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Working, overcome's the breast cancer

Yenly Catherine Londoño Calle1
1Nurse, Cardioinfantil Foundation, Institute of Cardiology in Bogota, Colombia

Mail delivery: C/ 163a N. 14D-21 Interior 2 Apto.303, Barrio Toberin, Bogota, Colombia

Manuscript received by 14.11.2008
Manuscript accepted by 4.3.2009

Index de Enfermería [Index Enferm] 2009; 18(3): 161-165








How to cite this document



Londoño Calle, Yenly Catherine. Working, overcome's the breast cancer. Index de Enfermería [Index Enferm] (digital edition) 2009; 18(3). In </index-enfermeria/v18n3/6920e.php> Consulted by





This is a qualitative study supported in the Founded Theory, which use interviews in depth to twenty women resident in the city of Medellin (Colombia) who receive treatment for breast cancer during 2005 to 2007. The purpose was discover the process of adaptation to new conditions of life and health, within a sociocultural context. The secondary objective was to understand how they fight with breast cancer. In this article will develop this last objective, that lets see how the women initiate a work of integral fortification from the moment in which they discover the disease. This strategy arose like an important category that it gives whatever of the creativity, persistence and dedication the women adopted to face and to leave victorious their fight against breast cancer.
Key-words: Breast Neoplasms/ Neoplasms/ Work/ Strengthrening/ Social Support.









     Breast cancer in women is a public health problem of global magnitude for two reasons. First of all, the number of cases presented daily is high, and secondly, because of the negative effects on physical, health, emotional, mental and social status of women who suffer it. This last aspect will be explored in the body of this article.
     The statistical report for 2002 trends of the International Association of Cancer Registries - IACR,
1 which is part of the World Health Organization, states that there are 1,151,298 annual incidence of patients and a prevalence in five years of 4,406,080 patients worldwide. For Colombia, the report points out that in the same period, there were 5,526 annual incidence of patients and a five years prevalence of 18,223 patients.
     In the Antioquia region where this investigation took place, according to a report by the Regional Health Directorate of Antioquia,
2 for the years 2002 to 2003, gynecologic cancer- breast and cervix accounted for 31% of all cancer cases and accounted for 43% of the top ten types of cancers. Thus, it can be concluded that because of its high morbidity, breast cancer is a major health problem to be investigated in order to explore alternatives for prevention, intervention and rehabilitation.
     The research on women with breast cancer are numerous and diverse. The consulted research show the wide range of knowledge concerning women with breast cancer and indicates the biological, clinical, social, intervention, and coping aspects among women with breast cancer. However, none of the research describes what the coping strategies are in the diagnostic phase, treatment and rehabilitation. Hence, the author conducted an investigation to understand how women facing breast cancer adapt to their new living conditions and health. The secondary objective of the research was to understand how the women overcame their fight with breast cancer. Both objectives seek to provide knowledge in this study area in order to improve nursing care to these women. This article will show how women initiate a work of integral strengthening from the moment they are diagnosed with the disease.


     In a period of one year and a half, twenty in depth interviews were conducted with twenty women living in Medellin who had completed their chemotherapy, brachytherapy and radiotherapy over a period of three months to nineteen years ago. The women signed written informed consent forms and voluntarily agreed to be interviewed. The participants were contacted by the oncology services of different hospitals in the city. Their ages ranged between 35 and 69 years and most participants lived with a permanent partner. Their educational background ranged from some elementary education to graduate degrees. The participant's socio-economic status varied. A qualitative approach using grounded theory was utilized for the interpretation and data analysis. This technique included the identification, definition and development of categories in terms of their properties and dimensions. Thereafter, these were linked using hypotheses or statements that established relationships.3 Then, the main categories were linked with subcategories, in order to describe the strategies used by women when facing breast cancer.


     The factors that influenced the ability of the patients to combat the illness are: the sociocultural and psychological. The cultural aspect is represented by social support and the patient's perception of cancer. These factors facilitate or obstruct the patient's fight against breast cancer.
     Since the time of diagnosis, the patient benefited from a social support network that included the formal support provided by health professionals and informal support provided by relatives, neighbors and friends. These supports were emotional, instrumental or material, value and spiritual.
4 The emotional support is represented by the establishment of empathy, expressions of love and transference of confidence.4 Emotional support was the most outstanding because it helped them to get out of the emotional crisis the process presented. The instrumental or material support provided goods and tangibles such as food, furniture, transportation, physical care, home care, money and shelter.4 Instrumental or material support was displayed by the family when they rigorously took care of the dejected women during the aggressive treatments, especially during times they could not exercise self-care. Family members also brought them food and took responsibility for household management. The Informational support was given by medical staff and focused on information about the disease, effects of treatment, skin care and warning signs during treatment. Value support was made visible through words of encouragement. This was provided by health professionals, families and friends.
     The Spiritual support manifested in the belief in spiritual beings was another important support during the diagnosis, treatment and rehabilitation. With the spiritual strategy, the women figuratively gave the disease to spiritual beings. After releasing their disease to spiritual beings, they were released from an emotional burden. They acquired strength and tranquility because they felt that they would be healed by these beings.
     However, not all experiences of the support network were healthy for the process of adaptation. Some women reported stressful situations generated by the inadequate attention of health personnel.
     The social perceptions of cancer had become another condition that affects the adaptation. Adaptation is affected when women perceive the cancer as "synonymous with death", "disease that invades", "eat inside" and can "repeat itself". These perceptions inhibited the adaptation due to the frequency of emotional and mental imbalances during the process. In the same vein, author Susan Sontag expresses: "Cancer is the disease that enters without calling, the disease lived as ruthless and secret invasion, a role that will continue until the day its etiology is clarified".
5 As a result of these perceptions, since their diagnosis, they felt accompanied by the ghosts of the uncertainty of being healthy or sick and presentiality of the cancer in their bodies when they feel a strange symptom or sign.
     In regards to the psychological factors that affected adaptation, two personal conditions were found to be essential for the women to achieve a successful process of adaptation. These two conditions were: attachment to life and positive mentality.
     The attachment to life was the motor that helped them start their struggle to face the disease. It is generated by their enormous wish to live and because they have a family to live for. In fact, the author Pryds and her colleagues
6 point out that when women decide to continue living, they do not give up against the disease. Likewise, author Vanistendael and others wrote that the motivation provided by family produces in people the capacity to give meaning to life in all kind of experiences and gives them a reason to continue living and fighting.7
Some of the women interviewed already had a positive mentality. Those that did not have a positive mentality developed it during the process. The women perceive positive mentality as a force that encouraged them to fight and not give in to the disease.

The work of patients on strengthening themselves. To understand the work of strengthening, it is important to consider that the physical, emotional, mental and social disequilibrium that women experienced after the diagnosis have actually empowered them. This was experienced as a force that motivated and mobilized the women8 to seek strategies to achieve a "state of adaptability".9 These strategies are expressed in the integral strengthening work that women have undertaken to rebalance the affected dimensions of their lives. Experiencing new needs as a power is illustrated in the approaching of Max Neef8 about the human needs. According to the author, to the extent that the needs commit, motivate and mobilize people, they are also empowering.
     In order to understand how the strengthening works, the sociologist Phil Bartle
10 points out that it is necessary to first make an effort to fortify, so that a person or community that faces adversity becomes stronger. Also, the person who needs to be fortified and become more competent is the person who does the active work. In this study, women made numerous physical, social, emotional and mental efforts to be fortified. The strengthening was the final product of their work. This is defined by Sanchez,11 who argues that the fortitude is not a matter of muscles, but is the virtue that leads to not worrying; facing difficult situations without over thinking; doing what you have to do and holding out what you have to hold out; pressing on the accelerator or the brake; and finding in each moment the best to bring out the good results that you aimed for. This definition of fortitude is applied to the women in the study, in the sense that they fortified themselves: they brought up strength, struggled and adapted the best way to all the adversities they experienced since the time they were diagnosed.
     As explained above, the women undertook the fortifying work after they learned of the diagnosis and the treatment to be carried out to eradicate the cancer from the body. With this news, they emotionally collapsed, but it is also from this moment that they started to focus on strengthening the emotional dimension which is the most affected at this time.
     The emotional collapse is characterized by feelings of sadness, crying, anxiety, depression, fear and numbness to the point that they felt close to death. The most shocking news for them was the news about losing their breasts and hair as consequences of the treatment. They described it as very hard and horrible news, they felt very bad and immensely concerned about how they will look without their hair and breasts.
     The cancer's social perceptions have influenced the magnitude of the emotional collapse. Some women shared that as a cause of these perceptions, they were in denial, because they felt their lives were threatened. How did these women face the emotional collapse? The data shows that in order to get out of this state, they started focusing on strengthening their emotional dimension.

Work of emotional fortitude. Strengthening emotionally is a dynamic process that arises to face the emotional imbalances. These emotional imbalances became a power for the adaptation. Thus, women were empowered to make significant balances in their life, make decisions and undertake strategies such as seeking spiritual support. Also, the company of social support helped them to achieve the necessary emotional fortitude  to accept the disease and treatments.
     During the work of emotional fortitude, the women had to choose between living with the cancer without treatment or undergoing treatment and enduring losses such as hair loss and breast mutilation. All of the women chose to continue living because they preferred to have losses and continue living. A woman explained that "this fight is for my life, it is better that my breast is removed so I can continue living. I had to accept anything in order to live" (MR10). The women weighed the two options and decided that it was more important to continue living and endure the loss of their breast.
     The research data showed that the two important factors that made the women attached to life were: having a family to live for and an innate desire to continue living. These reasons became a key stimulus for women to choose to live, so they undertook work of strengthening themselves to overcome the disease.
     Other phenomena that simultaneously occurred that contributed to this work of emotional fortitude is the search for spiritual healing.
     At the time of the diagnosis of the disease and treatment, the support provided by medical staff was emotional and value. The medical staff provided security, support, confidence and encouragement to strengthen the women and made them believe that everything was going to be well. Informal support was given by family and friends. Their informal support helped to strengthen the women by inculcating courage, tranquility and hope. Both supports had a positive outcome; the women were influenced by these voices of encouragement, so they were at peace. Also, they understood they had more options and their world is not going to end because of the disease.
     The search of support in spiritual being is made by surrendering to their spiritual being such as God, a saint or the Virgin, one of the women interviewed states "at the moment I knew I had the disease I surrendered the disease to my God" (LM02). With this search for spiritual support, the women experienced strength, resignation, tranquility and encouragement to keep going and they felt free from the burden of the disease.
     In conclusion, the social and spiritual support helped the women to be emotionally strong and to accept the disease. However, they must submit to treatment and this is where they undertake an integral strengthening work to overcome the disease. Integral strengthening work encompasses emotional, mental, physical and social fortification.
     The treatments that the women underwent are quite aggressive and mutilating, causing physical, emotional, social and mental disequilibrium. During treatment, the ghosts of uncertainty and presentiality were common in the testimonies of women when referring to concerns of cancer recurrence in their bodies.
     To better understand how the disequilibrium occurred at this stage, it is important to recognize the human being not as a sum of it parts, but rather as a holistic being, where any change in one dimension greatly or to a lesser extent affect the other dimensions. The physical balance is ruptured by the corporal losses and changes in the functionality of some parts of the body, such as malaise, gastrointestinal discomfort, skin changes, hormonal disorders (menopause) and reduction of body's defenses. All these bodily imbalances generated suffering, affected the health and well being, and thus, affected the mental and emotional dimensions. The mental dimension is affected because there are changes in the way of thinking about life and plans and how to behave with others. The emotional dimension is reflected in crying, depression, discouragement, despair and anguish. This affected their self-esteem, one of the women interviewed commented "I cried for many things, not just for the vanity, but also because my self-esteem is down, the process of the medication put my courage down" (LM02).
     The above changes generated a social imbalance; the women were not able to exercise their roles as housewife, worker, and caregiver for their body. They felt useless and anxious. These imbalances empowered the women and helped them to the adaptation during the process of the treatment; it encouraged them to constantly rebalance. In order to adapt, they started the fight to be well characterized by an integral strengthening work to overcome the disease.

Integral strengthening work. The two key conditions to assume the work of strengthening are attachment to life and a positive mentality. Moreover, the strategy to carry out this work includes: rigorous body care, maintenance of self-image and avoidance of situations that affected them. At this stage, social support and spirituality also play an important role, consequently these strengthened them emotionally.
     Assuming a positive mentality: the women related that in spite of the suffering, discouragement, uncertainty and feelings of giving up, they understood that the most important strategy to succeed and overcome the disease is having a positive attitude towards life and the disease. Women who naturally had a positive mentality maintained it through the process of the disease. Women who did not naturally have a positive attitude developed it during the process.
     Once this attitude was assumed, it became a mental strategy that helps them in difficult moments to be encouraged where they need it, that means they gained strengthen. For example, a woman said "I did not let myself be grieved, I say to myself go on, go on" (LA07). It also helped them to open their minds, have faith in others and hope that everything will be fine. One on the women interviewed expressed "I believed in the doctors, I thought I am in good hands, I will recover" (MR10). A positive mentality was cultivated in the mind by proclaiming "I'm healthy, I'm healthy, I am perfect, full of life" (AZ16).

Rigorous body care. The women undertook a work of corporal strengthening, wherein they strived to carry out a rigorous body care through various strategies, such as opening their minds to alternative therapies, and restore the appearance and functionality of their bodies. Rigorous care was not an easy task and consisted of a series of caring practices to nurture and restore the functionality of different systems and body parts, as well as to preserve their appearance and to resemble their former self before the disease.
     To undertake this care, the first thing they did was open their mind to all the things that their medical care, family and friends recommended to them to achieve normality. Secondly, they sought alternative therapies such as people and specialists in skin care and teeth. Another important strategy while doing the rigorous body care was the effort they put into it. This means they were dedicated and disciplined to achieve their goals. For instance, a woman emphasized "I was limited, but I can not continue being like this... I could not be with a motionless arm and the present pain, so I exercise and I'm fine, because I put effort and willpower" (Fl14).
     The women were not alone in this process, the family commitment and involvement in this care was astounding. They provided companionship and attention during the process.

Maintaining self-image. To adapt to their new body image, the women worked in a creative way. They used the strategy of maintaining self-image. They acted differently depending on the environment that they were in. In a public environment, they try to go unnoticed, using scarves, hats, and wigs to disguise hair loss. Furthermore, they use prosthesis such as patchworks, birdseeds or silicones to hide the loss of their breast, thus they continue keeping their body image. One of the women interviewed stated that "I felt empty and I said people do not have to notice it, so in my house, my family invented prosthesis... so I put a filler to disguise the absence of the breast" (MR10). With this strategy, they strengthened their emotional dimension when they presented themselves as "normal" to society and were not pitied. In the family context, everything changed, it was not important to conceal the losses and to be ashamed. At home, they had the confidence of show themselves as they are.

Avoiding situations that affected them. In order to be protected from having new disequilibrium, women worked to avoid situations that affected them psychologically and emotionally; so they remain strengthened. The data showed that women repeatedly avoid two situations: looking at their bodies and having situations that they believe affect them. These women were afraid to look at their maimed body and their bald head. A woman stated "I can not imagine myself bald, I never looked at my head" (CR13). They do not want to experience situations that reminded them of the reality that they are living and potentially can cause emotional imbalances, such as funerals and wakes. However, they preferred to attend parties or take trips.
     Furthermore, they avoided talking about their illness in order to not have a complex and inspire pity because of their cancer. A woman says "I do not want anyone to know... I feel like everyone feels sorry for me, I always feel a complex" (A12). In concordance with this finding, Susan Sontag expresses: "Given the numerous metaphorical flourishes that have made cancer synonymous of bad, many people have experienced it as shameful, therefore something to hide".
To avoid thinking about their situation, they spent their time doing diverse activities. For example, a women commented "to take away those thoughts of this chemo, I did house chores, I painted on fabric, I was enjoying doing something" (DE08).
     Having an emotional equilibrium was not an easy and it meant the women actively worked towards behavior changes and modification of situations to maintain control of their disease. They avoided worries and sufferings and made themselves believe that all was going well. It is also noteworthy that this work of integral strengthening included formal and informal support and seeking support in spiritual beings.


     Coping with the breast cancer was a complex process for the women because they continually had to face many imbalances that affected their emotional, physical, mental and social dimension. Additionally, they coped with the sufferings that accompany the diagnosis of disease they considered fatal. They also faced bodily looses and changes in the roles they played in their daily life. Moreover, they lived with the ghost of uncertainty about their future health and cancer presentiality in their lives.
     When facing these imbalances, women were not passive; on the contrary they were seeking balance through a work of integral strengthening in the emotional, physical, social and mental health dimensions. This strategy reflected the effort, creativity, commitment and dedication that women undertook to get ahead of their situation.
     One of the important strategies of the strengthening work was having or developing a positive mentality. This mentality helped them to cope when they passed through difficult moments in the course of treatment. Moreover, this mentality helped them in those moments when they felt faint and too weak to continue. Finally, they were convinced that with this mentality, they would overcome the tumor.
     A key factor in overcoming the disease was the formal and informal social support, which helped the women to have emotional, physical and mental strength. Similarly, their spirituality gained importance because it gave them vigor and courage to move forward and to get free from the disease.


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