Coping with a diagnosis of breast cancer among Omani women

Prevalence of anxiety, depression, and post-traumatic stress disorder among Omani children and adolescents diagnosed with cancer: a prospective cross-sectional study

BACKGROUND

Children and adolescents diagnosed with cancer often experience psychological distress, encompassing anxiety, depression, and post-traumatic stress disorder (PTSD). This study aimed to evaluate the prevalence of these conditions among Omani children and adolescents diagnosed with cancer, alongside identifying contributing factors.

METHODS

A prospective cross-sectional study was conducted from October 2021 to June 2023 among a cohort of Omani children and adolescents (6-18 years old) diagnosed with cancer at three primary cancer referral centres in Oman. Validated Arabic-language versions of the Screen for Child Anxiety Related Disorders, the Center for Epidemiologic Studies Depression Scale for Children, and the Impact of Event Scale-Revised instruments were used to assess symptoms of anxiety, depression, and PTSD, respectively. An initial assessment (T1) was undertaken within the first 3 months of diagnosis, followed by a second assessment (T2) 3-6 months later.

RESULTS

Of 113 eligible participants, 101 agreed to participate in the study (response rate: 95.6%), with 92 (91.0%) completing both assessments and included in the final analysis. Prevalence rates of anxiety, depression, and PTSD decreased from 43.5%, 56.5%, and 32.6%, respectively, at T1, to 38.0%, 35.9%, and 23.9% at T2. All average scores were below diagnostic cut-off points, except for the depression score at T1. Anxiety and depression scores decreased significantly (p = 0.043 and 0.001, respectively) between T1 and T2, as did the overall prevalence of depression (p = 0.004). At T1, linear regression analysis showed significant correlations between anxiety scores and the child's age and PTSD score (p < 0.05); these variables were also correlated with depression scores (p ≤ 0.001). At T2, significant correlations were observed between anxiety scores and the child's age and PTSD scores (p < 0.001). At both T1 and T2, anxiety, depression, and PTSD scores remained significantly correlated (p < 0.001).

CONCLUSIONS

Omani children and adolescents recently diagnosed with cancer exhibit a high prevalence of anxiety, depression, and PTSD over time. Age-appropriate communication, ongoing support, and mental health services are recommended to help this patient group cope with their diagnosis and manage their emotional wellbeing. There is a need for future research to determine the effectiveness of specific psychological interventions in reducing the frequency of these disorders.

Values and their relationship with emotion processing and physical and psychological symptoms among Jewish and Arab breast cancer survivors

Introduction

Individuals from different cultures differ in their values, which encompass belief systems that individuals develop based on their culture, and play a pivotal role in shaping their perspectives. These values may affect emotion processing (EP): the recognition, interpretation, expression and response to bodily sensations, translated as emotions. These varying values may contribute to distinct emotional experiences, impacting physical and psychological symptoms in breast cancer (BC) survivors.

Methods

This cross-sectional study investigated how EP including acceptance, expression (avoidance and approach coping), and awareness, may mediate the relationship between conservation values and symptoms of pain, fatigue, and depression among Arab (n = 62) and Jewish (n = 179) women BC survivors in Israel. Conservation values include tradition, conformity, and security.

Results

Depression and fatigue were negatively correlated with acceptance of emotions, and positively correlated with avoidance and conservation levels. Emotion processing mediated the relationship between conservation and fatigue and depression. Arab women reported higher levels of various values, emotional acceptance, pain, fatigue, and depression symptoms compared to Jewish women. Conservation was higher in Arab women and correlated with both approach and avoidance coping which was not the case in Jewish women. Avoidance coping had a positive relationship with fatigue in the Jewish, but not the Arab women. Similarly, approach coping was negatively related to depression in Jewish, but not in Arab women.

Discussion

Cultural differences are important for understanding the experience of cancer in individuals from different cultures. Future interventions for more conservative BC survivors should take culture into account.

Prevalence of psychological distress and associated factors among Omani women diagnosed with breast cancer: a single-centre, cross-sectional study

OBJECTIVES

To determine the prevalence of psychological distress (ie, anxiety and depressive symptoms) among Omani women diagnosed with breast cancer (BC) and to investigate associations with socio-demographic factors.

DESIGN

A cross-sectional, self-administered survey was conducted between September 2021 and June 2022.

SETTING

Sultan Qaboos Comprehensive Cancer Care and Research Centre (Muscat, Oman).

PARTICIPANTS

Adult Omani women diagnosed with BC during the study period.

OUTCOME MEASURES

Data regarding anxiety and depressive symptoms were collected using an Arabic version of the Hospital Anxiety and Depression Scale (HADS). Socio-demographic and clinical information was obtained from the participants and their hospital medical records.

RESULTS

190 Omani women diagnosed with BC were invited to participate in the study, of whom 171 participated (response rate: 90.0%). The mean age was 50.3±10.9 years. 52.3% of participants had been diagnosed with BC at stages III or IV and 28.9% had metastasis. 29 women (17.0%) exhibited depressive symptoms (HADS-D score: ≥8), while 37 (21.6%) exhibited anxiety symptoms (HADS-A score: ≥8). Women with anxiety symptoms were almost 15-times more likely to have depressive symptoms than those without anxiety symptoms (OR: 14.87, p<0.001). Younger women were less likely to exhibit depressive symptoms than older women (≤39 vs ≥60 years, p=0.050; 40-59 vs ≥60 years, p=0.005). Women at the school/diploma education level were less likely to have depressive symptoms than those at college/university level (OR: 0.19, p=0.017).

CONCLUSIONS

More than half of the women surveyed had been diagnosed at an advanced stage, with up to 21.6% presenting with symptoms of anxiety and depression. Healthcare professionals in Oman should consider additional screening for anxiety and depressive symptoms in this group and encourage patients with BC to disclose emotional information during consultations, particularly for those aged ≥60 years.

Concerns and coping mechanisms of breast cancer survivor women from Asia: a scoping review

PURPOSE

The incidence of breast cancer has increased significantly in Asia due to epidemiological transition and changes in human development indices. Advancement in medical technology has improved prognosis with a resultant increase in survivorship issues. The effects of breast cancer diagnosis and treatment are influenced by the patient's cultural beliefs and social systems. This scoping review aims to summarise concerns and coping mechanisms of women with breast cancer in Asia and understand gaps in the existing literature.

METHODS

We performed a scoping review using the population-concept-context strategy. A systematic search of MEDLINE (PubMed, Web of Science), CINAHL, SCOPUS, and Embase was conducted for studies conducted in Asia on women diagnosed with breast cancer, identifying their concerns and coping mechanisms, published between January 2011 and January 2021. Data from included studies were reported using frequencies and percentages.

RESULTS

We included 163 studies, of which most (81%) were conducted in hospital settings. Emotional and psychological concerns were reported in 80% of studies, followed by physical appearance and body-image concerns in 46%. Social support (59%), emotion-based coping (46%), spirituality, and problem-based coping (37%) were the major coping systems documented.

CONCLUSION

The mapped literature documented that anxiety, depression, and fear of cancer recurrence dominated women's emotional concerns. Women coped with the help of social support, positive reappraisal, and faith in God and religion. Sensitization of caregivers, including healthcare professionals and family members, to context-specific concerns and inquiry into the patients' available support systems is essential in strengthening breast cancer women's recovery and coping.

Associations between Spiritual Health Locus of Control, Perceived Discrimination and Breast and Cervical Cancer Screening for Muslim American Women in New York City

BACKGROUND

We sought to understand the impacts of religion-related factors, namely perceived discrimination and spiritual health locus of control, on breast and cervical cancer screening for Muslim American women.

METHODS

A total of 421 Muslim American women were surveyed at baseline of a breast and cervical cancer screening intervention, measuring discrimination through the Perceived Ethnic Discrimination Questionnaire (PED-Q), a 17-item scale measuring perceived interpersonal racial/ethnic discrimination; and spiritual beliefs through the Spiritual Health Locus of Control Scale, a 13-item scale measuring the link between control over one's health with a connection to religious beliefs. Multivariable logistic regression models were used to determine factors associated with an up-to-date mammogram and Pap test.

RESULTS

Most women preferred to receive medical care from a healthcare provider of their same gender (75.2%) and same race, ethnicity or religion (62.1%). The middle age group (50-59) and a lower God's Grace Spiritual Health Locus of Control subscale were associated with up-to-date mammogram. Younger age, lower education, higher Exclusion/Rejection subscale, and lower Spiritual Life/Faith Subscale were associated with an up-to-date Pap test.

CONCLUSION

The spiritual beliefs of Muslim American women impact their likelihood of obtaining breast and cervical cancer screenings. Therefore, these services need to be better tailored to match these needs, for example, by ensuring that Muslim American women have access to healthcare providers of their same gender, race, ethnicity or religion.

Magnitude and factors associated with anxiety and depression among patients with breast cancer in central Ethiopia: A cross-sectional study

BACKGROUND

Patients with breast cancer are assumed to be susceptible to anxiety and depression, while there is a lack of evidence about the epidemiology and underlying factors in Ethiopia. Hence, we aimed to assess the prevalence and predictors of anxiety and depression among patients with breast cancer in Ethiopia.

METHOD

An institutional-based cross-sectional study was conducted among patients with breast cancer who were attending treatment at the Oncology Center of the Tikur Anbessa Specialized Hospital, the largest referral teaching hospital in Ethiopia. The Hospital Anxiety and Depression Scale (HDAS) was used to evaluate the anxiety and depression status of the participants, and a structured questionnaire was used to collect sociodemographic, socioeconomic, and clinical data from the participants. Medical records of the participants were reviewed to collect and correlate information about the grade and stage of cancer. An analysis was done using STATA 15.1.

RESULTS

The study included 333 randomly selected participants, of which 35.4% were on stage III and 33% on stage II, and 67.9% were on chemotherapy and surgery. The prevalence of anxiety and depression were 60.7 and 58.6%, respectively. Poor patient-provider interaction (adjusted odds ratio [AOR] = 4.5, 95% CI: 2.49, 8.12) and having no financial support (AOR = 2.83, 95% CI: 1.63, 4.91) were the significant predictors of anxiety. Age >49 years (AOR = 0.48, 95% CI: 0.25, 0.90), poor patient-provider interactions (AOR = 3.36, 95% CI: 1.87, 6.02), and having no financial support (AOR = 3.36, 95% CI: 1.95, 5.79) were the significant predictors of depression.

CONCLUSION

In this study, the prevalence of anxiety and depression was high among patients with breast cancer, and the lack of financial support and poor patient-provider interactions were significant predictors of anxiety and depression among these groups of patients. Patients with cancer need regular screening for mental health and better emotional support from their healthcare providers and families to prevent and treat anxiety and depression.

Attitudes Towards Cancer Patients: A cross-sectional study of Omani patients and attendees at a university teaching hospital

Objectives

Many cancer patients experience social difficulties and feelings of isolation. This study aimed to evaluate patients' and attendees' attitudes towards cancer patients.

Methods

A cross-sectional study was conducted of patients and attendees attending Sultan Qaboos University Hospital (SQUH), Muscat, Oman, from December 2018 to March 2019.

Results

A total of 1,190 people participated (response rate: 91.5%). The majority (90.7%) did not express reluctance to help cancer patients. Most agreed that cancer patients were productive (76.2%) and are respected by the public (75.0%). However, many participants (63.1%) felt that cancer patients might face difficulties getting married. Multivariate analysis showed that participants who had a family history of cancer or had previously been a caregiver for cancer patients were more likely to believe that cancer patients could be productive (odds ratio [OR] = 1.92, 95% confidence interval [CI]: 1.31-2.82; P <0.05). Less-educated participants were more likely to believe that cancer patients feared not being productive (OR = 1.49, 95% CI: 1.01-2.19; P <0.05). Male and single participants were more likely to perceive that cancer patients faced difficulties getting married (OR = 1.56, 95% CI: 1.20-2.02 and OR = 1.68, 95% CI: 1.22-2.32, respectively; P <0.05 each).

Conclusion

Patients and attendees attending SQUH in Oman appeared to have positive and supportive attitudes towards cancer patients, although some felt that cancer patients might encounter social obstacles. Healthcare professionals should consider reassuring cancer patients of such positive sentiments. Governmental and non-governmental organisations should act to promote a supportive environment for cancer patients in Oman.

Social support for breast cancer patients in the occupied Palestinian territory

Previous research indicates that social support is beneficial to cancer patients in adjusting to the stress of the disease. Drawing on a qualitative content analysis of 36 semi-structured interviews, this article explores sources and types of social support in Arab-Palestinian women with breast cancer. Results show that members of the immediate family, husbands in particular, are reported to be the most supportive social sources. Given the limitations that characterize access to cancer care in the occupied Palestinian territory (OPT) and the collectivistic values of the society, women with breast cancer seem to rely mainly on their husbands to handle emotional, functional and informational needs. Emotional support includes the provision of care, trust, reassurance, and companionship. Functional support includes the practical assistance that the cancer patients receive in terms of financial support, attendance during treatment or help with domestic chores and childcare. Accessing appropriate informational support can be quite challenging in the OPT since available information is not always reliable. The family plays a key role in mediating communication with doctors. Contact with breast cancer patients and survivors is also a source of supporting information, with however a possible negative impact in terms of emotional coping. In this context, the immediate family becomes a fundamental resource for coping and a relational space that mediates connections with others, including doctors, acting as a "proxy" between the patient and the social environment. Findings are discussed in light of the historical and sociocultural context of the OPT.

Understanding the subjective experiences of South African women with recurrent breast cancer: A qualitative study

This study explored the subjective experiences of 12 South African women diagnosed with recurrent breast cancer. Women were invited to take part in unstructured narrative interviews, and to complete a diary in which they could reflect on their breast cancer experiences. Most responded to their recurrence with an optimistic stance. Religious beliefs and support structures were important coping strategies. Women's perceptions of their changed bodies varied from being of least concern, to becoming the most distressing aspect. The findings highlight the complexity of illness experience and the different ways in which women make sense of a second episode of cancer.

Symptom Perceptions and Help-Seeking Behaviours of Omani Patients Diagnosed with Late-Stage Colorectal Cancer: A Qualitative Study

OBJECTIVE

Colorectal cancer (CRC) is the fourth leading cause of mortality in Oman, with most patients diagnosed at advanced stages. Early diagnosis of CRC improves prognosis and survival rate. The aim of this study was to explore the symptom perceptions and help-seeking behaviours (HSBs) of Omani patients diagnosed with late-stage CRC.

METHODS

Semi-structured individual interviews were conducted with 16 patients.

RESULTS

Four main themes emerged, including normalisation and ignorance (patients felt healthy, perceived symptoms as not being serious and related to dietary habits, concealed them or prioritised work and family commitments), self-empowerment and self-management (patients were stubborn, employed 'wait and see' approach, used symptomatic or herbal treatments), disclosure and seeking help (patients disclosed symptoms to family members or friends, sought medical help only when symptoms worsened, visited faith healers or travelled abroad for treatment) and healthcare professionals (patients attributed treatment or diagnosis delays to lack of continuity of care, loss of trust in doctors or delays in referral).

CONCLUSION

Patients attributed delays in CRC diagnosis to several factors based on their perceptions of symptoms. Most HSBs driven by sociocultural and emotional causes. Increased awareness of CRC symptoms and modifying HSBs can encourage early diagnosis. Prompting patients to disclose CRC-related symptoms may aid referral decisions.

Knowledge of symptoms, time to presentation and barriers to medical help-seeking among Omani women diagnosed with breast cancer: a cross-sectional study

OBJECTIVE

To identify knowledge of breast cancer (BC) symptoms, time taken to consult a doctor and factors contributing to delays in medical help-seeking.

DESIGN

A cross-sectional study of Omani women diagnosed with BC.

SETTING

The two main teaching hospitals in Oman: Royal Hospital and Sultan Qaboos University Hospital.

PARTICIPANTS

Adult Omani women recently diagnosed with BC.

TOOLS

The Breast Module of the Cancer Awareness Measure and the International Cancer Benchmarking Partnership questionnaire were used to collect data.

RESULTS

A total of 300 women with BC participated (response rate: 91.0%). The mean age at diagnosis was 43.0±12.50 years and 33.5% were diagnosed at stage III or IV. Although most women (74.4%) recognised breast/armpit lumps to be a symptom of BC, less than half identified other symptoms, including breast/armpit pain (44.0%), changes in the position of the nipple (36.2%), redness (31.7%), fatigue (26.3%), weight loss (23.4%) and loss of appetite (20.8%). While most (91.6%) were aware that BC could be cured if detected early, only 66.4% sought medical help within a month of developing symptoms. Initial responses to symptoms included informing husbands (40.2%) or family members (36.5%). Barriers to seeking medical help included feeling scared (68.9%) and worried about what the doctor might find (62.8%). Highly educated women were more likely to recognise the following as BC symptoms: changes in nipple position (OR: 0.16, 95% CI 0.03 to 0.81), breast pain (OR: 0.10, 95% CI 0.01 to 0.86) and unexplained weight loss (OR: 0.18, 95% CI 0.04 to 0.88) (all p<0.05).

CONCLUSIONS

Although many Omani women with BC were aware of the importance of early diagnosis, most demonstrated inadequate knowledge of symptoms, did not prioritise seeking medical help and reported emotional barriers to help-seeking. More educational measures are needed to improve symptom recognition and address help-seeking barriers to minimise delays in diagnosis.

Identification of Evidence for Key Positive Psychological Constructs in Pediatric and Adolescent/Young Adult Patients with Cancer: A Scoping Review

Introduction: Children and adolescents/young adults (AYAs) with cancer are a vulnerable population susceptible to numerous late effects, such as fatigue and depression, which may diminish their long-term psychological, physical, spiritual, and emotional health. A well-rounded understanding of how positive psychological constructs affect the quality of care and treatment outcomes is therefore warranted.

Methods: We conducted a scoping review of 15 positive psychological constructs in children and AYAs with cancer. The primary research questions were (1) what is known about positive psychological constructs in children and AYAs with cancer; (2) what value is ascribed to these constructs by patients?

Results: Two hundred seventy-six articles were included after database search and screening. These studies were mostly observational or qualitative and conducted in North America. Constructs were often poorly defined, and measurement tools used to gather data were wide ranging. Numerous factors were correlated with increased or decreased expression of certain constructs, but overall themes were difficult to identify. Similarly, patients often spoke of what increased or decreased expression of a construct, with less emphasis on what they implicitly value.

Discussion: This scoping review found ample evidence for what increases or decreases expression of positive psychological constructs, but this evidence was observational and often conflicting. In the future, we recommend the development of a core set of psychological outcomes, with definitions and corresponding measurement tools. We further recommend an emphasis on randomized trials to more rigorously study how expression of constructs can be improved and what effect this has on the quality of life.

Understanding the Perceptions of Omani Women Regarding Life After a Breast Cancer Diagnosis

Objectives

There is a rising burden of breast cancer (BC) in the Eastern Mediterranean Region (EMR), and its sociopsychological impact is a quickly growing health concern in this region. Because understanding cancer patients’ perceptions of life is integral to their treatment, they are also a concern for healthcare providers. This qualitative study, therefore, explored changes in Omani women’s perceptions of life after a BC diagnosis.

Methods

Semi-structured interviews were conducted individually with 21 Omani women undergoing treatment for BC at the Oncology Ward of Muscat’s Royal Hospital from March to May 2017. The collected data were subjected to qualitative content analysis.

Results

After their cancer diagnosis, the women appeared to pass through three main stages in their coping processes. First, they passed through a stage of severe psychosocial distress and diminishment in personal identity. Next, they evolved strategies for coping based on cultural, religious and family resources. Finally, the women experienced acceptance and submission to the reality of the cancer as God’s will with changes in attitudes and perceptions of the meaning of life.

Conclusion

A BC diagnosis impacts Omani women severely, affecting their lives dramatically. They adopt coping strategies based on cultural, religious and spiritual beliefs. Healthcare providers need to acknowledge and facilitate women’s spiritual and cultural coping strategies as an integral part of their treatment which holds potential to improve their prognosis. Such strategies should be individualised to suit each woman’s experiences, perceptions and needs.

Barriers and Attitudes toward Breast Cancer Screening among Omani Women

Background:

Breast cancer (BC) is the most common cancer accounting for 24.5% of Omani female cancer. Early detection of BC through regular breast cancer screening (BCS) has been found to decrease mortality rates. The aim of this study was to identify knowledge, attitudes and barriers of Omani women toward BCS.

Methods:

A cross-sectional study was conducted among adult Omani women attending the Sultan Qaboos University Hospital (SQUH).

Results:

A total of 358 Omani women participated from 420 invited (response rate = 85.2%). Most women (92.1%) thought that BC could be cured if detected early, but less than half (46.8%) thought that they were at risk of BC if a relative had BC. The majority (81.1%) were aware that BCS was available in Oman, though less than half (48.5%) knew where to go for BCS and most (83.8%) had not undergone BCS before. The most common personal-related barriers to BCS were fear of BC diagnosis (40.8%), fear of treatment (52.1%) and embarrassment of the breast examination (46.6%). The most perceived system-related barriers to BCS were the concern over the availability of a male doctor (46.6%) or a non-Arabic speaking doctor (38.7%) and not recommended by the doctor (46.3%). Univariate binary logistic regression showed that attitudes toward BCS were influenced by their previous experiences of BCS (odds ratio [OR] = 2.28; 95% confidence interval [CI]: 1.18-4.41) and their willingness to participate in the future BCS [OR = 1.96; 95% CI: 1.14-3.37).

Conclusion:

Although Omani women showed an interest toward BCS, few had undergone BCS. Several cultural, practical and personal-related barriers were noted to interfere with BCS in Oman. Addressing these concerns through involving healthcare providers to reassure the women and implementing a national strategy of BCS could improve BCS screenings and early diagnosis of BC.

Experiences of breast cancer in Arab countries. A thematic synthesis

BACKGROUND

Breast cancer is the most common cancer in women globally. Its negative effects on a woman's quality of life are related to the individual and socio-cultural factors. This review aimed to identify and synthesise the reported experiences and quality of life of women with breast cancer in Arab countries.

METHODS

PubMed, Embase, Web of Science, SCOPUS, PsychInfo, CINAHL, Allied and Complementary Medicine Database, and Index Medicus for the Eastern Mediterranean Region were searched for articles published from start to March 2019 using PRISMA guidelines. These searches were complimented by citation tracking and  hand searching of relevant journals. A thematic synthesis was carried out on the 'findings/results' sections from the identified papers.

RESULTS

Of 5228 records identified, 19 were included in the review which represented 401 women from 11 Arab countries. All used qualitative methods of data collection to produce rich descriptions of experiences. Thematic synthesis of the extracted data identified three major themes, Perceptions and reactions, Coping or enduring and Changing roles.

CONCLUSIONS

This review provides a rich description of the reported quality of life and experiences of women with breast cancer in Arab countries. These are influenced by the women's and society's views of cancer, the women's role in society and family, religious faith and the healthcare context and access to treatment choices and information.

"For Every Illness There is a Cure": Attitudes and Beliefs of Moroccan Muslim Women Regarding Health, Illness and Medicine

In order to provide adequate health care, it is important to be well aware of the views and attitudes of the health seeker regarding health, illness and medicine. In the Belgian context, the views of Muslim women, particularly of middle-aged and elderly Moroccan women, have been understudied. The aim of this article is twofold. First, we seek to bring forward the attitudes and beliefs of middle-aged and elderly Moroccan Muslim women living in Antwerp (Belgium) towards health, illness and medicine. Second, we seek to explore which role religion plays in their views and attitudes regarding health, illness and medicine. Qualitative empirical research was conducted with a sample of middle-aged and elderly Moroccan Muslim women living in Antwerp (Belgium) (n = 30) and with experts in the field (n = 15). In-depth interviews and participant observations were conducted to reveal their perceptions regarding health, illness and medicine. This study reveals that religion plays a crucial role in how Muslim women perceive and deal with illness. Theological considerations that centre on God's omnipotence, the belief in the afterlife and religious virtues take up a central position. A holistic approach is adopted in the search for healing, i.e. an interplay between calling upon medicine and turning to God. Religious beliefs seem to be a powerful source in coping with illness.

The narrow treatment road to survival: Everyday life perspectives of women with breast cancer from Iraq and the former Yugoslavia undergoing radiation therapy in Sweden

This study aimed at exploring how women from Iraq and the former Yugoslavia, diagnosed with breast cancer and living in Sweden, experience their everyday life during radiation therapy. A qualitative research design was used comprising interviews with ten women, five originating from Iraq and five from the former Yugoslavia. Striving to survive, the women experienced their everyday life during radiation therapy as extremely challenging. This experience can be placed into three categories: strategies for survival, keeping up appearances and staying in control. Because of these specific challenges, immigrant women may need additional information and guidance in conjunction with the diagnosis, which may enable them to identify possible sources of support from those closest to them. Also, greater attention should focus on acknowledging the woman behind the diagnosis, regardless of her origin, to develop an individualised support programme to help her cope with everyday life during radiation therapy.

The Role of Patients' Families in Cancer Treatment Decision-Making: Perspectives among Eastern and Western families

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From a Death Sentence to a Disrupted Life: Palestinian Women's Experiences and Coping With Breast Cancer

This study explores women's experiences of breast cancer in the occupied Palestinian territory. We use an inductive qualitative design with a thematic analytical approach for conducting and analyzing 35 semi-structured interviews with breast cancer patients. The interviews focused on diagnosis, experiences and coping with breast cancer, social support and care needs, and the impact of illness on their families and social relationships. Three themes emerged: (a) the transition from initial shock to the daily struggles with disruptions caused by illness, (b) the role of social support in helping women cope with the burden of disease, and the importance of (c) faith and reliance on God (tawakkul). In the Palestinian context, women's narratives highlighted the disruptive nature of breast cancer. Our findings underline the importance of social support provided by extended family members. Finally, faith is an important overarching theme that influences how women make sense of and cope with breast cancer.

Public awareness of warning signs and symptoms of cancer in oman: a community-based survey of adults

BACKGROUND

The majority of deaths from cancer occur in low and middle income countries, partly due to poor public awareness of the signs and symptoms of cancer.

MATERIALS AND METHODS

A community based survey using the Cancer Awareness Measure (CAM) questionnaire was conducted in three different communities in Oman. Omani adults aged 18 years and above were invited to participate in the study.

RESULTS

A total of 345 responded from 450 invited participants (response rate=76.7%). The majority of respondents were unable to identify the common signs and symptoms of cancer identified in the CAM (average awareness was 40.6%). The most emotional barrier to seeking help was worry about what the doctor might find (223, 64.6%); a practical barrier was too busy to make an appointment (259, 75.1%) and a service barrier was difficulty talking to the doctor (159, 46.1%). The majority of respondents (more than 60% for seven out of ten symptoms) would seek medical help in two weeks for most signs or symptoms of cancer. Females were significantly more likely than males to be embarrassed (p<0.001), scared (p=0.001), and lack confidence talking about their symptoms (p=0.022).

CONCLUSIONS

Urgent strategies are needed to improve public awareness of the signs and symptoms of cancer in Oman. This might leads to earlier diagnosis, improved prognosis and reduced mortality from cancer.

Coping response following a diagnosis of breast cancer: A systematic review

Introduction

Coping with breast cancer is an important health issue that results in adjustments to the disease in survivors. The present systematic review aims to synthesize the evidence about the coping strategies used by women who are primary breast cancer survivors to adjust to their new situations in their lives.

Methods

Searches were conducted using Google Scholar, PubMed, Scopus, Wiley Online Library, and PsycINFO, using the terms “breast cancer,” “breast malignancy,” “coping strategies,” “coping behaviors,” and “adjustment” from January 2000 to July 2015. Only relevant studies in English were selected at the end of the search. Only those papers were selected that focused on coping strategies/behaviors that were used by breast cancer survivors.

Results

Searching the electronic databases resulted in 2390 articles. Ultimately, 20 studies met the inclusion criteria of the present study and were included in the review. Two reviewers independently reviewed all relevant articles using the same inclusion criteria. The reviewers completed a quality assessment using the Newcastle–Ottawa Quality Assessment scales for observational studies. The more frequent coping strategies that patients with breast cancer used in the studies were 1) seeking social support (9 studies), 2) positive reframing and reappraisal behaviors as problem focused strategies (7 studies), 3) religious/spirituality-focused efforts (8 studies), 4) emotional expression as positive emotion-focused strategies (3 studies), and 5) avoidance and distraction as avoidance orientated strategies (6 studies). Women with different ethnicities and educational levels used different coping strategies with breast cancer, and they used different strategies in different phases of the disease.

Conclusion

This systematic review revealed that seeking social support and emotion-focused efforts were the main coping strategies that women with breast cancer diagnosis used, especially in the early phase of breast cancer diagnosis. This information about the coping responses of patients may be useful in designing interventional programs to assist other women in dealing with the various challenges imposed upon them by their illness.

Psychosocial impact of breast cancer diagnosis among omani women

OBJECTIVES

The aim of this study was to explore different psychosocial impacts on Omani women diagnosed with breast cancer.

METHODS

Semi-structured individual interviews were conducted with 19 Omani women diagnosed with breast cancer to describe the impact of the disease on their personal and social life. Women were recruited from wards and out-patient clinics at the Sultan Qaboos University Hospital, Muscat.

RESULTS

Four main themes emerged. These were: a) factors related to psychological distress of the disease and uncertainty (worry of death, interference with work and family responsibilities, searching for hope/cure, travelling overseas); b) reactions of family members (shocked, saddened, unity, pressure to seek traditional treatments); c) views of society (sympathy, isolation, reluctant to disclose information); and d) worries and threats about the future (side effects of chemotherapy, spread of the disease, effect on offspring).

CONCLUSION

Breast cancer diagnosis has several devastating psychosocial impacts on women in Oman. Healthcare professionals working with women with breast cancer should be aware of the different psychosocial impacts of the disease on women's lives. Appropriate measures must be taken by the decision makers whenever needed, including enforcing positive views and support of Oman's society towards women with breast cancer.