title: Perspectives of the Breast Cancer Survivorship Continuum: Diagnosis through 30 Months Post-Treatment.
abstract: This study explored breast cancer survivors' perspectives regarding their experiences of the survivorship continuum from diagnosis through 30 months post-treatment. The sample included women (N = 379) with newly-diagnosed breast cancer undergoing treatment at a Midwestern university-affiliated cancer center. Semi-structured interviews were conducted using the Lymphedema and Breast Cancer Questionnaire at time of diagnosis, post-operatively, quarterly during the first year, and then semi-annually thereafter through 30 months post-treatment. A mixed-methodology was used to analyze participants' comments. Themes central to long-term survivorship experiences included social support, positive worldviews, breast cancer and lymphedema health literacy, religious/spiritual beliefs, self-empowerment, and recovery expectations. These themes were consistent with a psychoneuroimmunological model of health in which psychosocial variables mediate stress and influence health outcomes. Qualitative data showed that social support and positive worldviews were the two themes with the most significant impact on long-term breast cancer survivorship experiences. Survivors expressed a need to advance their health care literacy in order to share ownership of breast cancer and lymphedema treatment decisions. Since breast cancer is an immune-mediated disease, long-term survivorship planning should address psychosocial factors that influence the long-term psychological distress associated with immune dysfunction.
authors.affiliation: Sinclair School of Nursing, Ellis Fischel Cancer Center, University of Missouri-Columbia, DC 116.05 Suite 408 Mizzou North, University of Missouri, Columbia, MO 65211, USA. jmh5f3@mail.missouri.edu.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Hulett
authors.affiliation: Sinclair School of Nursing, Ellis Fischel Cancer Center, University of Missouri-Columbia, DC 116.05 Suite 408 Mizzou North, University of Missouri, Columbia, MO 65211, USA. armer@missouri.edu.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Armer
authors.affiliation: Sinclair School of Nursing, Ellis Fischel Cancer Center, University of Missouri-Columbia, DC 116.05 Suite 408 Mizzou North, University of Missouri, Columbia, MO 65211, USA. stewartb@missouri.edu.
authors.forename: Bob R
authors.initials: BR
authors.lastname: Stewart
authors.affiliation: Sinclair School of Nursing, Ellis Fischel Cancer Center, University of Missouri-Columbia, DC 116.05 Suite 408 Mizzou North, University of Missouri, Columbia, MO 65211, USA. wausanee@hotmail.com.|Boromarajonani College of Nursing Buddhachinaraj, Muang, Phitsanulok 65000, Thailand. wausanee@hotmail.com.
authors.forename: Ausanee
authors.initials: A
authors.lastname: Wanchai
keywords: breast cancer; health literacy; long-term survivorship; psychoneuroimmunology; self-empowerment; social support; spiritual/religious beliefs; worldview