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ASSESSMENT OF COPING STRATEGIES AMONG BREAST CANCER
PATIENTS ON CHEMOTHERAPY.
Guided by: Dr.M.Nagarathnam Ph.D.,Professor
N.Subhashini
M.Sc (N), Lecturer,
Narayana College of Nursing
Nellore.
Background: Breast cancer is the most common
malignancies and leading cause of death in women. The
breast cancer diagnosis entails the stigma of pain,
suffering and death mainly because it is associated with
losing one’s breast which is highly valued and significant
in most of the cultures, respecting a part of female
identity. The breast cancer diagnosis and its treatment
motivate changes in the woman’s body image and are
also responsible for distancing from their daily activities.
Study on coping behaviours among cancer patients has
grown enormously and urge more attention for the
specific population.
Objectives: To assess the coping strategies among breast
cancer patients.
Methods: 100 breast cancer patients were interviewed
by using Modified folk man and Lazarus ways of coping
scale for assessing the coping strategies.
Results and conclusion: Findings revealed that, 52%
had moderate level of coping, 28% had adequate level
of coping and 20% had low level of coping.
There was an association between the escape
avoidance and residence with the chi square value of
9.619,and positive reappraisal and second stage of
breast cancer with the chi square value of 17.67
significant at P <0.05.
The study suggest that, a majority of breast cancer
patients were having moderate level of coping and most
frequently used coping strategies were seeking social
support and planful problem solving followed by
distancing.
Key words: coping strategies, breast cancer,
chemotherapy.
Narayana Nursing Journal
INTRODUCTION
Breast cancer is the most common cancer in women
worldwide and second leading cause of cancer death in
women.In 2011 an estimated 230,480 new cases of
breast cancer among women and approximately 39,520
women are expected to die from breast cancer. About
40,000 women die of breast cancer each year. Breast
cancer is highly prevalent medical problem with current
data suggesting that more than 1 in 8 women will
develop breast cancer within their lifetimes1.International
association of cancer research projected that there would
be 2, 50,000 cases of breast cancer in India by 2015, a
3%increase per year2. Cancer of the breast is the
predominant site of cancer and has accounted for 24.6%
of the total cancer in females followed by cancer of the
cervix (15.9%), ovary (4.9), oesophagus (4.7) and mouth
cancer (4.6)3.
Diagnosis of breast cancer is not only physical but also
social, and psychological implications because of the
importance of the breast in women’s body image,
sexuality and motherhood .They may experience a range
of concerns and fears, which include physical
appearance and disfigurement, uncertainty regarding
recurrence and fear of death4.
Most of the African American women using the coping
strategies like relying on prayer, avoiding negative people,
developing positive attitude, to will to live, and receiving
support from the family and friends and support groups.
Receiving a breast cancer diagnosis has a persistent
deleterious effect on a women’s physical, emotional and
psychological wellbeing. Survivors of breast cancer must
learn to cope with this challenge5.
MATERIALS AND METHODS:
Research design & approach: Cross Sectional
Descriptive In Nature.
Setting: Medical Oncology Ward, SVIMS, Tirupati.
Population: Breast Cancer Patients on Chemotherapy.
Sampling technique: Non-probability convenient
sampling technique.
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Inclusion criteria:
Breast cancer patients on chemotherapy, aged 20-60
years, willing to participate, and undergone modified
radical mastectomy and breast conservative surgery.
Exclusion criteria:
Patients suffering from significant disability (40%),
severely ill patients.
Description of the tool: The tool consists of two
sections viz part 1 demographic data, part 2 Modified
folk man and Lazarus “ways of coping” scale, which
comprises of 38 questions to assess the coping
strategies among breast cancer patients. The scale was
rated on four point rating scale from0-3.0 not used,
1-somewhat used, 2-used quite a bit,3-used a great deal.
The total score was 114.The score reflects the level of
coping among breast cancer patients. The scores were
categorize as 0-38=Low coping, 39-76=Moderate
coping, 77-114 Adequate coping. Each participant was
interviewed on all the items of the scale to discover
different ways of coping used by breast cancer patients.
Content validity: it was obtained from nursing and
medical oncologist.
Reliability: Computed by split-half method by using Karl
Pearson co relation co efficient formula were r = 0.98.
Pilot study was done on ten samples, who met
inclusion by using convenience sampling technique.
Data collection: The data was collected from 100
breast cancer patients between 8to 1pm.The researcher
introduced herself and explained the purpose and took
consent from all study participants. The researcher
interviewed each sample and maintained confidentiality.
Descriptive and inferential statistics were used for
analysis and the data thus collected were analysed using
the SPSS Package.
RESULTS
SECTION I : Distribution Of Demographic Variables On Coping Strategies Of Breast Cancer Patients On Chemotherapy.
Most of the participants belongs to middle aged
women(51%),hindu religion (90%),married women
(90%),illiterate(58%),majority of women working as a
coolie (54%),living in rural areas(84%),Monthly income
1000-3000 (43%),most of the women were in stage II
breast cancer, no family history of breast cancer
(92%),most of the women were completes 3 cycles of
Narayana Nursing Journal
chemotherapy (42%),and women underwent modified
radical mastectomy(82%).
SECTION II Relative score of coping strategy
subscales among breast cancer patients.
(N=100)
Coping Strategy Sub Scale
Mean Standard Deviation
Seeking social support
Planful Problem Solving
Distancing
Escape Avoidance
Self Controlling
Positive Reappraisal
Confrontive Coping
Accepting Responsibility
0.18
0.17
0.16
0.14
0.13
0.08
0.09
0.01
0.04
0.03
0.04
0.04
0.02
0.01
0.02
0.01
Based on relative scores of the ways of coping
questionnaire, the most frequently used coping
strategies seeking social support and planful problem
solving followed by distancing. As shown in Table, the
other coping strategies were not as common. Accepting
responsibility was the least frequently used coping
strategy among participants.
SECTION III Distribution Of Coping Strategies Of
Breast Cancer Patients On Chemotherapy
Table:1 Frequency and Percentage Distribution of
Level of Coping Strategies among Breast Cancer
Patients. (N=100)
52% of breast cancer patients were having moderate
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coping strategies, 28 % were having adequate coping
strategies and 20% women were having low coping
strategies.
SECTION IV : Association between demographic
variables and coping strategies
In the association of demographic variables with
coping strategies among breast cancer patient’s residence
has obtained chi square value of 9.619 with ‘P’ Value
0.047 significant at P < 0.05.In the association of
demographic variables with positive reappraisal among
breast cancer patient’s stage of breast cancer has
obtained chi square value of 17.672 with ‘P’ value
0.007 significant at P < 0.05.
DISCUSSION: The study findings revealed that, 52%
had moderate level of coping, 28% had adequate level
of coping and 20% had low level of coping and the most
frequently used coping strategies were seeking social
support and planful problem solving followed by
distancing among the target population. There was an
association between the escape avoidance and residence
with the chi square value of 9.619, and positive
reappraisal and stage of breast cancer with the chi square
value of 17.67 and are statistically significant at P <0.05.
Narayana Nursing Journal
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CONCLUSION: From the present study it was
concluded that most of the breast cancer patients were
having moderate level of coping and most frequently used
coping strategies were seeking social support and planful
problem solving followed by distancing. So there is
necessity to improve knowledge regarding breast
cancer by conducting counselling sessions to all the
patients undergoing chemotherapy cycles, emphasizing
mainly on side effects of chemotherapeutic drugs.
REFERENCES:
1) American Cancer Society. Breast Cancer Facts &
Figures 2011-2012. Atlanta: American Cancer Society,
Inc.
2) Sanjithbagchi. breast cancer rises in India. CMAJ July
1, 2008; 179: 1 27-2a
3) Kounteya sinha. breast cancer cases on the rise. TNN
Feb 26 201; 12.14am IST.
4) Meyerowitz BE. Psychosocial correlates of breast
cancer and its treatments. psycholbull 1980;87:108-31.
5) Phyllis D.Henderson, Joshua fogel. Coping strategies
among African American women with breast cancer.2003; 3(4).
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