A qualitative study of the emotional responses in women with primary breast cancer
One in nine women in the UK will develop breast cancer in her lifetime. When a diagnosis of breast
cancer is made, the focus of health care professionals becomes the centrality of the 'body and
disease' leading to an immediate rapid-response in terms of treatment. Indeed the current directive
from the Department of Health sets a target standard within the National Health Service of 31 days
between the time a woman receives her diagnosis to the commencement of her treatment. Breast
cancer treatment is often radical, involving extensive surgery (mastectomy) and may include radio,
hormonal and chemo therapies. Altematively, treatment can involve less radical surgery,
conserving breast tissue whilst including radiotherapy, and may also include hormonal and/or
chemotherapy. Much is known about the incidence of breast cancer and the most effective ways of
managing the disease process and about the effects of treatment, particularly in terms of the
burdens and suffering that arise as a consequence of treatments. However, what is not as readily
available is detailed information on what a woman actually feels, deeply and personally, in
response to the imposed changes that a life threatening disease brings. In other words, how she
encounters her diagnosis, her treatment and subsequently comes to terms with her life at the end
of treatment and the imposed changes to her future.
For this study of women with early, primary breast cancer, the main foci were the participants'
responses to their diagnosis, the effectiveness of information in preparing them for extemal
radiotherapy and the impact of a temporary, surgically implanted source of radiotherapy
(brachytherapy), as part of their breast conservation treatment. Nineteen women partiCipated in
this prospective qualitative study, which used a grounded theory approach. Grounded theory was
chosen for this study, with its emphaSis on exploring and describing, not only the physical
experiences of breast cancer and its treatment, but also the prominent issues which emerged, such
as the life changing experiences and the subsequent effect on the psycho-emotional dimensions of
each participant. Attention is given in the analysis of the data to those experiences described and
emphasised by the participants as having the most important bearing on their life.
For the majority of the participants, the impact of a breast cancer diagnosis created an immediate
and penetrating fear of premature death, with its associated suffering. To this was added an
unswerving sensitivity to the knowledge that while treatment may avert immediate death, there
would always be an unrelenting dread, antiCipation even, that cancer would one day recur.
The entire study is based on the contents of four in-depth semi-structured interviews, in an inquiry
that was conducted over four distinct phases. The first interview was conducted following the
diagnosis of breast cancer, the second at the commencement of extemal radiotherapy, the third
following the radiotherapy implant and the fourth in the post treatment and rehabilitation period.
The study illustrates how each participant successfully navigated her way through her treatments,
but the overall effect of a cancer diagnosis was to profoundly challenge each partiCipants' belief
about their life and its meaning, a life that they came to view as for ever changed, life that was
ravaged and threatened, life that would never to be the same again.
The study illustrates the importance of personal resources at the time of severe threat to life.
Assessing the individual's psychological and emotional needs is a crucial part of care for the
woman with breast cancer. The risk of under assessed psychological distress cannot be over
emphasised since distress can affect the long-term outcome of not only psychological adjustment
but might also influence survival.