The 3rd International Nursing and Health Sciences Students and Health Care Professionals Conference (INHSP)
More infoCancer is still a health problem serious. Based on the Ministry of Health's report, cancer is the second leading cause of death in the world by 13% after cardiovascular disease. Approximately 30% of cancer patients had adjustment problems and 20% were diagnosed with depression.
MethodsA qualitative design with an ethnographic and phenomenological approach with a total of 10 participants.
ResultBased on the results of the interview, breast cancer sufferers experience stress and depression when they first find out the diagnosis from the doctor. However, they carry out strategic in order to get rid of excessive anxiety such as reading books, dzikir, meeting fellow survivors, and still trying to sincerely undergo all series of treatments.
ConclusionSupport from family, work environment, friends, relatives, fellow breast cancer survivors and treating doctors and fellow survivors greatly contributes to efforts to prevent stress and depression, fellow survivors have communities and groups to provide information and education as well as sharing related to breast cancer.
Cancer is the second leading cause of death globally with 9.6 million deaths in 2018. Lung, prostate, colorectal, stomach and liver cancer are the most common types of cancer in men, while breast, colorectal, cervical and thyroid cancers are the most common in women.1 The mortality rate from breast cancer in developing countries is much higher than in developed countries.2,3
The uncontrolled increase in cancer cases is due to many factors, such as lifestyle, diet, reproductive changes, smoking behavior, physical activity and the influence of urbanization and economic development.4–8 This cancer mortality rate ranks third after death from cardiovascular disease. The incidence of cancer can be estimated to reach 26 million people in 2030 and 17 million of them will die from cancer.9 In Indonesia, cancer is still a serious health problem, breast cancer was ranked second (1.7 million or 11.9%) after lung cancer (1.8 million or 13%). This figure shows that breast cancer ranks first in cancer cases experienced by women.10 The national incidence of cancer shows an increase from 1.4% 2013 to 1.8% in 2018.11
The psychological impact experienced by each person varies depending on the severity (stage), the type of treatment being undertaken and the characteristics of each patient. About 30.0% of cancer sufferers experience adjustment problems and 20% were diagnosed as having depression Eight psychological effects that are often felt by breast cancer patients, namely in the form of helplessness, anxiety, shame, decreased self-esteem, stress and anger.12 Psychological problems that arise due to breast cancer are anxiety, depression and stress.13 The results of the research by Sitepu and Wahyuni, (2018) explained that patients with cancer experience stress as much as 28.8%, patients feel stressful. ena haunted by the image of death, fear of the impact of treatment, stress will arise when a person knows for sure that he has breast cancer even though it is still in a very early stage. Stress can affect nerves and hormone secretion, resulting in decreased chemotherapy efficacy and decreased antibody production.14
The stress experienced is manifested directly through physiological and psychological changes. If stress symptoms are not handled properly in breast cancer sufferers, stress can continue and enter a depressive disorder. Depression is a common mental disorder characterized by feelings of sadness, depression, loss of interest, pleasure, decreased energy, feelings of guilt or feelings of inferiority, sleep disturbances and difficulty concentrating.1 Stress management program for breast cancer survivors is needed to deal with stress and train breast cancer sufferers’ skills in coping with stress so that it can improve the quality of life for breast cancer survivors.15
MethodsThis study used a phenomenological qualitative method. Phenomenological qualitative research aims to describe the general meaning of a number of individuals to various life experiences related to a concept or a phenomenon.16 Phenomenology focuses more on the concept of a certain phenomenon and the form of its study to see and understand the meaning of an individual experience related to certain phenomena or events.17 Phenomenology as a study to provide an overview of the meaning of the experiences of several individuals regarding a particular concept.
The location of this research is in South Sulawesi Indoensia. This research was conducted from February to Mei 2021, with a total of 10 informants. Data collection techniques used interview techniques to informants who are breast cancer survivors who live in South Sulawesi Province. Data analysis was performed using qualitative data analysis which was developed or better known as interactive analysis (interactive models of analysis). This interactive analysis consists of three main components, namely data reduction, data presentation, and drawing conclusions which are carried out in an interactive form with the data collection process as a cycle.
ResultThe results of the interviews conducted by the informants were related to how they felt when they first heard the doctor's diagnosis, the strategies they took to control stress, how the informants carried out their daily life activities, what made them remain optimistic and how fellow survivors were able to control stress during treatment.
Theme 1. The feeling when I first heard the doctor's diagnosis apos;I was shocked and didn’t believe it and felt like dyingapos; (Inf. 001, 40 Years). apos;Of course it is very depressed, why should I and refuse to accept the realityapos; (Inf. 002, 40 years). apos;It has been mentally prepared and ready to accept whatever the doctor's diagnosis isapos; (Inf. 003, 44 Years).
Theme 2. Strategies used to control stress apos;Meeting survivors, reading lots of books, hearing stories from fellow survivorsapos; (Inf. 005, 40 Years). apos;Strengthen yourself, surrender and keep thinking positively, and that death is certain (Inf. 007, 44 Years). apos;After mastectomy (breast removal), sad and really depressed, bought books about the remembrance of cancer healing apos; (Inf. 009, 41 Years).
Theme 3. How to survive daily activities and life apos;There are mothers who always give advice, fix dzikir, wake up midnight prayers, do dhuha prayers, I think that these are signs that all ages of God's health have been regulatedapos; (Inf. 001, 40 Year). apos;Stay as usual, assuming that nothing happenedapos; (Inf. 008, 44 Years).
Theme 4. What keeps you optimistic about recovering from this disease apos;That everything has to be lived, Meeting survivors, reading lots of books, hearing stories from fellow survivors apos; (Inf. 004, 44 Year). apos;Many provide support and from the experiences of previous survivorsapos; (Inf. 006, 41 Years). apos;Actually, just follow the medically suggested treatment, follow the doctor's advice, adjust the dietapos; (Inf. 007, 41 Years).
Theme 5. How do fellow survivors be able to control stress while the treatment is taking place apos;Very good fellow survivors, cancer members 230 support people from the survivors are very supportive and provide experiences - experiences of the survivorsapos; (Inf. 001, 40 years). apos;We have a group of fellow survivors and that's where we often share and encourage each otherapos; (Inf. 008, 44 Years). apos;It was necessary to meet fellow survivors, because I shared experiences with each other and I was included in the survivor groupapos; (Inf. 004, 44 Years).
Theme 6. How is family support in helping to deal with stress? apos;The first thing I know is my husband, my husband is very surprised, but my husband is very supprot and I am strong inapos; (Inf. 010, 40 Years). apos;Until the current treatment, my hair has fallen out, but my husband always gives motivationapos; (Inf. 002, 40 years).
Based on the results of interviews, breast cancer sufferers experience stress and depression when they first find out the diagnosis from a doctor. However, they carry out strategic in order to get rid of excessive anxiety such as reading books, dzikir, meeting fellow survivors, and still trying to sincerely undergo all series of treatments. Support from family and fellow survivors greatly contributes to efforts to prevent stress and depression, fellow survivors have communities and groups to provide information and education as well as sharing related to breast cancer.
Stress conditions often occur when undergoing treatment so that cancer patients experience pressure and the depression they feel causes the patient to perceive depression more severely.18 Sukma's research (2018) shows that breast cancer patients with depression levels found that age (36–45 years) experienced more depression.19 Sources of coping, optimism and various support are needed to deal with stress and depression experienced by breast cancer patients undergoing chemotherapy.20,21
Other studies have shown that patients who are first diagnosed with cancer may experience several psychological disorders including stress, depression, anger, and even poor self-acceptance. Coping strategies and support from the environment are several factors that can reduce the level of stress experienced by cancer patients.22 Research conducted by Hopman & Rijken (2015) shows that cancer patients have different perceptions of death, each individual knowing that cancer has very unpleasant and even frightening effects, ranging from physical deterioration to the fact that the disease can cause death.23
The psychological burden felt heavier by breast cancer sufferers after being convicted of breast cancer. Breast cancer sufferers maintain good social relations with the surrounding community by continuing to participate in community activities. An uncomfortable environment that does not provide a sense of security for breast cancer sufferers increases the sufferer's stress. The financial shortage for medical expenses adds to the burden for breast cancer sufferers. Social support is obtained by breast cancer sufferers from their closest people such as younger siblings, children and husbands. The support of the closest people makes the sufferer stronger in living and has better hopes for the future.24
ConclusionThe feelings experienced by breast cancer survivors when they were first diagnosed were feelings of sadness, anxiety, fear, disappointment, hopelessness, loss of self-confidence, shame, stress and depression which caused the patient to want to commit suicide. Support and motivation from family, work environment, friends, relatives, fellow breast cancer survivors and treating doctors are needed to deal with stress and depression.
Conflict of interestThe authors declare no conflict of interest.
Peer-review under responsibility of the scientific committee of the 3rd International Nursing, Health Science Students & Health Care Professionals Conference. Full-text and the content of it is under responsibility of authors of the article.
