The Impact Of Cancer On Identity

With the increasing length of cancer survivorship, a rising number of clinicians and researchers are turning their focus to the long-term outcomes or side effects of cancer and its treatments, including the impact on an individual's identity - which is defined as an individual's self-construal that is inclusive of how one construes oneself in the present, past and future (Weinreich, 2003). The aims of the research project presented in this thesis were (1) to examine the understandings of individuals with cancer and the community for cancer identities (and in particular the "survivor" identity); and (2) to investigate media representations of individuals diagnosed with cancer that may not only affect the formation of cancer identities in these individuals, but also influence public perceptions and policies. To address these aims, four independent but related studies were conducted. Study 1 addressed the first aim through a systematic review of 24 independent studies, consolidating the current literature about the understanding and endorsement of various cancer identities, in particular the "cancer survivor" identity, in individuals diagnosed with cancer. Analysis of these studies revealed that though "cancer survivor" is a widely accepted term, not everyone diagnosed with the disease would take on the label. Study 2 presented the findings of an online survey that examined lay understandings of cancer identities and survivorship in a sample of 263 crowdsourced adult residents of United States of America (USA) who self-reported not having been diagnosed with cancer. The term "cancer survivor" was mostly viewed as an individual who has beaten cancer, is cancer-free and/or is in remission, an understanding resembling that of individuals diagnosed with cancer rather than reflecting the views of health professionals. Only 57.4% of the respondents considered someone who is 5 years in remission to be a "cancer survivor" and some felt that the term was unnecessary or unhelpful. Study 3 addressed the second aim in a sample of Australian print newspapers published in 2015; Study 4 explored the possibility of cultural differences whereby the Australian study was replicated, using a selection of Singaporean newspapers, which allowed for cross-national cultural comparisons. In both countries, certain cancers were over-represented in the media whereas others were under-reported. The most common portrayal of an individual diagnosed with cancer was that of a female adult under the age of 50 and diagnosed with breast cancer. Although psychosocial issues were the second most frequently mentioned sequelae of cancer, cancer identity issues were not as frequently reported (n = 9 [Australia]; n = 2 [Singapore]). In line with the findings of Study 1, individuals with a cancer diagnosis reported having a lack of cancer identity or refusing to consider the cancer experience as being central to their lives. The "cancer survivor" identity was mostly used by journalists to describe people who have finished treatment, have survived cancer, or are in remission, and also used to describe those who are carrying out cancer-related activities such as fundraising or advocating for better care of those currently undergoing treatment. As hypothesised, Singaporean newspapers had significantly more human interest stories than Australian newspapers, possibly reflecting the greater collectivism of Singaporean culture. In conclusion, this research project highlighted the different understanding of cancer identities within two different populations (individuals with cancer and lay people), an understanding that was reflected in the media studies but not shared by advocacy groups or policymakers. With the term "cancer survivor" being shown not to be endorsed by everyone diagnosed with cancer, the various sectors involved in cancer care should take caution when using it - or use alternative terms that are more sensitive and acceptable. The mismatches between print media depictions of cancer and the actual statistics, and the under- or over-representation of certain cancers, demonstrated the need for accurate dissemination of information from researchers and health professionals to the public when using the media. Future research conducted in non-English speaking countries will be helpful to extend the current findings, because they might have a different understanding for the term "cancer survivor" and/or use other more culturally-accepted terms, and the way cancer and the individuals diagnosed with it are presented in the media will give an indication of public perceptions in those countries.

The purpose of this study is to determine the impact that breast cancer has on identity and how emotional support affects identity formation in women after cancer diagnosis and treatment. While there is much research on the medical treatment of breast cancer and the impact it has on women, there is a gap in research on the identity construction of women who have gone through breast cancer and the impact of emotional support and access to emotional support for them during and after treatment. This is an important aspect of research as demonstrated by the rising number of women diagnosed with breast cancer each year. Because of advances in medicine and emphasis in early intervention, more women are impacted by the emotional aftermath of cancer. In order to accomplish this aim, this study utilizes narrative-based interviews to learn about breast cancer survivors' stories of emotional support and its impact on their identity. This study uses a sociological approach of symbolic interactionism. In addition to the participant interviews, a content analysis of web searches was conducted on topics related to breast cancer in order to understand the information and resources available to breast cancer patients. This research helps evaluate the impact of emotional support for breast cancer patients in connection with medical support.

Identifying and Addressing the Needs of Adolescents and Young Adults with Cancer is the summary of a workshop convened by the Institute of Medicine's National Cancer Policy Forum in July 2013 to facilitate discussion about gaps and challenges in caring for adolescent and young adult cancer patients and potential strategies and actions to improve the quality of their care. The workshop featured invited presentations from clinicians and other advocates working to improve the care and outcomes for the adolescent and young adult population with cancer. Cancer is the leading disease-related cause of death in adolescents and young adults. Each year nearly 70,000 people between the ages of 15 and 39 are diagnosed with cancer, approximately 8 times more than children under age 15. This population faces a variety of unique short- and long-term health and psychosocial issues, such as difficulty reentering school, the workforce, or the dating scene; problems with infertility; cardiac, pulmonary, or other treatment repercussions; and secondary malignancies. Survivors are also at increased risk for psychiatric conditions such as anxiety, depression, substance abuse, and suicide and may have difficulty acquiring health insurance and paying for needed care. Identifying and Addressing the Needs of Adolescents and Young Adults with Cancer discusses a variety of topics important to adolescent and young adult patients with cancer, including the ways in which cancers affecting this group differ from cancers in other age groups and what that implies about the best treatments for these cancer patients. This report identifies gaps and challenges in providing optimal care to adolescent and young adult patients with cancer and to discuss potential strategies and actions to address them.

The purpose of the current investigation was to explore Identity Integration, defined as the reformation of post-illness identities, and its impact on psychosocial well-being among young breast cancer survivors. Two key aspects of identity were assessed: a) illness-related identity-women's experience of themselves in relation to developing breast cancer and b) gender-related identity-women's experience of themselves in relation to stereotypic and hegemonic gender constructions. A triangulation mixed method design was utilized to collect data on identity processes and related shifts among young breast cancer survivors. In the quantitative inquiry, 113 young women breast cancer survivors, diagnosed at age 36.25 (SD=5.89), mostly between stages I-III (93.9%) completed a measure of illness-related identity: the Impact on Self-Concept Scale (ISCS), four measures of gender-related identity: Gender Role Socialization Scale (GRSS), Objectify Body Consciousness Scale (OBCS), Mental Freedom Scale (MF), and Silencing the Self Scale (SS), as well as two measures of well-being: the Functional Assessment of Cancer Therapy-Breast (FACT-B), and the Experience of Embodiment Scale (EES). As predicted, the illness- and gender-related identity subscales were significantly correlated with both measures of well-being. In the multiple regression models, GRSS and MF significantly predicted FACT-B scores, R2=40.0%. In contrast, OBCS and MF predicted EES scores, R2=61%. In the qualitative inquiry, 12 women between the ages of 24 and 44 at diagnosis participated in one interview about identity processes and related shifts before, during, and after their breast cancer experience. Six core dimensions of women's identity emerged in the Constructivist Grounded Theory analysis: 1) Loss and Adversity, 2) Connection to the Physical Body, 3) Social Power Related to Bodily Experiences, 4) Internalization Versus Rejection of Gender- and Illness-Related Discourses, 5) Relational Connections, and 6) Meaning and Life Goals. Related to the centrality of body experiences in these emergent themes, the results suggested that identity was intertwined with bodily experiences and was therefore referred to as 'embodied identity'. Taken together, findings from the study highlighted a critical relationship between young women's altered bodies, illness- and gender-related identities, and their psychosocial well-being after a breast cancer experience. Unlike previous research in psychosocial oncology, which considered identity as disconnected from the body, this study underscored the importance of examining identity through an embodied lens. Theoretical innovation and clinical implications for psychological intervention are discussed.

The experience of cancer can have a significant impact on a person's life and identity. Facing this life-threatening illness in young adulthood can be particularly challenging and disruptive. Young adults diagnosed with cancer frequently experience significant losses, often including the loss of a sense control in life. This can lead to persistent feelings of helplessness and hopelessness, and make it difficult to maintain a sense of self-efficacy. In order for these individuals to adjust to the uncertainty of their situation and the many changes caused by cancer, a renegotiation of identity is necessary. Narrative approaches to psychotherapy are well-suited to facilitate a process of reconstruction of identity. Narradrama specifically, a narrative form of drama therapy, actively engages clients in a process of restorying their lives and experiences, allowing them to reconnect with a sense of personal agency. It is important that young adults affected by cancer have access to appropriate psychosocial support resources that can facilitate psychological healing and growth and help to improve their overall well-being and quality of life. This paper describes a narradrama group therapy intervention developed specifically for young adults affected by cancer. The aim of the intervention is to facilitate a reconstruction of identity in ways that promote a sense of self-efficacy and personal agency.

Health Communication and Breast Cancer among Black Women: Culture, Identity, Spirituality, and Strength addresses how the discourse of strength constructs the identity of Black women even during times of chronic illness through the lens of Black feminist thought and womanist ideology. In doing so, Madlock Gatison explores how the narratives surrounding pink ribbon awareness and survivorship culture, religion and spirituality, and the myth of the strong Black woman impact Black female breast cancer survivors’ self-perceptions, views others had of them, and their ability to express their needs and concerns including those involving their healthcare. This book will be of interest to scholars of public health, health communication, and sociology.

Emotional distress suffuses the experience of cancer survivors and is associated with adverse outcomes. Emotional distress is a response to a circumstance, which threatens the stability of identity. Of the antecedents to emotional distress in cancer patients, symptom burden accounts for the greatest amount of variance. Qualitative studies in populations of cancer survivors have shown that identity affects the experience of emotional distress related to symptom burden. The purpose of this dissertation research was to measure the relationships among symptom burden, identity balance, and emotional distress by testing whether identity balance mediates the relationship between symptom burden and emotional distress in cancer survivors. The research study framework is structured by a proposed path model, which displays the mediated relationship of identity balance, symptom burden and emotional distress. A cross sectional survey design was used, and mediation analysis was conducted to measure the relationships among the variables. Several cancer centers in the state of Colorado, U.S. were used to disseminate the questionnaire and a link to an online version of the survey was also offered. Data were collected using hard copy questionnaires and SurveyMonkey. Analysis of the mediated effect was conducted using SPSS. Results showed a small partial mediation effect of Identity Balance on the relationship between Symptom Burden and Emotional Distress.

This book analyses micro-level gender issues and other social factors impacting macro-level health care systems. Examining the health and health care issues of patients and providers of care both in the United States and in other countries, chapters focus on linkages to policy and population concerns as ways to meet global health care needs.

Cancer can have a profound effect on the well-being of individuals at any age; however, young adults often face additional challenges due to the disruption of many normative developmental tasks associated with this stage in life. One of the most significant tasks associated with young adulthood is the establishment of meaningful relationships. However, many young cancer survivors experience social isolation after treatment and find it difficult to relate to their peers who have forged ahead on the road to independence, careers and families. Self-disclosure, the expression of personal details about oneself, is an essential component of interpersonal relationships and is often viewed as a necessary prerequisite for social support and preventing social isolation. For young adult cancer survivors, disclosing details about their cancer history can be particularly challenging at a crucial developmental stage in life when both personal and professional relationships are just being established. This study provides an in-depth look at the experiences of young adult cancer survivors, their motivations for self-disclosure, and the sense of identity that develops as they attempt to reintegrate back into the social world after the completion of cancer treatment. Using a constructivist grounded theory approach, 28 telephone interviews were conducted with young adults from across Canada diagnosed between the ages of 18-39 with the two most common types of cancer in young men (testicular) and women (breast). This dissertation is presented in three manuscripts. The first manuscript is based on the study methodology and highlights the challenges and opportunities for incorporating reflexivity throughout the research process. The second manuscript focuses on the motivations for cancer history disclosure described by the young survivors in this study and some of the situational/contextual factors influencing their disclosure decisions.The third manuscript highlights some of the ways in which young adult cancer survivors (re)construct, redefine, and/or embrace their identities post-cancer and how they situate their cancer experience within their overall self-concept. This dissertation will be useful in the development of support programs and informational resources related to communication and interpersonal relationships after cancer that are tailored to the unique needs of young adult cancer survivors.

This contributed book covers all aspects concerning the clinical scenario of breast cancer in young women, providing physicians with the latest information on the topic. Young women are a special subset of patients whose care requires dedicated expertise. The book, written and edited by internationally recognized experts who have been directly involved in the international consensus guidelines for breast cancer in young women, pays particular attention to how the disease and its planned treatment can be effectively communicated to young patients. Highly informative and carefully structured, it provides both theoretical and practice-oriented insight for practitioners and professionals involved in the different phases of treatment, from diagnosis to intervention, to follow-up – without neglecting the important role played by prevention.