Hope and psychological well-being after 5 years become breast cancer survivors: a Qualitative Study

Background: Cancer is perceived as a deadly disease for most people, it will affect the hope and psychological well-being of long-term cancer survivors. Objectives: This study aimed to explore changes in hope and psychological well-being after 5 years become breast cancer survivors. Methods: This was a qualitative study with a phenomenological design. Samples were 23 breast cancer survivors in three health centers in Surabaya Indonesia taken by purposive sampling technique based on inclusion criteria. An in-depth interview was done when collecting the data. The interview was recorded with the permission of the participants. The data were inductively analyzed through conventional content analysis


INTRODUCTION
Being diagnosed with cancer triggers the emergence of psychological distress, anxiety, and depression, which are caused by a fear of the prognosis of cancer (1). The negative perception that cancer is a terrible and deadly disease is still widely perceived by the public (2).
The statistical agency determines that the long duration after being diagnosed with cancer is after 5 years, this is a period that various types of initial treatment have passed, a period of adaptation to the situation, but also a period of high risk of recurrence and metastasis of cancer cells to other organs. (3). A study mentions a gap in life expectancy in cancer survivors who have been diagnosed for more than 5 years compared to individuals without a history of cancer (4). Previous research explained that cancer can cause uncertainty, ambiguity, lack of emotional control, and insecurity in patients which has a significant impact on the emergence of negative effects on patients' life expectancy to live a normal life again (5). Cancer patients may experience anxiety, irritability, sadness, feelings of hopelessness or emptiness, lose interest, have thoughts that they are better off dead, and even have active plans of suicide (6). Anxiety is a predictor of the emergence of negative psychological well-being, especially in cancer patients undergoing chemotherapy (7). A study stated that cancer patients continue to worry about their future health because of the possibility of cancer recurrence even after completing their treatment (8). Likewise, depression can cause cancer patients to feel hopeless (9). In breast cancer patients, it is found that there is poor psychological well-being when undergoing mastectomy surgery (10). A study found that breast cancer patients showed a higher level of hopelessness than other groups of cancer patients and also experienced significantly more tension and fear of the possible side effects of treatment (11). Psychological distress and hopelessness can cause a significant reduction in quality of life (12).
Cancer prevalence of more than 16.9 million Americans with a history of cancer still alive on January 1, 2019, and this number is estimated to grow to more than 22.1 million by January 1, 2030. The five most common cancers A study explains that the majority of patients diagnosed with cancer feel physical discomfort, emotional disturbances (such as anxiety, fear of relapse) uncertainty in life, and the loss of social support (13). Data compiled from a study states that psychological disorders in breast cancer patients include anxiety, impaired body image, ineffective coping strategies, depression, fatigue, and decreased quality of life (14).
Psychological problems of cancer patients are usually found in stage II to IV, especially those who undergo chemotherapy or radiotherapy treatment (15). The stigma of breast cancer as an incurable disease causes patients to feel lonely, and lose social support from family and loved ones which can harm their emotional wellbeing (16). Hopelessness usually occurs after completing cancer treatment, because intensive support from the family is no longer available, and patients feel alone and fear the situations that remind them of the period of treatment (17). A study reported that the hopelessness in recurrence cancer patients was worse than in patients without recurrence (18). A study stated that cancer recurrence in the form of enlargement of the tumor size by more than 20 mm and the spread of cells through the lymph increased in cancer survivors more than 10 years to 32 years after being diagnosed with cancer (19). A study explains that cancer patients who have had breast cancer for a long time can become anxious and depressed because of their worry about the spread of cancer cells (20). From the explanation above, many previous studies discussed the physical condition and psychological disorders of cancer patients. However, there are no studies that clearly describe the hope and psychological well-being of breast cancer patients who have lived more than 5 years as cancer survivors. This study objectives to explore changes in hope and psychological well-being after 5 years becoming breast cancer survivors.  (3) last for 30-45 minutes each. The next process was to identify the sentence or paragraph form of statements and transcripts and provide the code. After extracting, it was then reviewed to get a theme.

RESULT
The number of participants were 23 women with breast cancer, within the age range 41 -70 years, 8 participants were still working and 15 participants have not worked anymore since being diagnosed with cancer, all participants are active members in their community. All participants hope to recover from illness Participant 7 said: "I hope that my cancer can be cured soon and I will be healthy again" Participant 15 said: "Everyone with any illness wants to get well, and so do I." Participant 22 said: "I have finished the all treatment program consisting of surgery, chemotherapy, and radiation. I hope to recover soon" Hope no recurrence occurs Many participants hope no recurrence occurs Participant 2 said: "I have undergone all treatments, I hope the cancer cells can die and not grow again" Participant 10 said: "The doctor has stated that my cancer cells are dead, I hope it won't recur again" Hope to be healthier All participants hope to be healthier and the symptoms reduced Participant 3 said: "I still feel pain and nausea sometimes, but it's not as often as before, and I hope to be healthier" Participant 14 said: "Since finishing the chemotherapy program, I am healthier and not tired anymore, and hope to continue to be healthy"  "Previously I was a person who easily thinks negatively about others, but now I become more positive and my family supported me" Participant 11 said: "No matter how bad the pain is if we always think positively, surely the disease will slowly disappear" Self-control ability Many participants had good self-control ability Participant 17 said: "I have changed to be a person who can control myself and not easy to be angry" Participant 21 said: "My ability to control myself is better now, I can respect others and I will never be angry with my family anymore because they always supported me" Happy feeling Many participants stated happiness after 5 years diagnosed with cancer Participant 3 said: "I can adapt to my illness now even though it is stage III and I feel happy no more stress" Participant 12 said: "The purpose of my life is only to be happy even in a healthy or sick condition like now"