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Adjustment for breast cancer survivors often involves turning their tragedy into positive meaning

Women who survive breast cancer typically confront fear of cancer recurrence, altered family life and marriage, challenges to sexuality and body image, fatigue and physical discomfort, financial strain, and feelings of loss and anger. However, some women also experience positive effects as a result of their illness. These range from a reappraisal of life, a new attitude toward life, increased self-knowledge or self-change, and reordering of priorities. This ability to attribute positive meaning to their illnesses may be the key to adjustment for these women, according to Elizabeth Johnston Taylor, Ph.D., R.N., of the University of Southern California.

In a study supported by the Agency for Healthcare Research and Quality (National Research Service Award fellowship F32 HS00078), Dr. Taylor interviewed 24 women diagnosed with breast cancer (who varied by race, age, and illness experience) in the past 2 years about how they coped with their illness. The interviews uncovered four phases for transforming the personal tragedy into something positive: encountering darkness, converting darkness, encountering light, and reflecting light. Encountering the darkness involved pain, asking "Why me?", depression, crying, and confusion. The second phase, converting the darkness, involved accepting that some questions were unanswerable and choosing to live beyond the questions. Women in this phase tended to ask, "Where do I go from here?"

The outcome of converting darkness to light was the ability to readily value the benefits or positive meanings inherent in their illness—that is, to see the significance in it. This helped them set priorities, such as family and friends, which in turn led them to encounter the light. They began to enjoy the beauty of nature and each day, adopted an attitude of getting on with their lives, stopped putting things off, and placed value on their time. Those who advanced to stage four, reflecting light, felt that their internal transformation made them a better person and that they were more sensitive to the needs of others. This was typified by involvement in cancer survival organizations or activities. Doctors and nurses can help women adjust to breast cancer by urging them go beyond asking "Why me?" to "How will it make me a better person?" They should not discourage women from encountering the psychospiritual pain necessary for personal transformation, concludes the author.

See "Transformation of tragedy among women surviving breast cancer," by Dr. Taylor in the Oncology Nursing Forum 27(5), pp. 781-788, 2000.

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