidence and sixth in mortality among all cancers of women in China. Prior work identified positive consequences following diagnosis and treatment, including benefit finding among breast cancer survivors from Western countries. This study evaluated psychosocial correlates of benefit finding in breast cancer survivors in China. A total of 148 participants completed measures of coping, perceived stress, depressive symptoms, social support, and benefit finding. Results indicated that benefit finding was positively related to active coping and negatively related to depression. Future research may evaluate whether interventions to enhance active coping will improve outcomes among Chinese breast cancer survivors.

Missed Opportunity: Spirituality as a Bridge to Resilience in Latinos with Cancer

Going through adverse life events can help a person learn how to cope with life's challenges, overcome them, learn from the adverse experiences, grow, and be positively transformed by them. Spirituality is a resource that supports adaptation and resilience to improve quality of life in patients with cancer or other chronic illnesses. For Latinos, spirituality is an important core cultural value. As such, it is crucial to pay close attention to how cultural values play a role in health-related concerns when caring for Latino cancer patients, and to how spirituality, being an important aspect of Latino culture, influences how Latinos adjust and cope with cancer. Understanding how to facilitate resilience in the face of potentially negative life events, such as cancer, can not only help Latino cancer patients in active treatment, but can also impact effectiveness of managing and coping with the consequences of cancer during survivorship.

"Surviving is not the same as living": cancer and Sobrevivencia in Puerto Rico

"Cancer survivorship" is an evolving concept that has been elaborated to a large extent in the mainland U.S. through the work of national advocacy organizations, and it has served as a source of cohesion for many people who have experienced cancer. However, anthropologists and other social scientists have argued that dominant meanings of survivorship-such as the idea of "cancer as a gift" or the role of positive thinking in influencing the disease course-reflect distinctively American cultural values, and survivorship outside the U.S. has remained largely unexplored even while the concept has gained some traction globally. This paper explores how the concepts of "survivorship" and "survivor" are engaged in the setting of Puerto Rico, an unincorporated territory of the U.S., and how well they are seen to explain the nature of post-treatment life. Ethnographic fieldwork for this study was conducted over 12 months split between two field visits (2 months and 10 months) between June 2010 and March 2012 in San Juan, the capital city, and Ponce, a smaller city on the southern coast. This paper is based on interviews with 23 participants treated for cancer as young adults. Participants drew from many of the prevailing discourses of survivorship-such as transformation and the importance of optimism-as well as from what they understood to be distinctive aspects of Puerto Rican culture and identity, in the crafting of a local understanding of post-treatment life. Support organizations played a key role in shaping roles and expectations associated with having had cancer, and in solidifying particular views of survivorship more broadly.