Psychological concerns of Indian women with breast cancer in different national contexts: a systematic review and mixed-methods synthesis

Abstract

BackgroundBreast cancer is becoming the most common cancer among women of Indian origin. However, little is known about the psychological impact of the disease and its treatment among this population.AimTo improve understanding of psychological symptoms among Indian women with breast cancer.DesignThis is a systematic literature review and critical interpretive synthesis. Medical Subject Headings(MeSH) terms and keywords for breast cancer, psychological symptoms and treatment were used to search databases from inception to 7 May 2019. The reference lists of the included articles were examined. Search results were screened against the inclusion criteria, data were extracted, and quality was appraised by two independent researchers with recourse to a third. Narrative (quantitative) and thematic qualitative syntheses were applied, followed by critical interpretive synthesis.Data sourcesProQuest, MEDLINE, Ovid EMBASE, EBSCO, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO.Results18 of 763 studies from India or Canada were included (13 quantitative, 5 qualitative). Critical interpretive synthesis found psychological concerns similar to ‘Western’ women, but were framed by the common culture of Indian women in either country. Family structure, religion and community appear to protect against and cause distress in relation to the expected core role of being a wife and a mother and the male dominance in decision making. Stigma was amplified by poor knowledge about the nature of cancer. Migrant Indian women had additional problems due to language barriers.ConclusionsIndian women with breast cancer living in India and Canada experience psychological morbidities which profoundly affect their role in their family and the wider community. Culturally congruent care, including accessible communication and information, may help prevent and alleviate distressing symptoms whether in India or in a migrant community.

“So, when a woman becomes ill, the total structure of the family is affected, they can’t do anything…” Voices from the community on women with breast cancer in India: a qualitative focus group study

“…The collectivist family [33] was considered as strong sources of support. However, consistent with our previous work [2,3], a "two-edged sword" was described whereby some women felt "unsupported" and worried particularly about "spousal abandonment", aggravated by a cultural reluctance of Indian men to show emotion. Similarly, faith practice is described as a major source of strength and resilience consistent in various other cultures [34,35].…”

“…Breast cancer is the most prevalent cancer among women globally. Psychological distress is common and is related to the impact of this disease on the woman's role in the family and wider community [1][2][3]. A recent systematic review [2] found that Indian women with breast cancer, living in India or as immigrants in Canada experienced distress, both ameliorated and exacerbated by similar cultural issues.…”

“…Psychological distress is common and is related to the impact of this disease on the woman's role in the family and wider community [1][2][3]. A recent systematic review [2] found that Indian women with breast cancer, living in India or as immigrants in Canada experienced distress, both ameliorated and exacerbated by similar cultural issues. India is the world's second-most populous country, with a rich culture including patriarchy, strong family systems and religious beliefs.…”

“…Four major religions (Hinduism, Buddhism, Sikhism, Jainism) originated in India alongside indigenous faiths and tribal creeds which have survived for centuries. The influence of religion is embedded within the culture and "travels" with the person [2], influencing the responses and behaviours of Indian women anywhere in the world.…”

‘I don’t talk about my distress to others; I feel that I have to suffer my problems...’ Voices of Indian women with breast cancer: a qualitative interview study

“…A recent systematic review [5] found that Indian women living in India or as immigrants in Canada experienced a range of psychological distresses both ameliorated and exacerbated by cultural issues personally, within the family, within their community, and in the context of faith. The cultural issues identified were similar for the women irrespective of the country studied.…”