Coping, meaning and symptom experience: A narrative approach to the overwhelming impacts of breast cancer in the first year following diagnosis

Purpose: Women's experience of breast cancer treatment is a complex feature of survival which reflects and impacts upon the quality of their inter-personal relationships. We aimed to explore and present the issues and means through which these women relate their symptoms, treatments and effects. We utilised the 'cancer journey' as a heuristic device to chart women's experiences in the first year following diagnosis. Method: Thirty-nine interviews were conducted over one year with a convenience sample of 10 women newly diagnosed with breast cancer recruited from a specialist oncology centre in England in 2005. Transcriptions of the interviews were analysed using a thematic narrative approach. Results: The findings suggested how women related coping and meaning to their experience of relationships, return to work, and self-management of breast cancer symptoms. The overwhelming impact of breast cancer was personal to each sufferer and yet reflects commonly reported treatment effects. These included unmet need for fatigue management, the impact of adaptation to hair loss and disfigurement, and the evident need for sexual health and relationship counselling. Conclusion: The multi-dimensional aspects of womens' relationships with family, friends, co-workers and care professionals impacts significantly on their coping strategies and how they make sense of their breast cancer experiences, which consequently bears upon symptom experience, and experience of survival. We suggest that narrative representation bears witness to the common and differing experiences of how women newly diagnosed with breast cancer cope with symptom experience and survival over time. Narrative representation of breast cancer is a useful pedagogical resource for supportive cancer care and highlights the needs of women that need to be addressed by health care professionals. (C) 2011 Elsevier Ltd. All rights reserved.