RESEARCH ARTICLES
Meanings attributed to cancer by a group of women
Adriana Gonçalves BarrosI; Mônica Cecília Pimentel de MeloII; Viviane Euzébia Pereira SantosIII
IMaster of the Postgraduate Program in Nursing at the Federal University of Rio Grande do Norte. Member of the Laboratory Research Group of Caution Investigation, Security, Health Technologies and Nursing of the Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Brazil. Email: adrianna_agb@hotmail.com.
IIMaster in nursing. Teacher of Nursing Course of the Federal University of Vale do São Francisco. Leader of the Nucleus of Studies about Gender and Attention to Women's Health. Petrolina, Pernambuco, Brazil. Email: monquinamelo@gmail.com
IIINurse. Doctorate in Nursing. Professor of the Nursing Department of the Federal University of Rio Grande do Norte. Leader of the Laboratory Research Group of Caution Investigation, Security, Health Technologies and Nursing. Natal, Rio Grande do Norte, Brazil. Email: vivianeepsantos@gmail.br
ABSTRACT: This qualitative, descriptive study aimed to examine meanings attributed to cancer by women attending the Dr. Muccini Oncology Center, in Petrolina, Pernambuco, Brazil. Data were collected in August 2011 from semi-structured interviews of 10 women. Data analysis based on Bardin content analysis revealed the categories: changes in body image; faith as spiritual comfort; and fear of the unknown. Through this study it was perceived that each person reacts differently to their setbacks. It is believed that attentive listening and looking become important tools for nurses to understand patients with cancer in their uniqueness.
Keywords: Oncology; neoplasms; women’s health; nursing care.
INTRODUCTION
The meanings aggregates to cancer usually represent a series of symbolic mergers that can generate unwanted effects, depending on how patients perceive their own condition and how other people act towards them1.
The trajectory travelled after the cancer diagnosis involves an initial phase of emotional conflict caused by the discovery of the disease. The following stages are accompanied by perceptions about changes and alterations related to various aspects of life, resulting from the disease and the treatments and finally, a phase of adaptation to living in the world as a carrier of cancer, which implies the adoption of a new lifestyle2.
However, the diagnosis of cancer has, generally, a devastating effect on the life of the woman who receives, whether for fear to the mutilations and defacements that the treatments can cause, either by fear of death or for the many losses, in the emotional, social and material spheres, which almost always occur.
Therefore, the experience with the disease causes many reactions and stressful feelings, because the patient and their family, will have to adapt to the different stages that the illness imposes. The treatment involves in carrying out diagnostic tests, which contributes to exacerbation of feelings of anxiety and distress of the patient. Often, it is also observed the fear that in relation to prognosis, possible changes in the body arising from the pathological process and how they will be seen by other people3.
Furthermore, cancer causes fear of imminent death, the physical and social limitations, pain and loss of self-esteem. The first feeling that arises is the guilt, associated with patterns of life. In this opportunity, the relationship between professionals and patients have fundamental consequences, both in adhesion and in the therapeutic results, because it is necessary to trust in the treatment and professional4.
Despite the technological advancement and the consequent disclosure in the media of cancer therapeutic successes, the confirmation of this and the therapeutic planning for patient require sensitivity of the health professional, the use of plain language, so that the patient and the family meet the illness, the treatment and can rely on a professional team4.
Based on this context, this research had as object of study the meanings of cancer according to the women who live with the disease. Thus, the objective of this research was to analyze the meanings attributed to cancer for women accompanied in the Oncology Center Dr. Muccini in Petrolina-PE, Brazil.
LITERATURE REVIEW
The historical evolution of knowledge about cancer crossed by various theories raised in the past. However, in the 19th century and first decades of the 20th century, the cancer was considered contagious and associated with the lack of cleanliness, physical and moral filth5. At the same time, it was thought that the illness could be contagious among lovers of the excesses of pleasure, especially in the case of women, in which the illness was a result of sins and vices, particularly in sexual practices5.
Over the years 30 and 40 of the last century, the argument of moral nature was still in evidence, however, by merging with new hypotheses derived from observation of modern life in major Brazilian cities that began to industrialize. Other predisposing factors to cancer are considered, such as food intake with chemicals products, the habit of smoking, overworking and the increase of daily concerns5.
From the decade of 50 of the same century, some areas of medicine, combining psychoanalytic knowledge, began to admit the possibility of influence of psychological factors in the development of cancer. However, the moral arguments do not disappear completely, just update through an emphasis on sexuality and its relation with the inner world5.
In this new conception, the candidate most likely to develop the cancer would present a personality marked by passivity, lack of emotionality, regularity of daily habits, low aggression or denial of hostility, depression and difficulty in forming emotional bonds7. Currently, more than for personality characteristics, attention turns to the family history as an important risk factor for the development of the disease5.
In this opportunity, despite advances in relation to the emergence and cancer diagnosis, this pathology always brought great suffering to humans and, even today, in the social imaginary, the disease remains associated with representations of helplessness, pain, loss and death8.
METHODOLOGY
For the realization of the present study, qualitative approach was adopted, of the descriptive type. The study took place in the Centre of Oncology Dr. Muccini in Petrolina-PE. The social actors selected were women who were at any stage of the treatment in Oncology Center Dr. Muccini, for cancers of the breast, uterus or ovary, aged between 20 and 60 years, who have agreed to participate in the study, upon signing of the Informed Consent Form.
There were excluded subjects who did not accept to participate in the survey, women who have completed treatment or who were discharged, in addition to disabilities such as deafness, muteness and psychiatric problems that interfere with the communication interviewed-interviewer.
As a tool for data collection, was used the semi-structured interview. The interviews took place in the second half of 2011, after a previous contact with the subjects of the study. The records were performed on recorder, upon consent of the deponent, and then transcribed. The survey was comprised of 10 women between 20 and 60 years.
The processing of the data gathered through the analysis of content of Bardin, which consists in seeking to know what is behind the words on which leans9. Thereby, the lines were divided into three categories according to the approach of the theme, presented the most significant lines of study, namely: changes in body image; faith as spiritual comfort; fear of the unknown.
The survey was conducted for analysis and opinion of the Research Ethics Committee of the Federal University of Vale do São Francisco (UNIVASF), being approved under the opinion n° 0044.0.441.000-11.
To guarantee anonymity, the interviewees were identified by names of personalities of nursing: Anna Nery, Martha Rogers, Myra E. Levine, Wanda McDowel, Edith Fraenkel, Florence Nightingale, Hildegard Elizabeth Peplau, Sister Callista Roy, Elizabeth Orem and Wanda Horta. The choice for these pseudonyms was in order to make an allusion to the careful, which is focus of this work.
RESULTS AND DISCUSSION
The meanings attributed to the discovery of the cancer, were mostly tied to ideas of changes in body image, spirituality and fear. Thus, three categories were defined that express in detail those meanings: changes in body image; faith as spiritual comfort; fear of the unknown.
Changes in body image
When questioned about the meanings attributed to the discovery of the cancer, some respondents reported the bodily changes as tasks of the cancer, emphasizing the alopecia as main factor in this process.
At the beginning I was kind of sad, because as a woman, we think soon in hair, in appearance. I'm not going to lie, it felt really ugly at the beginning, I didn't want to leave home, [...]. (Anna Nery)
The body is the site of the experiment and practice of life, so the way people experience an illness is, first, a synthesis between body and culture, to then, be a reflection about their own disease.
In this opportunity, is from the substrate formed by the anatomical body that builds the body image. Therefore, when relevant biological changes occur, this change will cause changes in body image10. So, body image is a subjective experience that refers to perceptions, thoughts and feelings about the body and its experiences, is multifaceted, because their changes may occur in many dimensions11.
For women affected by breast cancer, besides the concern with body image, appeared also in the lines of the interviewed the shame and fear of non-acceptance of the spouses, as expressed in the following:
I thought in my husband, I was embarrassed, because I had to take the breast, so I thought I was awful, I thought he wouldn't want me.[...]. (Myra E. Levine)
Among the treatments for breast cancer, the surgical procedure is the more aggressive and that more affects self-image and self-esteem of women. However, despite the existence of chemotherapeutic treatments and radiotherapeutic, the mastectomy or breast removal, in their various types, is still the most chosen treatment12.
On the confirmatory diagnosis, the woman is replaced by two types of problems: the fear of the cancer, and the mutilation of a body representing motherhood, aesthetics and female sexuality13. In Western culture, the assignment of meanings to the breasts due to its importance as a physical and psychological attribute to the female body. In this opportunity, the stigma of breast cancer leads to patient coexist with prejudice and negative feelings nourished by herself14.
Therefore, the change of the aesthetic and body image are aspects to be considered in professional practice, especially when thinks about a concerned assistance, also, with the psychosocial dimension. In this context, the body image has an impact on the self-esteem and sexuality and, understand the onco psychiatry of mammary neoplasms is a way to understand the feminine universe15.
Faith as spiritual comfort
The women interviewed showed that had positive thoughts and were confident in healing, because they believe in God and seeking on Him the balance to control their emotions.
I stayed patient, because I have faith in God that I will be good, I always had faith that I was going to be good. Today I feel good and enjoyable to be telling the story. (Wanda McDowel)
The human being has a propensity to seek meaning for life through concepts that transcend the tangible, that may or may not include a formal religious participation.
In this opportunity, the religion emerges as a strategy to meet the fundamental needs of human beings, enabling the creation of an identity of cohesion between people in search of meaning and meaning for life. Therefore, religion helps in confronting the threats and enables gain new energies to fight for survival, on the situation of fatal disease.
That way, patients generally have a foothold through religion, through which seek to mitigate losses, the fear of death and suffering16.
So, patients and their families, in the face of hopelessness and suffering caused by the discovery of the disease, seek in spirituality, a positive or negative sense to experiences17. Therefore, faith and belief are fundamental factors to face the difficulties and the hope of cure and a better life18.
Considering that the spiritual dimension occupies a prominent place in people's lives, it is essential to know the spirituality of users when planning nursing care19.
Fear of the unknown
The cancer is still related to the belief that its carrier is doomed to die. This is often by ignorance of the disease and their current therapeutic possibilities. This fear in relation to cancer was expressed in the following speech:
I was speechless, because we always think will never happen to us. I was afraid to die, I had anger, but then I got over it. At first I didn't know about this disease, I was afraid to stay, thus, finished, wan, but then I saw that it was not like this, if the person follow all right; because this is something that's healing, it's not like the old days. (Wanda Horta)
The diagnosis of cancer, usually carries a devastating effect in the life of the person who receives it. This fact can be related to fear of mutilations and defacements that the treatments can cause, as well as by fear of death or by the heavy losses, both in the emotional, social and material spheres. Thereby, the diagnosis of cancer directly affects the integrity of the ego of the patient, which is extremely fragile and vulnerable. This situation is generating a lot of anguish by the fear of pain, separation and death20.
In this scenario, while having a cancer diagnosis, the individual is subject to a series of imbalances that transcend the physical aspect21. It should be noted that, in addition to provoking changes in the life of the cancer patient, the diagnosis of this disease also affects the whole family environment, which is why the process of help to the patient and their family is of fundamental importance22.
So, was allowed to share stories of life and feelings of each subject of the study and, mostly, realize that caregiving is an art to be learned23.
CONCLUSIONS
It was realized with this work, that each person reacts differently to their setbacks, unveiling how painful or pleasurable are the facts of life.
With regard to meanings attributed to cancer, are associated with changes in body image, to feelings of insecurity, low self-esteem and fear in relation to marital ties. However, the faith also proved to be present, being linked to the idea of spiritual comfort and inspiration to overcome disease and their misadventures.
In this perspective of meanings, the fear of the unknown was another metonym tied to cancer, seen some women still do not know in fact that illness and its possibilities of treatment.
On what was seized with the completion of this research, it is expected that the listen and look closely at the woman with female cancer become important instruments for nurses understand patients with cancer, in its uniqueness. To this end, it is essential to enter into their world and see the facts/context, through their eyes, and hear with involvement their experiences to deal with humanity.
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