The Availability of Family Support to The Breast Cancer Patients

Acknowledgement

Finally this project has been completed after endless efforts with the help of Allah.

Therefore, we would like to take this opportunity to thank all of the people who helped us throughout the initial stages up to the final touches of the report and who were an endless source of inspiration to us.

University which gave us opportunity for showing our skills and hard work by completing this knowledgeable research report.

Department of Gender Studies provided us maximum support and guidance in completing this research report.

Our supervisor for providing us with enough knowledge and guidance and for her support and encouragement.

Last but not least we are grateful to our family and friends who supported and helped us throughout the report.

Abstract

This thesis aims to know the availability of family support to the breast cancer patients. It was also designed to explore the available family support to the female breast cancer patients.

The study was to know about the attitudes and behaviors of family members towards breast cancer female patients and about the physical, emotional and financial support of family to the patient in addition to the available resources for the treatment of patients.

The research found out different difficulties and barriers faced by the family and patients during treatment such as financial problems, moral support and understanding of the actual disease faced by the patient. These difficulties are discussed in detail in the literature of the research paper. The study implicated that the availability of family support to the patients could help them fighting the disease. On the contrary, the absence of such family attitudes could cause them psychological or emotional upheaval in dealing with the disease.

Table of Contents

Chapter # 1                                          Introduction

• Introduction to the breast cancer patients
• Statement of the problem
• Objectives of the study

Chapter # 2                                  Literature Review

• What is Cancer?
• What is Breast Cancer?
• Common kinds of breast cancer
• Stages of breast cancer
• Causes, incidences and risk factors of breast cancer
• Other potential risk factors of breast
• Symptoms of breast cancer
• Prevention of breast cancer
• Treatment of breast cancer
• Role played by family members of patients

Chapter # 3                      Methodology

• Type of research
• Population
• Sampling Technique
• Sample
• Data collection Tool
• Data analysis
• Limitation

 Chapter # 4                                Results

• Analysis of data
• Distribution of samples
• Age distribution of patients
• The stage on which a patients disease was diagnosed
• Resources of treatment
• Status of the patients
• Patient’s first reaction after knowing about the disease
• Reaction of family for breast cancer patients
• Reaction from society
• Changes in the attitude of husband
• Problems faced by family
• Support by family
• Family support in terms of money
• Effect of disease on marital relationship
• Nature of effects on marital relationship
• Which family member supports patient
• Have patient ever faced barriers or difficulties having disease
• Encourage to be active or to regain self-reliance and confidence
• Acceptance of Mood and Behavior by Family
• Faced unsupportive reaction by family
• Did the illness of breast cancer bring family closer

 Chapter # 5                  Discussion

• Summary
• Interpretation
• Implications
• Recommendations
• References

Chapter # 1

 Introduction

A detailed introduction of breast cancer patients and the availability of family support to them.

1.1 Introduction for the Breast Cancer patients

Mankind has to suffer from various diseases. There is a large proportion of population which is being hit by number of diseases and mortality rate is rising rapidly. Cancer is one of the fatal diseases. It is a very common disease in men and women .Breast cancer is one of the major types of cancer most common in women. Men can also develop breast cancer but it happens very rare in the case of men. It is estimated that Pakistan sees almost 90,000 cases of breast cancer, resulting in almost 40,000 deaths per year. (Saleem,2011)

Breast cancer is a cancer that starts in the tissues of breast. In this type of breast cancer, cells in the breast grow abnormally and in uncontrolled way. Breast cancer can be treated in earlier stages and if not diagnosed then it is not curable at last stages. Breast cancer is the most common cause of death in women between the age of 45 and 55. It is second common cause of death among women after lung cancer. (Moore, 2000)

Cancer is a major issue worldwide and breast cancer is one of its major types. This disease for the first time was noticed by Ancient Egyptians 3,500 years ago. By the mid 19^th century, surgery was the best option available for the treatment of breast cancer (Mandal, MD)

Women suffering from breast cancer naturally feel tremendous fear; even if her cancer is in early stages. Women with breast cancer often feel sad and isolated. (Majumdar, 2009) Most of the patients are worried about the expensive treatment and burden on their families. Patients get worried due to financial pressure because the treatment is very expensive and relationships with family members become tensed as it is sometimes considered incurable disease. Most patients or survivors suffering from breast cancer are worried not only about the effect of the disease on themselves but also being a burden to their family. The burden might have an impact on the economy of the family, quality of life issues and relationships with family members (Grunfeld et al., 2004)

The patients who don’t get support economically and emotionally by family, they go through a very tough situation. In some cases, husbands leave their wives as they cannot afford the expense of their treatment. It also has a bad impact on children. It is a very painful stage for women while the patients who are being supported and encouraged by their family are able to fight with the disease strongly and successfully .They get proper love and sympathy by their family due to which they have less anxiety, depression and are more efficient in coping with their illness. The support which breast cancer patients receive is an important factor for them to recover from the disease. In line with this idea, Kotkamp-mothers et al (2005) stated that ‘relatives and family members were increasingly seen as a source of social support for patients with potential influence on coping, morbidity and mortality”. Similarly, Hann and has colleagues (2002) reported that patients who receive adequate support from their family members have less anxiety and depression, better adaptation and are more efficient in coping with their illness. It seems that family members can promote patient autonomy, help them to cope with stressful events and enhance mental well-being in patients with breast cancer(Ommen et al., 2008)

Breast cancer patients need an environment which is very relaxing and comfortable. They need emotional support from their family members. Spouses who have satisfying relationships with each other are more understanding and supportive. In fact, close relationship between couples influence well beings of patients. Patients with breast cancer have many fears. They should be provided with such environment that they can easily share their feelings with their family.

Majority of the patients do not participate in social gatherings because they hesitate in answering the questions of people regarding their disease. They also face other difficulties like financial problems, uncomfortable environment at home society issues and others.

Breast cancer is a very hurting and unsafe disease and women do not have proper awareness regarding this disease. It is extremely painful and patients who are suffering through should be strongly encouraged by family, relatives and friends.

The study has highlighted the importance of family support for breast cancer patients. It has thrown  light on the availability of family support for breast cancer patients. Cancer has been increased and with the passage of time and its treatment has also been advanced. There are many changes which occur in women due to breast cancer such as hopelessness, fear of dying etc. Patients need family support so they can fight with their disease, so the study has explored regarding availability of family support for breast cancer patients.

The main focus of our research is to explore the supportive roles of family members in which spouse, children and other members are included for breast cancer patients. In the research, it is seen how family support affect their loved ones who are suffering from breast cancer.

1.2 Statement of the problem:

The study has determined that how much family supports the breast cancer patients have to cope up with the disease. It will also explore that what is the effect of support from family members on the self-esteem/will-power of patients to fight against the disease, as perceived by these patients.

1.3 Objectives of the Study:

The objectives of the study were to find to:

1. Social support by family.
2. Economic support by family.
3. Emotional support by family.

Chapter # 2

 Literature Review

 A literature review is an evaluating report of information found in the literature related to selected area of study.

2.1 What is Cancer?

Cancer is an extremely ordinary and serious disease. Cancer is not a new disease. It is found in all over the globe and owing to this disease the mortality rate is rising day by day in the developed countries. At present about 20 to 25% of the human population in the world die of cancer and it is feared that in future it might become the greatest enemy of mankind. (Niharika Bhatti). According to the American Cancer Society, this chronic disease is the second leading cause of death in the U.S. with half of all men and one-third of all women developing some form of cancer during their lifetimes. Although cancer is responsible for 23% of all deaths in the U.S (National institute of environmental health sciences)

In this disease there is a limit in the division of habitual cells. These cells have a system to finish themselves due to which the death of these cells occurs. It is called programmed cell growth. The tissues and cells found in different parts of body get increase inappropriately in number. These are called tumors and these tumors destroy the surrounding development. These cells, after production get spread in whole body through blood veins and causes severe damage.

There are two types of tumor, one is benign and the other is known as malignant. Benign tumors are those kinds of tumors that boost at a snail’s pace and are restricted to a spot. Cysts, moles, warts and polyps are benign tumors. But there can be a risk that they may turn into malignant forms. Malignant tumors are those tumors that grow speedily and afterward some of the cells may isolate from them, transfer into other fundamental organs via blood stream, and form new tumors there. This stage is known as metastasis or secondary stage.

• 2.1.1 Definition of Cancer:

Cancer can be defined as in which cells in part of body begin to grow out of control. These are abnormal cells that grow undisciplined at any component of body.

• 2.1.2 Types of Cancer:

Cancer is not just one; there are various types of cancer found in different forms. Types of cancer are different like skin cancer, lungs cancer, breast cancer, uterus cancer tongue cancer and stomach cancer etc.

The main focus of the study is on breast cancer which is one of the severe and deadly cancers found all over the world especially in women.

2.2 What is Breast Cancer?

Breast cancer actually is a type of cancer that is found mostly in females. From the past few years the rate of breast cancer in women has been increased in many countries. In the United States it is estimated that about 232,340 new cases of invasive breast cancer in women came out in 2013, about 64,640 new cases of non invasive breast cancer were found and about 39,620 deaths from breast cancer were caused in women. (American Cancer Society)

Breast cancers are serious malignancies that expand in one or both breasts. It is important to understand the structure of female breast first to understand this cancer:

There are fatty and fibrous connective tissues in the centre of the female breast. The female breast is divided into about 20 sections which are called lobes.

Each of the 20 lobes is further subdivided into a collection of lobules, structures that contain small milk-producing glands. Milk is produced by these glands into a complex system of tiny ducts. The milk is carried by the ducts through the breast and come together in a collecting chamber located just below the nipple.

Breast cancer or breast carcinoma is a fatal tumor that starts from the cells of breast and can spread at long distance cells of the body.

There is a malignant tumor in a breast cancer that causes damage to DNA. After spreading in a breast it can also affect other parts of the body like liver, bones etc.

2.3 Common Kinds of Breast Cancer

There are different kinds of breast cancer. Breast cancer can start in different parts of the breast, like the ducts or the lobes.

Common kinds of breast cancer are:

• 2.3.1 Ductal carcinoma:

The most common kind of breast cancer is ductal carcinoma. It begins in the cells that line the milk ducts in the breast and it is also called the lining of the breast ducts.

• 2.3.2 Ductal carcinoma in situ (DCIS): 

The abnormal cancer cells are only in the lining of the milk ducts, and have not spread to other tissues in the breast.

• 2.3.3 Invasive ductal carcinoma:

 The abnormal cancer cells break through the ducts and spread into other parts of the breast tissue. Invasive cancer cells can also spread to other parts of the body.

• 2.3.4 Lobular carcinoma:

 In this kind of breast cancer, the cancer cells begin in the lobes, or lobules, of the breast. Lobules are the glands that make milk.

• 2.3.5 Lobular carcinoma in situ (LCIS):

The cancer cells are found only in the breast lobules. Lobular carcinoma in situ, or LCIS, does not spread to other tissues.

• 2.3.6 Invasive lobular carcinoma:

 Cancer cells spread from the lobules to the breast tissues that are close by. These invasive cancer cells can also spread to other parts of the body.

2.4 Stages of Breast Cancer:

The process which is used to find out whether the cancer has spread within breast or to other parts of the body is called staging.  After your cancer is diagnosed, there are test and scans for the patient which gives information about the stage. It is important to know the stage of breast cancer because it helps your breast cancer specialist to decide best treatment for you.

Cancer stage is based on four characteristics:

1. The size of the tumor
2. Whether cancer is invasive or non-invasive
3. Whether cancer is in the lymph nodes
4. Whether cancer has spread to other parts of body

• 2.4.1 Stage 0:

It is the earliest stage of breast cancer. Stage 0 is used to describe non-invasive breast cancer such as DCIS and LCIS. At this stage, there is no indication that tumor cells have spread to other parts of the breast or other parts of the body. In stage 0, the atypical cells have not spread outside of the ducts or lobules intro the surrounding breast issue.

• 2.4.2 Stage 1:

In stage 1 breast cancer, cancer is evident but it is contained to only the area where first abnormal cells began to develop. Stage 1 is divided into sub categories known as 1A and 1B

Stage 1A:

Stage 1A describes invasive breast cancer in which tumor measures upto 2 centimeters and the cancer has not spread outside the breast and no lymph nodes are involved.

Stage 1B:

Stage 1B describes invasive cancer in which there is no tumor in the breast and if a tumor is found in the breast it is 2cm or smaller. Small clusters of cancer cells are found in the lymph nodes.

•  2.4.3 Stage 2:

It is an advanced form of breast cancer. Stage 2 is divided into stages known IIA and IIB

Stage 2A:

Stage 2A describes invasive breast cancer in which no tumor can be found in the breast but cancer is found in 1 to 3 axillary’s lymph nodes near the breast bone.

Stage 2B:

Stage 2B describes invasive breast cancer in which the tumor is larger than 2 cm but no larger than 5 cm and small areas of cancer cells are in the lymph nodes.

• 2.4.4 Stage 3:

Stage 3 is divided into subcategories known is 3A, 3B, 3C

Stage 3A:

Stage 3A describes invasive breast cancer in which either no tumor is found in the breast. Cancer is found in 4 to 9 axillary lymph nodes near the breast bone or the tumor is larger than 5 cm and cancer has spread to 1 to 3 axillary lymph nodes near the breast bone.

Stage 3 B:

Stage 3B describes invasive breast cancer in which:

In stage 3B, the tumor may be of any size and has spread to the chest wall or skin of the breast. It may have spread up to 9 axillary lymph node or may have spread to lymph nodes near breast bone. Inflammatory breast cancer is considered at least stage 3B.

Stage 3C:

Stage 3C describes invasive breast cancer in which:

There is no tumor in the breast and if founded it may be of any size and cancer may have spread to the chest wall or the skin of the breast. Cancer may have spread to auxiliary lymph nodes or to lymph nodes near the breast bone. Cancer has spread to lymph nodes above or below the collarbone.

• 2.4.5 Stage 4:

Stage 4 describes invasive breast cancer in which:

Cancer has spread to other parts of the body besides breast such as lungs, liver, bone or brain. The tumor can be of any size and the lymph nodes may or may not contain cancer cells.

2.5 Causes, Incidence and Risk Factors of Breast Cancer:

Risk factor basically means that there are chances to have the disease. Anything that increases your chance of developing cancer is called cancer risk factor. It is a fact that risk factors don’t tell us everything. It is not necessary that the women who are having risk factors they will surely suffer through the disease. There are some women who had the risk factors but never went through it.

Risk factors you cannot change:

• 2.5.1 Gender:

Being a woman is the main risk for breast cancer. Men also can get this disease but it is very rare in their cases. Mostly, women are the victim of breast cancer patients.

• 2.5.2 Age:

As the age increases the chances of getting breast cancer increases as well. Majority of the women who were suffering from breast cancer were 55 or older than that. Age matters a lot in the case of women.

• 2.5.3 Family History:

A woman with blood relatives (sister, father, and mother) has this disease have more chances to be the victim of this disease. It is important to note that more than 85% women who do not have family history of this disease do not get breast cancer. So it’s not necessary if there is not family history of this disease, you won’t get it.

• 2.5.4 Dense Breast Issue:

Dense breast issue means that there is less fat than glandular and connective tissue. It describes the relative amount of different tissues present in breast.

• 2.5.5 Menstrual periods:

Those women who get their periods early (before the age of 12) or who went through the change of life (menopause) after the age of 55 have an increased risk for breast cancer

• 2.5.6 Alcohol:

Women who drink they are more likely to develop breast cancer. Those women who drink once in a day have less chances of developing breast cancer as compared to those women who drink three or more times a day. Use of alcohol is not good for health. One doesn’t remain in senses after having it. It increases the risk of other types of cancer.

• 2.5.7 Child Birth:

Those women who never had children or had their children after the age of 30 have greater risk of breast cancer. Those girls who get pregnant at an early age have less chances of breast cancer.

• 2.5.8 Breast Radiation Early in Life:

Radiation therapy is an effective way to destroy cancer cells in breast that may stick around after surgery. Those women who have radiation treatment to the chest area earlier in life had an increased risk of breast cancer.

• 2.5.9 DES:

In the past, pregnant women were given the drugs ( Dethystilbestrol) so their chances of miscarriage be very less. Studies have shown these women have more risk to have breast cancer. This drug was given to women in 1940-1960s

• 2.5.10 Not Breastfeeding:

There have been studies that report those women who feed their baby for 1 and half or 2 years have less chance to be the victim of this disease. This could be because breastfeeding lowers a women total number of menstrual periods, as do pregnancy. Those women who don’t feed their baby have chances to have breast cancer.

• 2.5.11 Personal History of Breast Cancer:

A woman who already has cancer in one breast have more chances of having new cancer in other breast or in another part of the same breast.

• 2.5.12 Age at First Birth:

If a woman has given birth at a very young age, then her chances of having breast cancer are very low.

• 2.5.13 Hormone Replacement Therapy:

If a women have received hormone replacement therapy for several years or more have higher risk for breast cancer. Many women take HRT to reduce of the symptoms of menopause.

• 2.5.14 Birth Control Pills:

There are many women who use birth control pills because they don’t want to have a baby. These pills are very effective for body. It increases the risk of breast cancer among the women who are taking it.

2.6 Other Potential Risk Factors of Breast Cancer:

Following are the risk factors which have not been proved through research. They are:

• 2.6.1 Pollution:

A lot of researches has been done in order to know how environment develops breast cancer risk. At present, research does not show clear link between breast cancer risk and exposure to things like plastics, cosmetics and personal care products.

• 2.6.2 Tobacco Smoke:

There have been studies which that smoking increases the risk of breast cancer but it has not been proved through a research. People do know that smoking do cause lung, liver cancer. Women who began to smoke at a very early age have more chances to have breast cancer. In 2009, The International Agency for Research on Cancer concluded that there is limited evidence that tobacco smoking cause breast cancer.

• 2.6.3 Night work:

This is a fairly recent finding that those women who do work at night (such as nurses, in call centers) have greater risk of breast cancer. This factor has not been proved through by a research.

•  2.6.4 Diet and Vitamin Intake:

There have been some studies which report that diet play an important role in having breast cancer while on the other side there are those studies as well which found no evidence that diet has an effect on breast cancer risk. International findings suggest that breast cancer rates are less among the countries where standard diet is low in fat.

•  2.6.5 Breast implants:

Breast implants are one of medical devices that are implanted under the breast tissue or under the chest muscle to increase breast size. Silicon breast tissue can cause scar tissue to form in the breast. But according to the findings of studies, this does not increase the risk of breast cancer.

2.7 Symptoms of Breast Cancer

Every person should know the symptoms and signs of breast cancer and if any time an abnormality is discovered it should be investigated by health care professional.

When a woman comes to know that she is having breast cancer, it is very difficult time for her. Men can also have this disease but very rare. Breast cancer patients need encouragement by their family so they have to their life. But if a cancer is recognized at stage IV, then it is very hard to survive for a long time. STAGE IV is the dangerous stage of cancer. It is a stage in which cancer has spread to other parts of the body beyond breast.

It is very important for women with breast cancer patients to that if the cancer is vanished for present, but there can be chances for cancer to reoccur. Those women whose caner has vanished they still need to go for check up in a daily routine. There are many symptoms that cancer may be an indicator of the recurrences of breast cancer. (Breast cancer article, 2010)

One of the symptoms of breast cancer which noticed first is a lump that feels differently from the rest of the breast tissue. There are more than 80 % of breast cancer cases discovered when women feels a lump. The earliest cancers are detected by Mammogram. (Wikipedia, 2013)

It is important to remember that, lumps in the breast are very common, especially right before your periods. Most lumps are not breast cancer. Usually, young women think they cannot have breast cancer and in fact, just under 7% of all breast cancer occurs in women under 40 years old. But, it is a fact that breast cancer can strike at any age and women of any age, should be aware of it. It is difficult to diagnose breast cancer in younger women (under 40 years old) because their breast tissue is generally denser than the breast tissue in older women. (Wax, 2011)

If there has been delay in diagnosing breast cancer, it also creates a problem. There are many young women who ignored the symptoms such as breast lump or unusual nipple discharge because they believe they are very young to get breast cancer.

Breast self-exam should be part of monthly health care routine, and patients should visit their doctors if they feel any breast changes. As soon the breast cancer is diagnosed, more there are chances for it to be recover

The most effective way to know if a women is having breast cancer or not is by mammography along with regular breast exams by your health care provider. Medical organizations are not in the favor for beast self exams, it is an option for women starting in their 20’s

Following are some symptoms very common among the women who have breast cancer:

• Lump in the breast. It is the most common sign of breast cancer.
• Lump in present all the time and does not get smaller or go away with menstrual cycle.
• Lump may feel it is attached to skin or chest wall
• Lump may feel hard or irregular in shape.
• A lump in armpit
• Changes in the breast shape or size
• Discharging from one nipple
• The skin of breast may become dimpled or puckered.
• In explained swelling of breast.
• Nipple that is turned slight inward or inverted.
• Dimple anywhere on breast.
• Shrinkage of breast (especially if on one side)

2.8 Prevention of Breast Cancer

If you are concerned about breast cancer, you may think if there are steps towards breast cancer prevention. Some risk factors, such as family history, can’t be changed. But there are some things which you can change in your life to reduce the risk of breast cancer.

Following are some steps to lower your risk:

•  2.8.1 Limit Alcohol:

The use of alcohol for women is not good for health. It should be very limited or vanished. Alcohol use increases the risk of breast cancer. To protect from breast cancer, consider limiting alcohol to less than one drink a day or avoid alcohol completely.

• 2.8.2 Don’t Smoke:

There have been researches which suggest that smoking destroys internally and long term smoking is associated with increased risk of breast cancer in some women.

• 2.8.3 Control Weight:

Studies have looked between the link of breast cancer and diet. There are benefits for women who maintain a healthy weight, do regular exercise and take less fat diet. It has also been suggested that regular exercise can reduce the risk of breast cancer. Obesity raises the risk of breast cancer after menopause, the time of life when breast cancer most often occurs so one should try to avoid gaining weight.

• 2.8.4 Need of Physically Active:

Woman needs to be very active in their daily life. Those women who exercise 5 days a week reduces their breast cancer risk by 37 percent as compared with less active women. Exercise is very important for human body it burns all the extra fats in your body.

• 2.8.5 Consider Limiting fat in your diet:

A study was conducted which results suggest that those women who intake fat in a very less quantity have very minor chances to have breast cancer. There is also another advantage of taking less fat in your diet is that you can be safe from other diseases as well such as diabetes, heart disease and stroke. For a protective benefit, limit fat intake to less than 35% of your daily calories and restrict those meals which have much fats. (Mayo clinic staff, 2010)

• 2.8.6 Breastfeeding:

Breast-feeding may play a role in breast cancer prevention. Women who breast-feed their babies for at least a year in total have a reduced risk of developing breast cancer later.

•  2.8.7 Avoid Hormone Replacement Therapy:

Menopausal hormone therapy increases risk for breast cancer. If you must take hormones to manage menopausal symptoms, avoid those that contain progesterone and limit their use to less than three years.

2.9 Treatment of Breast Cancer:

Women with breast cancer should be cared by a multidisciplinary team(MDT). It is a team of specialists who work together to provide best treatment and care. The team often consists of a specialist cancer surgeon, an oncologist (a radiotherapy and chemotherapy specialist), a radiologist, a pathologist, a radiographer, a reconstructive surgeon and a specialist nurse. Other members may include a physiotherapist, a dietitian and an occupational therapist. The team often consists of a specialist cancer surgeon, an oncologist (a radiotherapy and chemotherapy specialist), a radiologist, a pathologist, a radiographer, a reconstructive surgeon and a specialist nurse. Other members may include a physiotherapist, a dietitian and an occupational therapist. Treatment of breast cancer depends upon on the type of breast cancer, its stage, whether the cancer cells are sensitive to hormones, your overall health and your own preferences.

The main treatments for breast cancer are:

• Surgery
• Radio Therapy
• Chemotherapy
• Hormone Therapy
• Biological Therapy (targeted therapy)

The first type of treatment for breast cancer is usually surgery. The type of surgery depends on the type of breast cancer you have. Surgery is usually followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments. Again, the treatment you will have depends on your type of breast cancer. Your doctor will discuss the best treatment plan with you. Sometimes, chemotherapy or hormone therapy will be the first treatment.

There are two types of surgery for breast cancer. These are surgery to remove just the cancerous lump (tumor), known as breast-conserving surgery, and surgery to remove the whole breast, which is called a mastectomy. In many cases, a mastectomy can be followed by reconstructive surgery to recreate the breast that was removed.

2.9.1 Breast Cancer Surgery:

Operations used to treat breast cancer include:

• Removing the breast cancer (lumpectomy):

Breast-conserving surgery ranges from a lumpectomy or wide local excision, in which just the tumor and a little surrounding breast tissue is removed, to a partial mastectomy  in which up to a quarter of the breast is removed.

If you have breast-conserving surgery, the amount of breast tissue you have removed will depend on:

• the type of cancer you have
• the size of the tumor and where it is in your breast
• the amount of surrounding tissue that needs to be removed
• the size of your breasts

The surgeon will always remove an area of healthy breast tissue around the cancer, which will be tested for traces of cancer. If there is no cancer present in the healthy tissue, there is less chance that the cancer will recur. If cancer cells are found in the surrounding tissue, you may need to have more tissue removed from your breast.

• Removing the Entire Breast (Mastectomy):

A mastectomy is the removal of all the breast tissue, including the nipple. If there are no obvious signs that the cancer has spread to your lymph nodes, you may have a mastectomy, in which your breast is removed, along with a sentinel lymph node biopsy (SLNB). If the cancer has spread to your lymph nodes, you will probably need more extensive removal (clearance) of lymph nodes from the axilla (under your arm).

• Lymph node surgery:

To find out if the cancer has spread, a procedure called a sentinel lymph node biopsy (SLNB) may be carried out. The sentinel lymph nodes are the first lymph nodes that the cancer cells reach if they spread. They are part of the lymph nodes under the arm (axillary lymph nodes). The position of the sentinel lymph nodes varies, so they are identified using a combination of a radioisotope and a blue dye. If no cancer is found, the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes need to be removed.

 2.9.2 Radiation Therapy:

Radiotherapy, also known as radiation treatment, is the controlled use of high energy X-rays to treat many different types of cancer. About 4 out of 10 people with cancer have radiotherapy. In some cases, radiotherapy can also be used to treat benign (non-cancerous) tumors. The length of each course of radiotherapy will depend on the size and type of cancer and where it is in the body.

Radiation therapy is typically done using a large machine that aims the energy beams at your body (external beam radiation). But radiation can also be done by placing radioactive material inside your body (brachy therapy).External beam radiation is commonly used after lumpectomy for early-stage breast cancer. When external beam radiation is used after a woman has tested negative on a sentinel node biopsy, there is evidence that the chance of cancer occurring in other lymph nodes is significantly reduced.

Radiotherapy is often used in combination with other treatments, such as chemotherapy (powerful medication that is used to treat cancer). This is known as chemo radiotherapy. Chemo radiotherapy can be used to try to cure a cancerous tumor, to shrink a tumor before it is removed using surgery, or after surgery to reduce the risk of relapse.

Side effects of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Breast tissue may also appear swollen or more firm. Rarely, more-serious problems may occur, including arm swelling (lymphedema), broken ribs, and damage to the lungs or nerves apse.

2.9.3 Chemotherapy:

Chemotherapy is a type of treatment for cancer where medicine is used to kill cancer cells.  Chemotherapy uses drugs to destroy cancer cells. If your cancer has a high chance of returning or spreading to another part of your body, your doctor may recommend chemotherapy to decrease the chance that the cancer will recur. This is known as adjuvant systemic chemotherapy.

Chemotherapy is sometimes given before surgery in women with larger breast tumors. Doctors call this neo adjuvant chemotherapy. The goal is to shrink a tumor to a size that makes it easier to remove with surgery. This may also increase the chance of a cure. Research is ongoing into neo adjuvant chemotherapy to determine who may benefit from this treatment.

Chemotherapy is also used in women whose cancer has already spread to other parts of the body. Chemotherapy may be recommended to try to control the cancer and decrease any symptoms the cancer is causing. Chemotherapy is a very effective cancer treatment that has helped save millions of lives, but it also has side effects. Majority of the people had much side effects. There were only few who had very less side effects.  Living with and adapting to the side effects of chemotherapy can be challenging. But it’s important to realize that most, if not all, side effects will disappear once the treatment is complete. Some common side effects of chemotherapy were hair loss, nausea, vomiting, fatigue and a small increased risk of developing infection.

2.9.4 Hormone Therapy:

Hormone therapy is often used to treat breast cancers that are sensitive to hormones. Hormone therapy works by lowering the levels of hormones in your body or by stopping their effects.

The type of hormone therapy you have will depend on the stage and grade of your cancer, which hormone it is sensitive to, your age, whether you have been through the menopause and what other type of treatment you are having. You will probably have hormone therapy after surgery and chemotherapy, but it is sometimes given before surgery to shrink a tumor, making it easier to remove.

Treatments that can be used in hormone therapy include:

• Tamoxifen
• Aromatase inhibitors
• Ovarian ablation or suppression

 Tamoxifen:

Tamoxifen stops oestrogen from binding to oestrogen-receptor-positive cancer cells. Ta mo xi fen is taken every day as a tablet or liquid. It can cause several side effects, including: fatigue, hot flashes, night sweats and vaginal dryness, headaches and weight gain.

2.10 Role Played by Family Members of Patients

• 2.10.1 Emotional Support by Family members to Patients:

For many cancer patients and their families the occurrence of cancer is an extremely traumatic one. Emotional support is essential for most cancer patients during their ill health and can be gained from their close relationships. A finding of cancer evokes a wide range of emotions, such as terror, fear, anxiety, nervousness, irritation, sadness, misery and helplessness. It can be a moment of immense emotional distress for patient and family. The patient is plunged from a state of apparently good health through a series of frightening transitions (Bloom, 1982): investigations and treatment with their potentially unpleasant side-effects, unanswered questions concerning recurrence, pain and death (Wortman and Dunkel-Schetter, 1979). During the stage of a patient’s disease, it becomes important for family members to give her extra care and love to escape patient from emotional distress. Patients who receive strong and consistent emotional support are thought to adjust more successfully over time (Dunkel-Schetter, 1984).

Emotional support involves spending time with another person, listening and talking about problems and concerns in a way that is helpful and supportive. Emotions are such feelings that are needed by everyone at every stage of life but when someone is diagnosed with a disease like cancer, the patient becomes sad and starts feeling helplessness. Emotional support has been described as behavior which assures the individual that he is loved and valued as a person regardless of achievement (Bloom, 1982; Cobb, 1976).

Breast cancer when diagnosed is a stressful time for patient and for family as well. That is why it is necessary to build a strong emotional relationship between patient and family so that the patient could share her feelings easily with family. Co-survivors are family and friends who should be there to lend support from diagnosis through treatment and beyond. Emotional support from co survivors can help a lot through this difficult time of patient.

Different sources of support such as family, friends or doctors often provide different types of support (Rowland, 1990). For example, a doctor may offer information as a form of support, whereas family provides love and affection. In Dunkel-Schetter’s 1984 study looking at the most helpful and unhelpful behaviors given to cancer patients, help most often meant emotional support and was perceived as most supportive when given as a combination of information and direct help. Further studies have shown that information giving is an important predictor of satisfactory emotional support for patients (Blanchard et al., 1990; Wortman and Dunkel-Schetter, 1979; Peck, 1972).

By allowing patients to state their concerns, family and friends can recognize and help out to deal with their suspicions. Caring and sensitive manner may provide one of the most important sources of emotional support for cancer patients.

If a patient is married and diagnosed with breast cancer she first feels about her relationship with her partner. They have been through both happy and hard times together and this news may be shocking news at first for the partner of patient. Breast cancer is not just the wife’s fight. Husbands should be proactive about offering support to his wife. Husband should know how to support her emotionally and also caring for his own needs. He should be non judgmental towards wife’s feelings and fears. He should satisfy his wife by giving her love and care and should console her by saying that everything will be alright, don’t worry. In this way the feelings of his wife could be minimized. The partner should go to doctor’s appointments with his wife so that she would not feel that she is alone. Husband should let her wife know that she is still beautiful and he loves him very much. This affection and love is necessary in such situation to make patient strong. Therefore, patients need the emotional support to be provided by their own members both during and after the treatment process (Çam and Gümüş 2006; Gümüş, 2006, Liao et al., 2007; Güner, 2008; Arslan et al., 2009; Brothers  and Andersen, 2009; Çam et al., 2009).

Married women diagnosed with breast cancer also face difficulties to break the news of her disease on her children. Mother is an anchor of child’s world. When an anchor is threatened, she must take steps to tell her children. She should be honest as possible, even it seems difficult.

A research was done in which it was studied that how children of mothers newly diagnosed with breast cancer perceive their mother illness and its treatment. As a result it was found that children described specific aspects of their mother treatment as especially stressful (seeing her immediately postoperatively, chemotherapy and hair loss.) Some reported that they didn’t show their stress to their mother and tried to make her relax so that she could cope up with disease (Forrest, 2006).

As children depend on mother, the mother also depends on them too. Children also must encourage their mother and talk to her and show her love and care so that she should not feel alone. If mother is losing her hair or breast due to treatment, it is necessary for children to make her feel that she is still that much beautiful. Children must listen to her, kiss her, hug her and spend time with her so that she could fight with her disease.

Breast cancer for unmarried women is really painful for herself and her family. A recent study conducted at University of Manchester found that women with primary breast cancer reported feelings of shame, self-blame and low social and economic support. Some of the patients experienced episodes of major depression and 40 percent had episodes of general anxiety disorder during the first year after the diagnosis. However, results showed that shame and self-blame typically indicated the recurrence of a previous disorder and low social support was isolated as a possible predictor of depression following cancer diagnosis (Kristan Binczewski 26 dec 2011)

• 2.10.2 Social support by family members to patients:

Breast cancer is a very fatal disease and the women who are going through it, their basic need is encouragement and support by their family, relatives and friends.  They need people who are very nice and caring towards them. Social support plays a very important role for breast cancer patients. Patients with breast cancer can experience a feeling of hopelessness very deeply in the adjustment process, and the social support provided during this period can be effective in increasing the level of hope.

Social support can be defined as the perception and actuality that one is cared for, has assistance available from other people, and that one is part of a supportive social network. Social support includes supportive resources which can be informational, emotional, companionship, tangible and intangible.

There are many disciplines in which social support is studied including psychology, medicine, sociology, nursing, public health, and social work. There are many benefits of social support that has been linked for both physical and mental health, but social support is always not beneficial.

Social support can come from a variety of sources, including (but not limited to): family, friends, romantic partners, pets, community ties, and coworkers. Sources of support can be natural (e.g., family and friends) or more formal (e.g., mental health specialists or community organizations). Support from a romantic partner is associated with health benefits, particularly for men.

Social support is a critical, yet underutilized resource when undergoing cancer care. Underutilization occurs in two conditions:

(a) When patients fail to seek out information, material assistance, and emotional support from family and friends or (b) When family and friends fail to meet the individualized needs and preferences of patients. Social networks are most effective when kept up to date on the patient’s status, yet updating everyone takes effort that patients cannot always put in.

There are some researches regarding social support for breast cancer patients.

When a woman is diagnosed with breast cancer, she feels that her life is almost to an end. Those women who lack of family support have very difficult time and they feel hopeless, while in the case of those women who receive family and social support can fight with the disease better. There has been a new research conducted by an assisted care centre based in the US shows that breast cancer patients who have the support of friends and family can manage pain and other symptoms better.

Surroundings matter a lot in difficult times. If a person is worried or having a tough time one wants to be encouraged. Breast cancer is a serious disease and the women who are going through it they need to be encouraged by their family, friends and relatives. They should be provided with social support. They should spend a lot of time with the patient and make her feel easy. When the patient is given time by others, then one thinks less of pain and feels better. These Breast cancer patients who say they have people with whom they have a good time, or have “positive social interactions” with, are better able to deal with pain and other physical symptoms, according to a new Kaiser Permanente study. This study provides research-based evidence that social support helps relieve physical symptoms,” said lead author Candyce H. Kroenke, staff scientist with the Kaiser Permanente Division of Research. “Social support mechanisms matter in terms of physical outcomes,”

Social support is characterized as any combination of emotional, tangible, appraisal, and informational support. Support can be formal, informal, social, professional, structured, or unstructured. It has been recognized for many years that social support is an important factor which may affect the general well-being of individuals living with chronic and life-threatening health conditions like breast cancer. Social support can help women with breast cancer to adjust and copes, and can have positive impacts on the survivor’s health. For an individual who has completed treatment, social support can enhance her quality of life and ease her transition into life after treatment. For breast cancer survivors, access to a supportive environment can prevent long-term psychological difficulties and benefit her general well-being. Unfortunately for older women, most studies examining the role of social support for women diagnosed with breast cancer have so far focused on the experience of younger women.

Cancer patients have many needs. The need for fast and accurate diagnosis and timely treatment is vital, but social support is also an important aspect of modern cancer care (Clark et al., 2006). Women dealing with the stresses of diagnosis and treatment of breast cancer have been found to benefit from supportive relationships (Parker et al., 2003); and social support has been shown to mitigate the deleterious effects of stressful events, including cancer. So women need support in coping with the stresses associated with the diagnosis and treatment of breast cancer immediately following diagnosis and during and after treatment (Friedman et al., 2005)

Social support has a remarkable importance in preventing psychological problems like anxiety and depression that are commonly observed in cancer patients. In a study on patients with different types of cancer, the incidence of psychological disorder one year after diagnosis was found to be 31.8%, while it was observed that patients with low social support scores were diagnosed with depression (Simpson et al., 2002).

Social well-being at six months after diagnosis was linked with both survival and risk of recurrence. Women with the highest level of social well-being had a 38% reduction in risk of death and a 48% reduction in risk of recurrence. The aspects of social well-being that appeared to provide the most benefit were marriage and family, social support, and interpersonal relationships. The researchers conclude “Social well-being in the first year after cancer diagnosis is a significant prognostic factor for breast cancer recurrence or mortality, suggesting a possible avenue of intervention by maintaining or enhancing social support for women soon after their breast cancer diagnosis to improve disease outcomes.”

• 2.10.3 Economical Support for Breast Cancer Patients:

Economical support basically means support in the form of money. There is always a need of money in human life. Life cannot move on without money. There is no disease which can be treated without money. People who are financially strong they don’t have such problem, but the people who are not strong, it is very difficult for them to get the disease treated. For the patient, economical support matters a lot, because if there is no money, it is less possible for the disease to be cured, especially disease like cancer, as it requires huge amount.

Breast cancer treatment includes large number of costly treatments. Chemotherapy, doctor appointments, mastectomy and breast re-constructive procedures and costly medicines are included in the treatment of breast cancer. If family will be financially strong then it will be easy to give all kind of treatment to patient. Financial support from family is necessary because patient will feel relax and easy and will have less chances of dying. No financial support from family can lead patient to more stress, one from the disease and other from financial status.

Breast cancer is a disease whose treatment is very expensive. Its treatment has a long procedure. Breast cancer has great impact on the family as well including patient. In some cases the disease can have profound impact on the financial status of patients and their families. Wage losses resulting from breast cancer treatment can negatively affect financial situation of working women and their families. It is very important as you plan your recovery from breast cancer, you also think about personal plan. (Gordon)

Economical support has great importance for breast cancer patients. Financially support matters a lot. Those patients who had economically support were not worried about the expense of their treatment. Their family was very supportive and their family made them feel relax that you should no worry at all regarding financial matters. Economic support matters a lot because those patients who are not financially supported they basically realize the importance of being supported economically. Such patients have big tensions on their mind and that is not good for them. They should not be having any kind of stress. So those patients who are being supported economically by their families should be very thankful to Allah and their families. (Breast Cancer Article, 2011)

Patients are greatly impacted by not being supported economically. Those patients who don’t have economic support are not able to get treatment properly and their chances of death increase because cancer is a disease, once it is diagnosed, it should be treated right away. As much it gets late, the more patient life is in danger and to an end. Many women diagnosed with breast cancer suffer long term hardships including depleting their savings and losing their jobs, according to a study by Canadian Breast Cancer Network (CBNC).

The patients who are doing job, they are more suffering because they were the one who were supporting home financially and due to their disease they are not able to do their job properly.

There is a growing awareness that cancer have a major financial impact on newly diagnosed patients, those living with disease and their families. Indeed, it has been claimed that almost all families confronted with a diagnosis of cancer have financial issues or economic lossess of some kind (Bertman & Sampson, 1993; Gordan et al., 2007)

Cancer patients have more financial problems because then they quit their job and whatever they were earning, is no more in their income and what they saved is being spent on their treatment. They are more likely to report financial difficulties than persons without cancer. (Arndt et al, 2004; Arndt et al., 2005)

Breast cancer patients suffer a lot. They face a lot financial problems as in the case they are not being supported ecnomicaly. They use to work a lot when they were perfectly fine but once they are diagnosed with disease, everything changed in their life .Patients who use to do much hours at work started doing less work because of disease and now they very less pay due to providing less services at work ( Bennett et al .,2008 Lauzier .,2008)

There are many problems economically faced by breast cancer patients mentioned in a report which is done in Ireland published by name of Financial Impact of Cancer Diagnosis:

Patients who have private health insurance can experience additional costs for tests or appointments not covered by their policy. Some patients had the costs of their chemotherapy met by their insurance. Social workers considered that one of the first worries for cancer patients relates to the cost of the medications that they need, particularly those required to manage pain or offset the side-effects of chemotherapy. Some of these can be obtained on prescription and others are bought over-the-counter. , but had to pay for the cost of the blood tests required prior to a chemotherapy session.

Besides the expense of the treatment of cancer, other expense increases as well such as expenses associated with travelling to hospital appointments. This included transport fares, taxi fares, and petrol costs. Because of the specialized and multi-modal nature of cancer treatment, many patients repeatedly travel long distances for treatment, and incur substantial costs each time.

Radio therapy is delivered five days a week over several weeks. For some radiotherapy patients, especially those who are living in rural areas or those receiving treatment in another city , overnight accommodation was a significant extra cost. Some patients managed staying overnight at relatives home while those who could not manage, they had a huge expense.

Those patients who have economical support, they are more likely to survive because their treatment is being done and they don’t have any stress on their mind due to financial reason. They are completely relaxed. Their family is supporting them economically, socially and emotionally. Families are a lot appreciated by the patient because they are providing her so much love and care. Family makes the patient feel that your life is much important than money, and this action makes the patient a lot better.

Financial Strain of Cancer:

In a 2006 study conducted by USA, the Kaiser Family Foundation and the Harvard School of Public Health, 25 percent of families affected by cancer said that the patient used all or most of their savings, and one in eight said they borrowed money from relatives. The study found that having health insurance throughout treatment limited but did not eliminate the financial consequences of a cancer diagnosis – one-fifth still used up all or most of their savings, 10 percent borrowed money from relatives and nine percent were contacted by a collection agency.

For those without insurance the financial burden was even greater. Respondents in this group were five times more likely to delay or forgo treatment, 50 percent used all or most of their savings, 40 percent were unable to pay for basic necessities, and six percent filed for personal bankruptcy. (Jane Larkin, 2013)

Financial strain is very painful for the family because they are unable to make proper arrangements for the treatment of their loved one. Understanding the economic impact to individuals with breast cancer (and their families) is important for several reasons. Financial distress is a quality-of-life issue and contributes to the context in which a patient makes decisions about treatment and recovery (Moore, 1999).

Most of the families who could not support or make possible the treatment of cancer divorced the woman just because it was costly and unable for them to arrange for her treatment.

Chapter # 3

Methodology

This section of the report discusses various techniques and tools used to collect the data.

3.1 Research Methodology:

• 3.1.1 Type of research:

The present study is quantitative and qualitative in nature.

• 3.1.2 Population:

The population of the study consisted of female cancer patients from Anmol, Shaukat Khanum and Mayo Hospital, Lahore. The study was done from June 3^rd to June 7^th 2013 over several visits.

•  3.1.3 Sampling technique:

The purposive sampling technique was used for the study.

• 3.1.4 Sample:

A sample of 43 women was selected from the three hospitals.The total number of registered breast cancer patients at INMOL (Institute of Nuclear Medicine and Ecology) was 70; 30 at SKH and 50 in Mayo. This was over the week of June 3^rd to June 7^th 2013. This information was disclosed to me by the hospital receptionist.

• 3.1.5 Data Collection Tool:

The tools used to collect data were in the form of interviews and questionnaire through a survey which comprised of 24 questions.

• 3.1.6 Data Analysis:

The data/information obtained through the tools was analyzed via excel computations such as frequency/mode; nominal scale was used through the questionnaire to determine the responses. A questionnaire was designed to collect information about the availability of family support for breast cancer patients. Collected data was presented in the form of tables and charts.

• 3.1.7 Limtation of the Study:

Due to lack of time and resources the study was restricted to Lahore.

Chapter # 4

Results

This chapter describes the results of the study through descriptive statistical technique.

Analysis of Data:

The purpose of the study was to know the availability of family support to the   breast cancer patients. It also intends to explore the various possible social, economic and emotional supports available through conventional support systems to traumatized cancer patients. The study was actually on the availability of family members towards the breast cancer patients.

The data was collected from 43 breast cancer patients from Shaukat Khanum Hospital, INMOL( Institute of Nuclear Medicine and Ecology) , Mayo Hospital altogether. From the sample of 43, 22 patients were from INMOL, 11 from Shaukat Khanum and 10 from Mayo Hospital.

A Questionnaire was designed to collect information about the availability of family support for breast cancer patients. Collected data were presented in the form of tables and charts.

The data shows, majority of patients belonged to INMOL Hospital, while others are from Shaukat Khanum Hospital and Mayo Hospital.

Fig.1: Distribution of Samples

According to data, the sample shows that majority of the patients who are suffering from breast cancer fall in the age of 36-45.

Fig. 2: Age distribution of patients

This data shows the different stages of breast cancer patients that are suffering from this cruel disease. Through this data, it is found out that most of the patients were diagnosed at the stage of 1 and 2.At stage 3, 14% patients were diagnosed and 5% patients were diagnosed at the last stage. A brief introduction of various stages of breast cancer is given below:

 Stage 0:

Stage 0 is the earliest stage of cancer. It is a stage in which there is no indication that tumor cells have spread to other parts of the breast or other parts of the body.

 Stage1:

In stage 1, cancer is evident but it is contained to only the area where first abnormal cells began to develop.

Stage 2:

It is divided into 2 stages known Stage 2A and Stage 2B. Stage 2A is the stage in which no tumor is found in the breast  but cancer is found in 1 to 3 axillary’s lymph nodes near the breast bone. Stage 2B is the stage in which tumor is larger than 2cm but not larger than 5cm and small areas of cancer cells are in the lymph nodes.

Stage 3:

It is divided into 3 stages knows Stage 3A, 3B, 3C. 3A is the is tage in which no tumor is found in the breast. Cancer is found in 4 to 9 axillary lymph nodes near the breast bone or the tumor is larger than 5cm and cancer has spread to 1 to 3 axillary lymph nodes near the breast bone. Stage 3B is the stage in which tumor may be of any size and has spread to the chest wall or skin of the breast. It may spread up to 9 axillary lymph nodes. Stage 3C is the stage in which either there is no tumor in the breast and if founded it may be of any size. Cancer may have spread to auxillary lymph nodes or lymph nodes.

Stage 4:

It is the most dangerous stage of cancer. It is a stage in which cancer has spread to other parts of the body such as liver, blood, lungs.

Fig. 3: The stage on which patient’s disease was diagnosed

The data shows the various treatments the patients are going through to treat this disease.The data shows 47% of patients were going through chemotherapy while 33% of patients were going surgery. In less percentage, patients were going through hormone therapy, biological therapy and radio therapy.

Fig. 4: Resources of treatment

This data shows that 81% percent of patients who are suffering from this killing disease are the one who are married. Research shows that breast cancer mostly occurs after marriage. 19 % are the females who are going through this disease are unmarried.

Fig. 5: Marital status of patients

This data shows the patient’s reaction after knowing about his or her disease. Most of the patients get depressed and shocked, while some felt close to death. Some felt helpless & some felt fear of breakup of spouse.

Fig. 6: Patient’s first reaction after knowing about the disease

Positive reactions include being caring, sympathetic, willing to spend time and loving. Most of the families encourage to fight the disease. Negative reactions include ignoring the patient, being distanced, divorcing and/or sending the wife back to her home. Very less families were rude to the patient

The data shows that 70% of patients of breast cancer got positive attitude from their families, while 30% of patients got negative attitude from the family.

Fig. 7: Reaction of family for the patient

Supportive means that patient was getting attention, love, care. Discriminatory means that they were being treated unequally. Prejudiced means being biased towards the patient. Discourage means negative conversation or actions for patient.

This data shows the reaction of society against the breast cancer patients. It shows that 49% society’s reaction is positive towards the breast cancer patient. They also encourage the patient for its treatment. 33% were very encouraging towards the patient. 2% were Prejudiced and discouraging. 4% were discriminatory.

Fig. 8: Reaction from society

This data shows the changes in the attitude of husband after knowing about the disease. Through this data, study found out that husband got more close towards the wife. About 65% husbands were attached to their wives. There was less percentage of the husbands which distanced their wives.

Fig. 9: Changes in the attitude of husband

This data shows the problems faced by the family of breast cancer patients. Through this data, it was found out that 47% of the families faced emotional problems. It was difficult for them seeing their family member in such a pain.

Fig. 10: Problems faced by family

This data shows the availability of family support for the breast cancer patients. It was found out that family supports patient 35% financially &emotionally and this support is the major need of the patient.

Fig. 11: Support by family

This data shows the family support of a breast cancer in terms of money. It was found out that 58% were open hearted and they had no problem in spending their money. While in less percentage, some families spent limited amount, some did not have money, some were miser and some applied for donation.

Fig. 12: Support from family (money wise)

This data shows whether this disease effected on marital relationship or not. Through this table, it was found out that 65% did not affect on marital relationship, instead the couple got closer. It affected 19% to some extent while for 16%, it did affect on marital relationship.

Fig. 13: Effect of disease on martial relationship

This data shows the nature of effects on marital relationship. Through this table it was found out 65% it had no effect on marital relationship.

Fig. 14: Nature of effects on marital relationship

This data shows that 34% of spouse supports the patient, while parents also support the patient 28%. In laws support is less towards the patient. 9% of the kids support the patient.

Fig. 15: The most supportive family member

This data shows the barriers and difficulties faced by a breast cancer patient. It is found out through the data that 37% of the family loved and cared more about the patient. They were concerned about the patient. While some families had financial problems because the treatment of cancer is very expensive; in very less percentage people avoided to meet the patient.

Fig. 16: Patients faced barriers/difficulties

This data shows those patients whose families encourage them to be active or to regain self-confidence. It is found out that 60% of the patients are encouraged by their familes. 23% percent of the families discourage the patient. 12% were the familes who always boost the patient.

Fig. 17: Encourage to be active/regain self-confidence

This data shows that 35% percent of the family supported them in the matter of their mood and behavour. 26% of the families accepted all the changes in the patients. In very less percentage families are found which expect from the patient to be always in a good mood.

Fig. 18: Acceptance of mood

This data represents the unsupportive & supportive reaction of family of breast cancer patients. It shows that 52% of families are supportive for patients, while 19% percent of the families reaction was unsupportive.

Fig. 19: Patients had support/repulsion from family

This data shows that families got more close to the patient after the disease. 79% of the families got closer.

Fig. 20: The disease brought family closer

Chapter # 5

Discussion

A summary, conclusions, implications, interpretations and recommendations are presented in this chapter.

5.1 Summary of the study

The aim of the study was to know about the availability of family support for the breast cancer patients. It was also designed to realize the families for the social, emotional and economic support to the patient.

The study was to know the attitude of family members towards breast cancer patients and about the available resources for the treatment of breast cancer patients.

A questionnaire was developed for data collection. The questionnaire included both open ended and close ended questions that covered the problems of different types of supports of patients during treatment.

Purposive sampling techniques were used for this study and INMOL Hospital, Shaukat Khanum Hospital and Mayo Hospital was selected. This data was presented in the form of percentages.

5.2 Conclusions

The study was to know about the availability of family who give different types of support to the patient and its physical, social and psychological effects on women. Most of the patients, who have taken chemotherapy and mastectomy, need special support from their family. Most of the patients get financial support from their families while some patients were suffering from financial problems.

According to the research, it shows that most of the families showed positive attitudes to their disease. Majority of the families bear all the expenses of the disease. They are ready to treat their patient open-heartedly in terms of money. They also give physical and emotional support to the patient so that patient can fight with disease without any hesitation. They are always very encouraging to the patient. On the other hand, it was found out that in a very less percentage, some families had very negative attitude towards the patient. They considered this disease as incurable. They did not help make the patient feel better or hopeful. They treated the patient as a burden.

Family support is very important for female breast cancer patients. Without financial, emotional and physical support this disease can’t be cured. Patients who are being supported by their families are hopeful to God and mentally prepared to fight with their disease.

5.2 Implications & Interpretations

The implications of this research via the personal visits and the questionnaire show various effects that the patient has to go through both personally and family wise.  The patient goes through a very hard time but at the same time, nearly 70% of them received a positive reaction from their family members such as husbands, brothers, sisters and parents etc. The research shows various statistics about the support they receive from their family members. The positive reactions include various aspects such as encouragement to fight the disease, more time for the patient and more understanding of the disease. It can be interpreted that the disease actually helped bring most families together.

In addition, the research aimed to look at the reactions from the society which includes patient’s colleagues, friends, peers and teachers for this paper. The research data shows that nearly half of the sampled population had a supportive reaction from their colleagues/friends/peers/teachers.  Also, 1/3^rd of the sampled population got encouragement to fight the disease.

The research looked at 43 female patients and about 88% of them were married.  The research then delved into the attitude of the husbands of these patients after the disease was diagnosed. The data shows about 2/3^rd of the sampled population had a closer relationship with their husband along with a more hopeful future even after the disease was found.

The various questions and hospital visits showed a side of breast cancer patients not often perceived by ordinary folks. It is normally assumed in the Pakistani society that when a wife is diagnosed with breast cancer, a typical husband distances himself from his wife. The research actually proves this perception wrong and in fact goes out to show that nearly 65% of the husbands actually grew closer or had no effect to their marriage.

The data interpretation can vary due to the limited scope of this paper. The interpretations are quite concise and should be taken in context of the 43 patients visited. It can be concluded that the 3 hospitals visited for the purpose of this research paper don’t perhaps reflect the most impoverished areas of Lahore. On many occasions during the hospital visits, the two researchers questioned the patients to see how they perceived their family’s support and actually got surprised from some of the responses. The data through the graphs (discussed in the literature review earlier) shows that a vast majority of patients actually got closer to their families. In fact, the percentage is as high as 70% out of the 43 patients’ responses. However, there are few things which were beyond the scope of this research paper such as how different family backgrounds affect the reaction towards this disease. An example is how a family from a rural/backward area of Pakistan would treat a closed one such as one’s wife or sister. Will the patient have positive reaction such as encouragement to fight the disease or will she be shunned from the family? This is one of the few questions which need a separate/further study.

5.3 Recommendations

On the basis of findings & conclusions of the study, the following recommendations are given below:

Recommendations from Government

• There should be some policies and plans to give proper awareness to the families of breast cancer patients that the patient needs fully support. Some techniques should be focused for the availability of family support.
• Government should made financial aids to the families of the patients. Majority of females are dependent on their families and spouses and belong to lower middle class families. Government should give them free medication for this expensive treatment.
• Government should publish materials to aware families for the support of patient because most of patients having chemotherapy and mastectomy treatment and become irritated from their disease so at this tough time families should show positive attitudes and must help them from financial as well as emotional support.

Recommendations from Private sector

• NGO’s could conduct awareness campaign in rural areas and give necessary education about the breast cancer patients to families & spouse.
• Media can also play a vital & positive role for changing people’s thoughts, it can also boost up the families for the physical, social, emotional & economic support.
• In order to live full lives, myths like losing looks and hair need to be countered. Healthy diet exercise and support by loved ones is the quickest way for a survivor to return to her former self.
• Health care facilities in Pakistan should be satisfactory.
• People need to understand that breast cancer is not a punishment, but a disease like many other needs to be treated accordingly. So, the families related to breast cancer patients should be council.

Also See the Related links:

Breast Cancer Case Study Example With Answers

References;

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