The relationship of self-acceptance with decision making duration in cancer patient to perform mastectomy

Abstract

BACKGROUND:

Cancer is a disease caused by abnormal growth of body cells that turn malignant and continue to grow uncontrollably. One of the treatments for breast cancer is mastectomy. The quickness of decision-making determines the survival rate of prognosis patients.

OBJECTIVE:

This study aimed to determine the relationship of self-acceptance with decision-making duration in cancer patients to perform a mastectomy.

METHODS:

An analytic observation method with cross-sectional design. The samples were taken by purposive sampling method with 50 samples of breast cancer patients. Data collected include age, last level of education, marital status, profession, stage of cancer during mastectomy, self-acceptance score, and decision-making duration to perform a mastectomy.

RESULTS:

The data analyzed with the Kruskal–Wallis test. The test showed the relationship of self-acceptance (p = 0.027) with decision-making duration in breast cancer patients to perform a mastectomy.

CONCLUSION:

In conclusion, there is a relationship of self-acceptance with decision-making duration in breast cancer patients to perform a mastectomy.

Keywords

Breast cancer self-acceptance decision-making duration mastectomy

1. Introduction

Cancer is one of the deadliest diseases in the world caused by abnormal cell growth gives rise to malignant and spreads to many parts of the body. Malignant cells cannot die but continue to grow, invasive, and force normal cells to die [1]. Breast cancer is cancer most feared by women around the world, especially in Indonesia. In 2017, an estimated 252,710 new cases of invasive breast cancer will be diagnosed among women worldwide [2]. Nationally, the prevalence of cancer in the Indonesian population in 2013 is 1.4%, or an estimated 347,792 people. The prevalence of cancer in East Java in 2018 has also increased from 2013 and is the seventh-highest in Indonesia [3]. The main goals of breast cancer treatment are to remove the cancer cells and determine the stage of breast cancer. One of the surgical treatment options is mastectomy. Mastectomy is often taken as a method of healing because it has the greatest cure rate [2].

The decision-making process to undergo mastectomy is important. The speed of decision-making determines the prognosis of breast cancer survival rate. The timing and decision-making process differs for each patient. A study finds many patients need recovery time from the shock of initial diagnosis before they can make a treatment decision [4], whereas the longer the decision, the cancer cells will continue to grow. The doubling times of cancer cells are 30 days for the fast-growing type and 90 days for the slow-growing type, so it is intended that the patient can make treatment decisions before that time to a better prognosis.

The number of factors that are considered in the decision-making process will relate to the decision time to perform a mastectomy. One of them is the self-acceptance of breast cancer patients [5,6]. The importance of a woman’s breasts has a dramatic impact on the way she views her body. Depending on the woman, breast loss through mastectomy can have many implications and can lead to emotional conflicts. Self-acceptance of breast cancer women is considered the ability to be kind to themselves and the happiness when suffering from a disease, it is an internal source that affects the women’s coping process as compassion [7]. Evidence suggests that self-compassion is linked to psychological health, and as an internal resource, can help a woman to experience many physical changes when she is exposed to cancer detection unexpectedly [8].

This study aims to determine the effect of self-acceptance on the duration of decision-making in breast cancer patients undergoing mastectomy. A study about women with breast cancer may help us to understand and increase the patient’s health.

2. Method

2.1. Research location

This research was conducted at the oncology department at X hospital Surabaya. It was chosen because it was one type A hospital in East Java that was able to provide specialist and subspecialty medical services. It had been chosen as the highest referral service place because it had comprehensive services for cancer patients.

2.2. Type and sources of data

The data taken were demographic data, including age, latest education, occupation, marital status, and stage of cancer at the time of mastectomy; patient self-acceptance assessed by questionnaire, and the duration of patient decision-making to perform a mastectomy. The data taken was primary data from patients using a questionnaire. The samples were 50 breast cancer patients using the purposive sampling technique.

2.3. Data collection technique

The data collection technique was preceded by submitting research ethics to the hospital. After being approved, data collection was carried out. Before the questionnaires were distributed, the researcher would explain the purpose of the study and asked the patient for permission, and interviewed the patient first whether or not they fitted into inclusion criteria as follows:

Female.

Age of 20–60 years, age at risk of breast cancer.

Patient with stage I–III breast cancer who had undergone mastectomy.

Patient with stage I–III breast cancer who had decided to undergo mastectomy.

The patient was willing to be the research respondent.

The exclusion criteria included patients who had undergone mastectomy for more than 5 years, because of the uncertainty from the results of filling in the data because the adaptation process had taken a long time. After all the inclusion criteria were met, the researcher would distribute the questionnaire. The data taken was demographic data included age, latest education, occupation, marital status, and stage of cancer at the time of the mastectomy. Self-Acceptance was assessed using the Body Image Scale (BIS) questionnaire with four Likert scale alternative answers containing 10 questions [9]. The score for self-acceptance was obtained by calculating the total score on the body image scale questionnaire which the results were divided into four categories, including poor for scores 21–30, moderate for scores 11–20, and good for scores 0–10. The duration of the decision-making to undergo mastectomy was categorized into three, including long (more than 2 months), moderate (1–2 months), and short (0–1 months). The data obtained would be analyzed using the Kruskal–Wallis bivariate test.

3. Result

This study examined the relationship of self-acceptance on the duration of decision-making to undergo mastectomy. The majority of respondents’ ages were in the early elderly phase, aged 46–55 years (64%). Most respondents’ last education was senior high school (48%). Almost all of the respondents were married (98%) and the majority occupations were housewives (58%). The majority of respondents were in stage II when undergone mastectomy (54%).

Table 1
Demographic data of respondents

Characteristics Frequency

n %

Early adulthood (26–35) 2 4

Age (years) Late adulthood (36–45) 16 32

Early elderly (46–55) 32 64

Total 50 100

Elementary school 5 10

Junior high school 8 16

Last education Senior high school 24 48

Vocational high school 5 10

College 8 16

Total 50 100

Marital status Married 49 98

Divorced 1 2

Total 50 100

Private employee (Swasta) 13 26

Housewife 29 58

Occupation Civil servant 6 12

Farmer 1 2

Teacher 1 2

Total 50 100

I 7 14

Cancer stage during surgery II 27 54

III 16 32

Total 50 100

Characteristics		Frequency
	Early adulthood (26–35)	2	4
Age (years)	Late adulthood (36–45)	16	32
	Early elderly (46–55)	32	64
Total		50	100
	Elementary school	5	10
	Junior high school	8	16
Last education	Senior high school	24	48
	Vocational high school	5	10
	College	8	16
Total		50	100
Marital status	Married	49	98
	Divorced	1	2
Total		50	100
	Private employee (Swasta)	13	26
	Housewife	29	58
Occupation	Civil servant	6	12
	Farmer	1	2
	Teacher	1	2
Total		50	100
	I	7	14
Cancer stage during surgery	II	27	54
	III	16	32
Total		50	100

Table 2

The frequency distribution of respondent’s self-acceptance

Characteristic		Frequency
		n	%
	Poor	7	14
Self-acceptance	Moderate	17	34
	Good	26	52
Total		50	100

The distribution of self-acceptance included 7 people (14%) who had poor self-acceptance, 17 people (34%) had moderate self-acceptance, and 26 people had good self-acceptance (52%).

Table 3

The frequency distribution of the duration of the decision-making

Characteristic		Frequency
		n	%
	Long	24	48
The duration of decision-making to undergo mastectomy	Moderate	8	16
	Short	18	36
Total		50	100

The distribution of the duration of decision-making to undergo mastectomy consisted of 24 respondents (48%) who decided in a long time, 8 people (16%) decided in moderate time, and 18 people (36%) decided in a short time.

Table 4

Cross-tabulation between self-acceptance and duration of decision-making to undergo mastectomy

		Duration of decision-making			Total
		Long	Moderate	Short
		n (%)	n (%)	n (%)
Self-acceptance	Poor	7 (14)	0 (0)	0 (0)	7 (14)
	Moderate	8 (16)	4 (8)	5 (10)	17 (34)
	Good	9 (18)	4 (8)	13 (26)	26 (52)
Total		24 (48)	8 (16)	18 (36)	50 (100)

On the self-acceptance variable, the results showed that 7 respondents who had poor self-acceptance and needed a long time in decision-making to undergo mastectomy were 7 people (14%). The respondents who had moderate self-acceptance and needed a long time in decision-making to undergo mastectomy were 8 people (16%). The respondents who had moderate self-acceptance and needed moderate time in decision-making to undergo mastectomy were 4 people (8%). The respondents who had moderate self-acceptance and needed a short time in decision-making to undergo mastectomy were 5 people (10%). The respondents who had good self-acceptance and needed a long time in decision-making to undergo mastectomy were 9 people (18%). The respondents who had good self-acceptance and needed moderate time in decision-making to undergo mastectomy were 4 people (8%). The respondents who had good self-acceptance and needed a short time in decision-making to undergo mastectomy were 13 people (26%).

Table 5

The relationship of self-acceptance on the duration of decision-making to undergo mastectomy

Variable	Sig. (P)
The relationship of self-acceptance on the duration of decision-making to undergo mastectomy	0.027^∗

^∗p < 0.05.

Based on the results of the bivariate analysis test, it was found that there were significant results on the relation of self-acceptance with the duration of patient decision-making to undergo mastectomy.

4. Discussion

Based on these study results, self-acceptance related to the duration of decision-making to undergo mastectomy with a P-value =<0.05. Mastectomy was one big step for breast cancer women. A study stated that the breast was an organ that symbolizes feminism, beauty, and importance for a woman’s life [10]. This type of treatment is understood to represent a major challenge for women, exerting a negative effect on emotional and social aspects. Changes in physical appearance following treatment, limitations in physical functioning and daily activities, limited functioning in previous roles, and the stigma of the disease and failing to accept it can lead to changes in the patient’s self-confidence [11]. Another study showed that patients who submitted to mastectomy are very concerned with their body image [12]. Of the body image domains evaluated in another study, having been submitted to mastectomy resulted in a negative effect only on body image related to appearance [13]. Several women in one study expressed fear of undergone mastectomy because they thought it would change themselves, leading to the postponement of treatment [14]. In another study, all women had negative appraisement regarding their appearance after mastectomy as something ugly, missing, and strange [10].

After being diagnosed with breast cancer, most women indicated that they had difficulty accepting the identity transition from a healthy individual to a patient [15]. Just after receiving the diagnosis, women’s lives have undergone tremendous changes: they may lose their breasts, have to fight disease, and even their lives will be threatened, which caused shock and had a negative impact on the women’s self-efficacy and self-assessment that they are “normal” people and inhibited their ability to self-define [16,17]. This was in accordance with this study results stated that all respondents with poor self-acceptance had a long time in deciding to undergo mastectomy that included in the old category. It because the patients are more concerned about their appearance and other things than their health.

Individuals with self-acceptance have an impact on body perception positive image in cancer patients. High self-acceptance makes individuals have a positive attitude towards themselves, acknowledge and accept some conditions good or bad, and judge positively about lives [18]. Knowing and understanding the current conditions resulting in changes in understanding and thoughts about breast cancer [19] and helped the patients to prioritize their health over physical conditions. Women who accepted themselves positively to undergone mastectomy were more able to tolerate negative emotions and feelings, so they focused more on the stages of treatment, rehabilitation, and restored their health conditions [20]. This was also in accordance with this study results stated that respondents with moderate and good self-acceptance had a shorter time in deciding to undergo mastectomy. However, not all respondents with moderate and good self-acceptance had a short time in decision-making, some of them had a long time of decision-making that was categorized in the old category. It was because there were other factors that more influential than the respondent’s self-acceptance. The development process of self-acceptance among women with breast cancer is also a process of active practice.

The potential limitation of this study was the small sample study. Further study was needed to access additional information on this issue. The sampling method (purposive) was another limitation affecting the generalizability of all studies. Future research is needed to study other factors that are related to decision-making duration in breast cancer patients to perform a mastectomy.

5. Conclusion

In conclusion, this study has determined that there is a relationship of self-acceptance with decision-making duration in breast cancer patients to perform mastectomy with p < 0.05.

Footnotes

Acknowledgements

The researchers would like to thank all people who have helped them in the research process. This gratitude especially goes to breast cancer patients who have participated as respondents of this study and oncology clinic doctors and nurses who have been very supportive during data collection.

Conflict of interest

None.

Funding sources

None.

References

Indonesia KKR. InfoDatin Bulan Peduli Kanker Payudara_2016.pdf, Jakarta, Kemenkes RI.

Paulsson

, Sherertz

, Park

, Breast cancer, Handb. Evidence-Based Radiat. Oncol. 343–399, 2018.

Kementerian Kesehatan

, Badan Penelitian dan Pengembangan Hasil Utama Riset Kesehatan Dasar, Kementrian Kesehat. Republik Indones. 1–100, 2018.

Caldon

LJM

, Collins

, Wilde

, Ahmedzai

, Noble

, Stotter

, Why do hospital mastectomy rates vary differences in the decision-making experiences of women with breast cancer, Br J Cancer , 104(10): 1551–1557, 2011.

Alizadeh

, Khanahmadi

, Vedadhir

, Barjasteh

, The relationship between resilience with self-compassion, social support and sense of belonging in women with breast cancer, Asian Pac J Cancer Prev , 19(9): 2469–2474, 2018.

Bellavance

, Kesmodel

, Decision-making in the surgical treatment of breast cancer: Factors influencing women’s choices for mastectomy and breast conserving surgery, Front Oncol , 6: 1–7, 2016.

Raes

, The effect of self-compassion on the development of depression symptoms in a non-clinical sample, Mindfulness (N.Y.) , 2(1): 33–36, 2011.

Neff

. Self-Compassion , . Leary

, Hoyle

(eds), Guilford Press; 2009.

Hopwood

, Fletcher

, Lee

, Al Ghazal

, A body image scale for use with cancer patients, Eur J Cancer , 37(2): 189–197, 2001.

10.

Kocan

, Gursoy

, Body image of women with breast cancer after mastectomy: A qualitative research, J Breast Heal , 12(4): 145–150, 2016.

11.

Leite

MAC

, Nogueira

, Terra

de FS

, Evaluation of self-esteem in cancer patients undergoing chemotherapy treatment, Rev Lat Am Enfermagem , 23(6): 1082–1089, 2015.

12.

Rosenberg

, Tamimi

, Gelber

, Ruddy

, Kereakoglow

, Borges

, Body image in recently diagnosed young women with early breast cancer, Psychooncology , \unskip\break 22(8): 1849–1855, 2013.

13.

Carolina

, Prates

, Freitas-Junior

, Ferreira

, Prates

, De Faria Veloso

, Influence of body image in women undergoing treatment for breast cancer influência da imagem corporal em mulheres em tratamento contra câncer de mama, Rev Bras Ginecol Obs , 39: 175–183, 2017.

14.

Memon

, Shaikh

, Rizwan

, Sardar

, Reasons for patient’s delay in diagnosis of breast carcinoma in Pakistan, Asian Pac J Cancer Prev , 14(12): 7409–7414, 2013.

15.

Chen

, Sun

, Ge

, Su

, Li

, The development process of self-acceptance among Chinese women with breast cancer, Japan J Nurs Sci , 17(2): 1–8, 2020.

16.

Karnilowicz

, Identity and psychological ownership in chronic illness and disease state, Eur J Cancer Care (Engl) , 20(2): 276–282, 2011.

17.

Paterson

, Lengacher

, Donovan

, Kip

, Tofthagen

, Body image in younger breast cancer survivors: A systematic review, Cancer Nurs , 39(1): E39–E58, 2016.

18.

Hernandez

, The right reflection: Improving women’s self- acceptance, Master Appl Posit Psychol , 562014.

19.

Naughton

, Weaver

, Physical and mental health among cancer survivors: Considerations for long-term care and quality of life, N C Med J , 75(4): 283–286, 2014.

20.

Izydorczyk

, Kwapniewska

, Lizinczyk

, Sitnik-Warchulska

, Psychological resilience as a protective factor for the body image in post-mastectomy women with breast cancer, Int J Environ Res Public Health , 15(6): 1181, 2018.