“Lights and Shadows”: An Interpretative Phenomenological Analysis of the Lived Experience of Being Diagnosed With Breast Cancer During Pregnancy

Abstract

Cancer diagnosed during pregnancy is a rare event. The most common type of malignancy diagnosed in pregnant women is breast cancer, whose incidence is expected to raise in the next future due to delayed childbirth, as well as to the increased occurrence of the disease at young age. Pregnant women diagnosed with breast cancer are exposed to multiple sources of stress, which may lead to poorer obstetric outcomes, such as preterm birth and low birth weight. In addition, pregnancy involves physiological changes in the breasts that may blur the signs of cancer, with delayed diagnosis and poor prognosis. However, the lived experience of these women was investigated in very few studies. Given this scenario, we conducted this qualitative study to describe and understand women’s subjective experience of being diagnosed with breast cancer during pregnancy. The study was conducted following the principles of Interpretative Phenomenological Analysis. Participants were five women with breast cancer diagnosed during pregnancy, purposefully recruited at a public hospital during medical visits and interviewed at treatment initiation. The interview transcripts were analyzed using thematic analysis. The textual analysis led to the identification of three main themes related to: (1) the emotional storm experienced after cancer diagnosis, and the importance of receiving appropriate information and being focused on treatment decisions; (2) physical changes and comparisons with healthy women, associated with feelings of sadness and inadequacy; (3) being positive, feeling free to disclose all kinds of emotions, religion and spirituality as sources of strength. The paradoxical coexistence of pregnancy and cancer represents a stressful experience for women and their loved ones. Adopting a systemic perspective may be important to understand the effects of such a complex condition, also considering its impact on healthcare workers.

What do we know about the psychosocial issues associated with cancer during pregnancy? A scoping review and gap analysis

“…26 One study focused on clinicians’ (n=12) experiences of caring for eight women and their families 27. Nine studies were qualitative, all using semistructured interviews,26 28–34 two were quantitative cross-sectional surveys11 35 and one was a mixed-methods cross-sectional survey that included both closed and open-ended items 36. Three qualitative studies specifically reported being informed by a broad theoretical approach such as interpretative feminism,29 interpretative phenomenological analysis33 and symbolic interactionism 26…”

“…Nearly all (11/12) studies were conducted in more economically developed countries. Three studies were conducted in Australia,28 30 34 two were conducted in the USA,35 36 Italy31 33 and Japan 27 32. The remaining studies were undertaken in the UK,29 Belgium and the Netherlands,11 and Brazil 26.…”

“…Studies were published over a 25-year period, with six in the past 2 years (table 1). Studies focused on the subjective experiences and perceptions of women,26 28–34 their main concerns during treatment and coping strategies,11 36 the perceived consequences of their cancer diagnosis, care and decision-making on their own psychosocial well-being and that of their family,26 or the demographic and clinical correlates related to higher distress 35. Only one study focused on clinicians’ experiences of shared decision-making in the context of cancer and pregnancy 27.…”

“…Eight studies11 28–30 33–36 included some reporting of trimester or gestational stage at cancer diagnosis, only two studies reported stage of cancer when diagnosed11 35 (table 3) and seven reported relationship status (tables 1 and 2). 11 26 30 31 33 34 36 Only two studies reported mode of delivery (62.0% vaginal, 36.6% caesarean section and 1.4% forceps) 22 35.…”

Women with breast cancer: social issue and chemotherapy treatment in an oncological unit in the agreste Pernambuco, Brazil

“…When a woman is diagnosed with cancer, she faces several conflicts, which are often not clarified by the multidisciplinary team, such as the fear of not being able to get pregnant, the adverse reactions of chemotherapy that will prevent her from carrying out her work activities and that will impact in their monthly family budget, in addition to the emotional damage, due to the loss of hair and breasts, which directly impact on female high spirits (Medeiros et al, 2019;Taberna et al, 2020;Facchin et al, 2021;Vanstone et al, 2021). In addition to these internal conflicts, there are those related to the health service, with continuous trips to the oncological treatment environment, changes in the daily routine and difficulty in accessing the necessary tests and treatment, often having to take the tests and buy medicines privately , compromising even more the monthly budget of the family (Luiza et al, 2016;Cabral et al, 2019;Alves et al, 2022;Ivama-Brummell et al, 2022).…”