{"paper_id":"48b6ffe0-e48d-4786-86f8-63c393b1a464","body_text":"Coping with Breast Cancer in Ghana: A Qualitative Study of Women’s Lived Experiences Following Breast Cancer Diagnosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Coping with Breast Cancer in Ghana: A Qualitative Study of Women’s Lived Experiences Following Breast Cancer Diagnosis Dzifa A. Attah, Josephine Nsaful, Promise E. Sefogah This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7834537/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Mar, 2026 Read the published version in BMC Cancer → Version 1 posted 11 You are reading this latest preprint version Abstract Objective Breast cancer remains a global concern as the most commonly diagnosed cancer and the leading cause of cancer death among women. In Sub-Saharan Africa, although breast cancer accounts for the highest burden of mortality in women, there is little documentation on the experience of having breast cancer. This article explores the lived experiences of a group of Ghanaian women diagnosed with breast cancer. Materials And Methods The findings presented here, are drawn from a broader mixed-methods study on breast cancer and fertility preservation. Women receiving treatment between November 2023 and January 2024 at two study sites – Korle Bu Teaching Hospital and the National Radiotherapy, Oncology and Nuclear Medicine Center in Ghana were purposively sampled for recruitment. A total of 300 women were conveniently sampled to participate in a cross-sectional survey. Out of this number, 15 willingly agreed to participate in a semi-structured interview to explore their experiences of living with breast cancer. The interviews were audio-recorded, transcribed, and analyzed for key themes and patterns. Results The diagnosis of breast cancer marked a pivotal point in the lives of these women, characterized by acute focus on survival. This diagnosis seemed to precipitate a cascade of psychological responses, including catastrophic thinking and an overwhelming preoccupation with mortality, anxiety and sadness. The ramifications of cancer treatment further compounded the experience of emotional and physical toll, manifesting in a myriad of challenges such as fertility complications, impaired daily activities, and diminished social, occupational, and educational functioning. Despite this life-changing circumstance, some participants demonstrated a subsequent healthy adaptation as they navigated the recovery journey using coping skills largely influenced by the tenets of religion, trusted social ties and medical expertise. Conclusion The women’s narratives highlight a journey of recovery characterized by initial grief reactions, subsequent acceptance, adaptation, and the hope of recovery. Religious beliefs and social connections played vital roles in the recovery process, underscoring the need to incorporate these into existing service delivery care models. Impact Statement: By amplifying the voices and experiences of women living with breast cancer, we can culturally inform routine services and targeted strategies to enhance support, education, and resources for individuals and communities affected by breast cancer in Ghana. lived experiences breast cancer diagnosis women psychological coping INTRODUCTION Breast cancer is a critical public health challenge globally, significantly impacting the health and overall well-being of many middle-aged women and contributing substantially to cancer-related mortality [ 1 ]. In the year 2022, 157 out of 185 countries recorded breast cancer as the most commonly diagnosed cancer among women [ 1 ]. In 2020, Ghana recorded 4,645 new cases of breast cancer and 2,233 fatalities [ 2 ]. In low- and middle-income countries (LMICs) countries such as Ghana, a lack of awareness, late-stage detection, inadequate access to quality healthcare and resources, cultural beliefs and stigma adversely affect health-seeking behaviour, adherence to treatment and ultimately, survivorship of the disease [ 3 ][ 4 ][ 5 ][ 6 ][ 7 ][ 8 ]. Research shows that individuals diagnosed with breast cancer often face challenges in their daily activities, such as self-care, household tasks, and mobility, due to physical symptoms caused by the disease and its treatment [ 9 ][ 10 ][ 11 ][ 12 ]. Cognitive impairments are also commonly experienced by women with breast cancer [ 13 ]. Financially, breast cancer imposes significant costs, including medical expenses and lost income [ 14 ][ 15 ][ 16 ]. Disparities in the financial burden can exacerbate existing inequalities in gaining access to care [ 17 ]. Notably, breast cancer is a difficult condition that can pose considerable physical and emotional obstacles. Lazarus and Folkman's Transactional Model of Stress and Coping sheds light on how women perceive and respond to many aspects of breast cancer diagnosis and treatment [ 18 ]. For example, upon receiving a breast cancer diagnosis, women appraise the significance and implications of their condition, including the perceived threat to their health and well-being [ 18 ]. In essence, they evaluate their condition and the potential impact of this on their physical, mental, or overall quality of life. In response to their diagnosis and its ramifications for their future, women may experience a variety of emotions, such as shock, anger, fear and despair. The appraisal is crucial in determining how women will cope with their diagnosis and treatment. Following the initial evaluation, women proceed to secondary appraisal, where they conduct an assessment of their coping resources and analyse the available options for managing breast cancer-related stressors, such as treatment decisions and emotional discomfort [ 18 ]. This evaluation includes determining how effectively a person feels they can handle the difficulties presented by their illness as well as utilize coping mechanisms, useful resources, and social support. In addition to employing external resources like assistance from friends, family, medical experts, and support groups, women may also rely on internal resources like optimism, resilience, and self-efficacy. Women may use a combination of emotion-focused coping strategies, like reaching out to family and friends and finding purpose in their cancer experience, and problem-focused coping strategies, including adopting healthy lifestyle choices, such as diet and exercise, searching available treatment programmes and also making decisions about medical care, to manage the complex stressors associated with breast cancer [ 18 ]. Accordingly, dealing with breast cancer is considered a dynamic process in which each person's assessment and coping mechanisms may change over time in response to the illness's shifting demands [ 18 ]. Despite the high prevalence of breast cancer in Ghana as the leading cancer in women, research on the experiences of women living with breast cancer in Ghana appears limited [ 4 ], creating a major knowledge gap. This study therefore explored the lived experiences of these women, with the view to generating scientific data that informs the development of tailored policy, interventions and support systems for improving their quality of life. METHOD AND MATERIALS The findings presented here are drawn from a broader mixed-methods research study on breast cancer and fertility preservation [ 38 ]. Women receiving treatment between November 2023 and January 2025 at the Breast Clinic of Korle Bu Teaching and the National Radiotherapy, Oncology & Nuclear Medicine Center in Ghana were purposively sampled and recruited into the study. A total of 300 women were conveniently sampled and participated in a cross-sectional survey. Out of this number, 15 women willingly agreed to participate in a qualitative semi-structured interview that explored their experiences of living with breast cancer. We explored the experiences of women living with breast cancer using a semi-structured interview schedule guide purposely developed and designed by the research team (see supplementary file 1). This guide was pretested with two women and revised and refined for final use. Details of this guide have previously been published [ 38 ]. Interviews were audio-taped. Audiotaped and transcribed, with each audiotape played repeatedly to ensure the accuracy and correctness of each transcript. A content analysis was conducted to identify emerging themes and sub-themes, using the NVIVO analysis software. The coding process involved creating a code book based on the interview guide and research questions, followed by inductive coding to capture emergent themes from the data]. To ensure rigor, two members of the research team with a background in qualitative research coded the transcripts independently, and subsequent the inter-coder reliability was assessed. Discrepancies between the researchers were resolved through discussion and consensus. The resulting data is presented using themes and sub-themes, in a thematic table, supported with direct quotes from participants. Ethical approval was obtained from the Institutional Review Board of the Korle Bu Teaching Hospital (KBTH-IRB/00039/2023). Prior to their involvement in the study, all participants gave informed consent, and appropriate measures were put in place to uphold privacy and anonymity. All interviews were held in private secured rooms to ensure adequate privacy and the participants’ comfort. RESULTS Of the 300 participants surveyed, 15 women willingly agreed to share their lived experiences of receiving a confirmed diagnosis of breast cancer from a medical practitioner. The study results show a profile of women aged between 32 - 49 years with the majority (7) of them having a basic level of education. Participants’ occupations included businesswomen, nurses, policewomen, caterers, administrators, and traders, among others. Some participants reported having no children, while others had up to four children. The timeline of receiving a diagnosis of breast cancer ranged from 2016 to 2023 (See Table 1). Table 1: Participants’ Demographic Characteristics No. Identity Age Year diagnosed Occupation Educational level Children 1 Patient 1 Undisclosed 2016 Undisclosed Tertiary 1 2 Patient 2 41 2022 Undisclosed Undisclosed Undisclosed 3 Patient 3 44 2023 Unemployed JSS 3 4 Patient 4 42 2019 Businesswoman JSS Undisclosed 5 Patient 5 37 2020 Nurse Tertiary 3 6 Patient 6 44 2021 Businesswoman JSS 4 7 Patient 7 44 2022 Policewoman Tertiary Undisclosed 8 Patient 8 48 2017 Businesswoman JHS 3 2 9 Patient 9 46 2021 Unemployed JSS 4 10 Patient 10 43 2023 Entrepreneur SHS Undisclosed 11 Patient 11 44 2022 Caterer JHS Undisclosed 12 Patient 12 39 2018 Unemployed Uneducated None 13 Patient 13 49 2021 Administrator Tertiary None 14 Patient 14 49 2021 Unemployed SHS 1 15 Patient 15 32 2022 Trader JSS 2 Table 2: Symptom that alerted possible breast cancer across participants’ marital status Three major themes were identified from the qualitative data. The first theme, “Initial reactions” reveals the preliminary reactions of the participants upon receiving a diagnosis of breast cancer. The second theme, “emerging challenges and disabilities,” describes the effects and impairments these women experienced due to the disabling nature of their condition. Finally, the third theme “healthy adaptation, coping and hope” showcases the growth and the ability of these women to adapt to living with breast cancer. (Table 3) Table 3: Summary of Thematic Analysis THEME SUBTHEMES Initial reaction Catastrophic thinking Preoccupation with sadness and anxiety Emerging disabilities: The reduced capacity to work and reproduce The reduced capacity to work: The impact of fatigue, pain and stress reproductive health concerns Healthy adaptation, living and coping Healthy adaptation Living and coping Selective disclosure Theme 1: Initial reaction Two main sub-themes emerged to describe the initial reaction of participants upon receiving a diagnosis of breast cancer: Catastrophic thinking, and preoccupation with sadness and anxiety. Subtheme 1: Catastrophic thinking Receiving a diagnosis of breast cancer can be incredibly daunting, particularly in the light of how it is appraised. Participants initial reactions were characterised by catastrophic thinking, marked by shock and the imagining of worst-case scenarios. Exemplifying the initial shock and disbelief, one woman shared: I was most worried in the beginning because I didn’t think it would happen to me (Patient-11, 44years, 2022). Worrying was a prominent reaction for these women “Hmm at the time, …. I used to think about it a lot.” (Patient-4, 42years, 2019). Another woman echoed similar sentiments, describing the preoccupation of negative thoughts which was founded on societal myths about breast cancer progression and treatment: What people say about this disease, they say that treatment can either kill you or spoil your chances of ever having children. So as soon as someone is diagnosed, their mind is immediately filled with several thoughts (Patient-9, 46years, 2021). In the early stages, participants were preoccupied with thoughts about treatment implications, including mortality, body disfigurement and possible recurrence: I used to think that I will not stay long in this world, ... that I would die early since I have cancer. Those were the particular thoughts in my mind (Patient-8, 48years, 2017). My breast, that’s what I think about often because I don’t want them to cut it (Patient-15, 32years, 2022). Even though I knew how it can affect others, I wasn’t really scared. Aside losing one breast, (Patient-11, 44years, 2022) Psychologically too, it's been stressful. Like, you are always thinking of it that it might even recur. I’m not comfortable at all; it's been so stressful, generally (Patient-13, 49 years, 2021). Interestingly, some women were overlyconcerned, particularly regarding their children, both born and unborn. I think of the fact that I may not be able to take care of my children further in their lives. That thought comes to mind a lot (Patient-3, 44years, 2023) . Another who was pregnant at the time of diagnosis recounted: In the beginning phases my mind was just floating, so, I didn't really pick up a lot of the things that were said. I was pregnant during diagnosis, and I was more concerned if the pregnancy would still hold (Patient-1, undisclosed age, 2016). Unhealthy thought patterns regarding the diagnosis of breast cancer and its implications contributed to subsequent experiences of sadness and anxiety. Subtheme 2: Preoccupation with sadness and anxiety Participants also reported an overwhelming sense of sadness, anxiety and feelings of abandonment upon receiving the diagnosis. Oh, it wasn’t easy. I cried that day, I really cried. And I was greatly sad in this world I came to. (Patient-2, 41years, 2022). I was anxious, I was afraid…I thought was just going to die (Patient-5, 37years, 2020). Well, you know, from the beginning, when you are told you have cancer, not all people will sympathize with you but, you know, the people you think will be there for you might not be there. (Patient-13, 49years, 2021) Theme 2: Emerging disabilities: The reduced capacity to work and reproduce For these women living with cancer was life-changing, resulting in impaired daily functioning and disabling effects that affected work and reproduction. Subtheme 1: The reduced capacity to work: The impact of fatigue, pain and stress Recounting their experiences of treatment, some participants shared: I'm not strong like I used to be. (Patient-13, 49years, 2021). before I went through chemo, I was strong but now I get tired when I walk for a bit. (Patient-15, 32years, 2022). When I was taking chemo, I saw some of the women who came out of surgery. I saw how drained they were. Referring to her previous work functioning, one participant reported: how I could work previously, I can't work like that now. It’s like strength now is not how it was before (Patient-14, 49years, 2021) . The pain associated with chemotherapy caused a decline in work functioning: because of the pains, how I used to work at first isn’t the same now. I am managing bit by bit (Patient-3, 44years, 2023). Others reported the pain was so disabling that they reported not being able to work , It’s the pain that has affected me the most. I’m in so much pain that I can’t even work again (Patient-9, 46years, 2021). The stress of going through extended breast cancer treatment can affect one’s ability to continue working. it’s a long process of treatment, so I ended up not working. I'm not working again because of the process and then physically too. Explaining the impact of the breast cancer treatment on their daily lives, one woman shared: It has changed my life drastically, I would say. Yeah, in a lot of ways, dealing with... I mean, you have a plan, and then later you realize you have cancer. So, then everything has come to a standstill, because you have to go through treatments, and it takes a while (Patient-10, 43years, 2023). For some, living with breast cancer diagnosis seemed to impair one’s capacity to work, such that they had to stop working. One woman shared how she had to close down her business because of her condition. I used to have a provisions shop at first, but when it happened like that, I couldn’t do it. Because when I was sick, I couldn’t do anything to help myself, so I even sold it. Like it brought me a lot of issues that pushed me back (Patient-8, 48 years, 2017). Another participant narrated how she could no longer pursue her dreams as dealing with breast cancer was stressful. Yeah. I was planning to go back to school. I was planning to get a job. All these things had to change. Because some of them are time-bound. Like going to school now, I can't go to school again. Because you can't do those. It's stressful. I mean, so it has affected my future. (Patient-13, 49 years, 2021). Not only did it affect their lives but also family as they had to make some sacrifices to take care of them, one woman explained: My firstborn was supposed to be in the boarding house in 2017, but because of my illness, he went to day school so that he could take care of me. (Patient-8, 48years, 2017) Subtheme 2: Reproductive health concerns In addition to affecting participants’ work and school plans, some patients described how their fertility was affected, due to treatment. They couldn’t give me protection for the womb. And so, for mine they said that I will have to become menopausal do you understand? And so, I agreed for me to go menopausal for the treatment to happen. (Patient-2, 41years, 2022) One participant, only realized the impact on her fertility, after chemotherapy , It was after the chemo that I told the doctor that my menses was not coming and he said that it would not come (Patient-6, 44years, 2021) Another participant expressed confusion about the medical implications of treatment and egg storage, she stated: I remember the doctor telling us that the treatment can attack the womb and when that happens, the womb and ovaries would have to be removed. What I don’t understand is, how can the eggs be stored if the womb and ovaries are to be removed? (Patient-9, 46years, 2021). The quotes cited above suggest that some women may not have been fully prepared for the potential effects of treatment on their reproductive health. Theme 3: Healthy adaptation, living and coping Subtheme 1: Healthy adaptation Some women demonstrated the ability to experience growth and healthy adaptation, despite the struggles associated with breast cancer. Ah with me, nothing has changed. I’ve been doing the same things I was doing before my diagnosis, like working in the house. (Patient-12, 39 years, 2018). Others regained physical strength and restoration of functional abilities, during treatment: Oh, there was some weakness when I first started chemo, where you get tired after doing something. But God being so good, after my first rounds of chemo, I saw that I had recovered. It hasn’t really affected my day-to-day dealings. It didn’t really weaken me or change a lot of things in my life. (Patient-11, 44years, 2022) The trauma I went through it wasn’t okay but now it’s okay. (Patient-7, 44years, 2022) I am okay. I am strong. I am fit. My life is fine. There is nothing wrong going on. You see at first when I did the surgery …, I couldn’t lift things but now I can do so (Patient-6, 44years, 2021). So yes, I had to stop work for some time just to take treatment and all of that, and I resumed. So, in the beginning, it was a little rough but then, we’ve come so far. (Patient-1, 2016) Subtheme 2: Living and coping Drawing on three major factors, women disclosed how they had coped with their illness: through the use of religion, social connections and following the doctors’ recommendations. Some participants indicated their religious belief helped to create a positive outlook despite the cancer diagnosis, address negative thinking patterns and fear, and minimize functional impairments suffered. Although I had heard of it, but I didn’t think it would happen to me. I’ll say because of my standing in Christ, I began to worry and fear less, and because I had made up my mind to defeat the disease, it didn’t weaken me as much. (Patient 11, 44years, 2022) Oh, what I think is that God is the healer and so He is the one I am looking up to (Patient-3, 44years, 2023). Having strong social connections with family and friends helped to buffer patients from the stress associated with breast cancer: Close family members and friends supported me physically and spiritually, so it didn’t have that much of an effect on me. (Patient 11, 44years, 2022). My sisters actually take good care of me. (Patient-12, 39years, 2018). My family was a great support. My mother, my siblings, my external relations, they all supported me throughout the process of the treatment. Yeah. (Patient-13, 49years, 2021) One woman reported her diagnosis had created an opportunity for growth, and also strengthened her social relationships in this time of adversity. It has strengthened the relationships I have with friends, relationship with family. I had a lot, a lot of support, massive love. So, if anything, it has strengthened the relationship. (Patient-10, 43years, 2023) Others leveraged the recommendations from their doctors to navigate the challenges resulting from their cancer diagnosis: I had hope that no matter what this illness meant, what I could do was to follow the recommendations of the doctor to help myself. (Patient-2, 41years, 2022) The doctors made me aware that when you do the chemo, it affects your system. So, it isn’t a hundred percent sure that you can give birth afterward. The doctors made me aware of that. (Patient-8, 48years, 2017) The doctor told me when they found out that, I would have to undergo chemo for eight months, then undergo surgery. He reassured me that the surgery was safe and I would come out alive to take care of my family. So, I thanked him for reassuring me. What he told me really made me happy, and made me so calm because I knew God would see me through every situation (Patient-9, 46years, 2021) On the whole, the narratives of these women with breast cancer revealed their resilience in the face of breast cancer diagnosis, treatment and life after that. Subtheme 3: Selective disclosure. Many survivors chose to keep their condition private sharing their diagnosis with a few trusted persons, mainly close family: I didn’t really tell that many people. It was private for me. (Patient 11, 44 years, 2022) I didn’t tell many people; just my family and siblings. Even where I work, all they know is that my breast hurt. They don’t know what became of that or what I was diagnosed with. (Patient-12, 39years, 2018) For one participant, the decision to remain secretive was driven by the desire to maintain privacy and avoid unsolicited advice on healthcare. I also didn’t tell others. You see when you tell people around what it is, someone may tell you to do such medication, go to herbal medications and others and so I didn’t want anyone to give me such ideas. What I knew to do was to go to the hospital but I was fine with everyone. It was just my sister, mother and sister who knew I had such a problem. (Patient-2, 41years, 2022) Selective disclosure seemed to allow the participant to maintain control over their health status, while allowing them privacy and autonomy over their recovery process. DISCUSSION This study examined the lived experiences of women undergoing breast cancer treatment. The ages of women diagnosed with breast cancer highlight a significant peak in the 40–45 age group, (38.0% of participants). This is consistent with global trends indicating an increased incidence of breast cancer with age [ 19 ]. Also, research by Jedy-Agba et al. [ 7 ] had revealed that the median age at diagnosis of breast cancer in Sub-Saharan Africa, including Ghana, is notably lower compared to high-income countries, emphasizing the disproportionately higher burden of breast cancer among younger women in this region. These underscore the importance of targeted screening and early detection efforts among middle-aged women in Ghana to enhance outcomes and alleviate the burden of breast cancer on this economically viable population. A significant proportion of participants (29.3%) had attained basic education, while 25.3% had completed secondary school. This underscores the importance of tailored health education and awareness programmes for different educational levels to ensure equitable access to essential breast cancer information and screening services for all women. From this study, although a considerable proportion of women in Ghana took the initiative to seek medical assistance when they detected breast cancer symptoms, a significant group either postponed seeking professional help or chose alternative remedies. For example, previous studies have revealed that some Ghanaian women may adopt the strategy of incorporating traditional healing practices, including herbal remedies and traditional medicine, in conjunction with conventional breast cancer treatments [ 6 ]. This finding underscores the need for culturally sensitive approaches to health education and promotion in Ghana. Understanding the preferences and beliefs of Ghanaian women regarding healthcare practices can help inform the development of effective interventions. This intervention may involve collaboration with traditional healers or community leaders to promote the benefits of early detection and evidence-based treatment options for breast cancer. Understanding healthcare preferences and needs are important when diagnosing and treating breast cancer as women have to make complex decisions about their health, often influenced by various factors including societal pressure and personal relationships. Interestingly, qualitative results from our study indicate the resistance to disclosing a diagnosis of breast cancer to maintain privacy and to avoid unsolicited health advice from people other than trusted connections. This finding illustrates that some women are initiating attempts to control potential social influence over their healthcare, which appeared empowering and a helpful coping mechanism. This outcome underscores the need for health professionals to respect the privacy and autonomy of clients and provide them the needed guidance and support to make informed decisions, while they seek care. Many women in this current study primary appraisal of breast cancer was catastrophic, characterised by excessive rumination, and the imagining of worst possible outcomes. These women initially perceived the diagnosis as a threat to their wellbeing and health and in turn these negative thoughts evoked a range of negative emotions such as sadness, feelings of abandonment and anxiety. These reactions are consistent with Lazarus and Folkmans (1984) transactional model of stress and coping, which explains how people process and cope with difficult situations such as a breast cancer diagnosis and treatment [ 20 ]. This study also found that receiving a cancer diagnosis and commencing treatment was life changing and often characterised with functional impairment and emerging disabilities. Many women reported a decline in their working ability as they grappled with the fatigue, pain and stress caused by their illness and treatment. Previous studies report similar findings with medical procedures including surgery, chemotherapy, and radiation therapy, causing patients physical discomfort, fatigue, and changes in appearance [ 21 ][ 22 ][ 6 ][ 23 ]. Other research work highlights the difficulties survivors have preserving their careers, balancing work and personal obligations, and encountering unsupportive managers and colleagues [ 24 ][ 25 ][ 26 ]. In this study, participants also reported experiencing educational setbacks due to their breast cancer diagnosis. Some women were unable to pursue their educational goals, and so had to forgo their educational aspirations. This is consistent with findings by Maggio et al. (2020), who examined the educational repercussions of breast cancer among younger women with academic or vocational ambitions [ 27 ]. Other studies also report that patients encounter obstacles in their educational pursuits, such as schooling and career progression disruptions and difficulties maintaining satisfactory academic performance [ 28 ][ 29 ]. In this present study fertility loss seemed a major concern faced by the participants particularly because they did not seem well informed or prepared for the potential effects of treatment on their reproductive health. Previous reports suggest breast cancer and its treatments present significant obstacles to fertility in reproductive-age women, potentially resulting in ovarian dysfunction, premature ovarian insufficiency, or infertility [ 30 ][ 31 ]. According to Bonsu et al., (2014) some Ghanaian women report failed dreams of marriage and motherhood due to their experience of breast cancer [ 32 ]. The lack of clear communication between healthcare professionals and some of these women was apparent as they recounted loss and still seemed to grapple with unanswered questions about fertility preservation options. This underscores the significance of comprehensive support and survivorship care plans for patients [ 33 ]. The coping strategies employed by the women in this study included a reliance on religious beliefs, social support networks, and advice from medical professionals. Some patients found solace in their faith and subsequently found purpose to live, and the strength to persevere despite the grim prognosis. Related studies highlight the importance of patients drawing strength and comfort from religious and spiritual convictions as a coping mechanism. This involves engaging in prayer, meditation, and religious practices in Ghana [ 32 ][ 34 ]. Studies have shown that seeking support from family, friends, spiritual leaders, medical experts and support groups is a common coping mechanism for women with breast cancer, providing them with emotional reassurance, understanding, and practical assistance [ 32 ][ 35 ][ 36 ]. Consistent with Lazarus and Folkman’s model of transactional stress, these women seem to rely on both emotional and problem coping strategies sourced from family, friends, spiritual leaders and medical experts. Previous studies report that these strategies help breast cancer patients maintain a sense of control, resilience, and emotional well-being [ 34 ]. The results also indicated that, as a coping strategy, these women are selective of who they disclose their illness to. An earlier study in Ghana highlighted the importance of seeking social support from trusted persons as a prevalent coping strategy for women facing cancer [ 32 ][ 37 ]. The emotional and psychological benefits of having a strong support system during the challenging journey of breast cancer treatment cannot be overemphasized. Women who felt supported by their loved ones reported feeling less anxious, depressed, and isolated, and were better able to maintain a positive outlook on their recovery. Conclusions The diagnosis of breast cancer invoked a cascade of physical and psychological responses, including catastrophic thinking and overwhelming preoccupation with anxiety, sadness and feelings of abandonment. The dynamics of breast cancer treatment further compounded the patients’ experiences of emotional and physical distress stemming from particularly fertility complications, impaired daily activities, and diminished social, occupational, and educational functioning. Religious beliefs, social connections, and professional medical advice played vital roles in helping the patients to cope, and therefore, underscore the need for incorporating these tenets into routine breast cancer management. Implications f or Healthcare Practices and Support Services The overall quality of life, encompassing physical, psychological, and social well-being, can greatly impact a woman's ability to navigate the difficulties associated with breast cancer. The findings highlight the urgent need for tailored psychosocial support services in Ghana's healthcare system to address the significant psychological effects of breast cancer diagnosis and treatment. Healthcare professionals need to be aware of these emotional reactions and provide appropriate support and interventions to help women cope with their diagnosis and treatment. It is also important to be mindful of individual preferences and beliefs, incorporating culturally sensitive approaches that include religious and social support into the care framework to assist with adjustment and recovery. By amplifying the voices and experiences of women dealing with breast cancer, culturally sensitive interventions can be developed to enhance support, education, and resources for affected individuals and communities in Ghana. Additionally, proactive discussions and access to fertility preservation services are crucial in empowering women to make informed decisions about their reproductive health, after receiving a diagnosis of cancer. Limitations and Future Research Directions This qualitative study provides valuable insights among women with a lived experience of breast cancer in Ghana. However, few women were willing to take part in the qualitative study, thus the results are limited by the small sample size of 15 participants which may not fully capture the diversity of experiences. Future research could explore conducting a cross-sectional study with a larger sample to enhance the generalizability of the findings. The sampling method may have introduced a selection bias of participants. Similarly, the reliance on self-report is subject to other biases related to recall and social desirability. Further research is warranted to explore the factors influencing the healthcare-seeking behaviours of Ghanaian women with breast cancer. By identifying barriers and facilitators to timely medical intervention, targeted interventions can be developed to improve outcomes and reduce disparities in breast cancer care in Ghana. Ultimately, by addressing the unique needs and preferences of Ghanaian women, strides can be made towards improving breast cancer outcomes and promoting overall health and well-being in the community. Declarations Ethical Approval and Consent to participate Ethical approval was obtained from the Institutional Review Board of the Korle Bu Teaching Hospital (KBTH-IRB/00039/2023). Prior to their involvement in the study, all participants gave informed consent, and appropriate measures were taken to uphold their privacy and anonymity. All participants provided informed consent prior to being enrolled in the study. The study was implemented in compliance with the ethical principles outlined in the Declaration of Helsinki, and the ethical guidelines and applicable laws and regulations in Ghana. Consent for Publication All participants provided informed consent prior to being enrolled in the study, as well as consent for publication of the study findings without any identifiers or personal information. Competing Interests All authors have declared no conflict of interest. Funding Statement This study received no funding or grant support. Author Contribution Conceptualization: PES and DAA. Methodology: PES, DAA, and JN. Investigation: PES, JN, and DAA. Data curation and analysis: DAA. Data validation: PES, JN. Drafting of manuscript: DAA and PES. Editing of manuscript: JN, PES, and DAA. Final revision and approval of manuscript: All authors have read and approved the manuscript for submission. Correspondence Author: PES Acknowledgement The authors are grateful to the staff of the Breast Clinic, Korle Bu Teaching Hospital and the National Radiotherapy, Oncology and Nuclear Medicine Center for their support during the data collection for this study. 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Breast Cancer Survival Experiences at a Tertiary Hospital in Sub-Saharan Africa: A Cohort Study. World J Surg Oncol. 2015;13:1–8. https://doi.org/10.1186/s12957-015-0632-4 . Kugbey N, Meyer-Weitz A, Oppong Asante K, Yarney J, Vanderpuye V. Lived experiences of women receiving medical treatments for breast cancer in Ghana: a qualitative study. Sage Open. 2021;11(3):21582440211045077. https://doi.org/10.1177/215824402110450 . Jedy-Agba E, McCormack V, Adebamowo C, Dos-Santos-Silva I. Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Global health. 2016;4(12):e923–35. https://doi.org/10.1016/S2214-109X(16)30259-5 . Marlow LA, Waller J, Wardle J. Barriers to Cervical Cancer Screening among Ethnic Minority Women: A Qualitative Study. J Family Plann Reproductive Health Care. 2015;41(4):248–54. Ax AK, Johansson B, Carlsson M, Nordin K, Börjeson S. Exercise: A positive feature on functioning in daily life during cancer treatment–Experiences from the Phys-Can Study. Eur J Oncol Nurs. 2020;44:101713. https://doi.org/10.1016/j.ejon.2019.101713 . Iddrisu M, Aziato L, Dedey F. Psychological and physical effects of breast cancer diagnosis and treatment on young Ghanaian women: a qualitative study. BMC Psychiatry. 2020;20(1):353. https://doi.org/10.1186/s12888-020-02760-4 . Mehra S, Kumar P, Soni A. Physical Functional Impairment in Breast Cancer Patients: A Cross-Sectional Expert Survey. Cureus. 2024;16(3):e57364. https://doi.org/10.7759/cureus.57364 . van Leeuwen M, Husson O, Alberti P, Arraras JI, Chinot OL, Costantini A, Darlington AS, Dirven L, Eichler M, Hammerlid EB, Holzner B, Johnson CD, Kontogianni M, Kjær TK, Morag O, Nolte S, Nordin A, Pace A, Pinto M, Polz K. Understanding the quality of life (QOL) issues in survivors of cancer: towards the development of an EORTC QOL cancer survivorship questionnaire. 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Richter-Ehrenstein C, Martinez-Pader J. Impact of breast cancer diagnosis and treatment on work-related life and financial factors. Breast Care. 2021;16(1):72–6. https://doi.org/10.1159/000507313 . Wheeler SB, Spencer JC, Pinheiro LC, Murphy CC, Earp JA. Financial impact of breast cancer in Black versus White women. J Clin Oncol. 2018;36(17):1695–701. https://doi.org/10.1200/JCO.2017.77.6310 . Lazarus RS, Folkman S. Stress, appraisal, and coping. Springer Publishing Company; 1984. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. (2018). Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 68(6), 394–424. Mitchell AJ, Ferguson DW, Gill J, Paul J, Symonds P. Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: A systematic review and meta-analysis. Lancet Oncol. 2013;14(8):721–32. https://doi.org/10.1016/S1470-2045(13)70244-4 . Anand U, Dey A, Chandel AKS, Sanyal R, Mishra A, Pandey DK, de la Lastra JM P. Cancer chemotherapy and beyond: Current status, drug candidates, associated risks and progress in targeted therapeutics. Genes Dis. 2023;10(4):1367–401. Lovelace DL, McDaniel LR, Golden D. Long-term effects of breast cancer surgery, treatment, and survivor care. J Midwifery Women's Health. 2019;64(6):713–24. https://doi.org/10.1111/jmwh.13012 . National Cancer Institute. (2022). Breast cancer treatment (PDQ®)–Patient version. Retrieved from https://www.cancer.gov/types/breast/patient/breast-treatment-pdq Lyons KD, Newman RM, Sullivan M, Pergolotti M, Braveman B, Cheville AL. Employment concerns and associated impairments of women living with advanced breast cancer. Archives Rehabilitation Res Clin Translation. 2019;1(1–2):100004. https://doi.org/10.1016/j.arrct.2019.100004 . Silvaggi F, Mariniello A, Leonardi M, Silvani A, Lamperti E, Di Cosimo S, Folli S, Trapani S, A., Schiavolin S. Psychosocial factors associated with workability after surgery in cancer survivors: An explorative study. J Health Psychol. 2023;28(11):999–1010. https://doi.org/10.1177/13591053231151286 . Sun W, Chen K, Terhaar A, Wiegmann DA, Heidrich SM, Tevaarwerk AJ, Sesto ME. Work-related barriers, facilitators, and strategies of breast cancer survivors working during curative treatment. Work. 2016;55(4):783–95. https://doi.org/10.3233/WOR-162449 . Maggio A, Guerrieri-Gonzaga A, Gulisano M, Magni P, Mano MP, Sporchia A. Unmet needs of breast cancer survivors: The importance of quality attention devoted to the young. Breast. 2020;49:175–82. Mahlaq S, Lahlou L, Rammouz I, Abouqal R, Belayachi J. Factors associated with psychological burden of breast cancer in women in Morocco: cross-sectional study. BMC Womens Health. 2023;23(1):590. https://doi.org/10.1186/s12905-023-02769-3 . Sisk BA, Fasciano K, Block SD, Mack JW. Impact of cancer on school, work, and financial independence among adolescents and young adults. Cancer. 2020;126(19):4400–6. https://doi.org/10.1002/cncr.33081 . Lambertini M, Peccatori FA, Demeestere I, Amant F, Wyns C, Stukenborg JB, Paluch-Shimon S, Halaska MJ, Uzan C, Meissner J, von Wolff M, Anderson RA, Jordan K, ESMO Guidelines Committee. Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2020;31(12):1664–78. https://doi.org/10.1016/j.annonc.2020.09.006 . Rodriguez-Wallberg KA, Eloranta S, Krawiec K, Lissmats A, Bergh J, Liljegren A. Safety of fertility preservation in breast cancer patients in a register-based matched cohort study. Breast Cancer Res Treat. 2018;167(3):761–9. https://doi.org/10.1007/s10549-017-4555-3 . Bonsu AB, Aziato L, Clegg-Lamptey JNA. (2014). Living with advanced breast cancer among Ghanaian women: emotional and psychosocial experiences. International Journal of Palliative Care, 2014, 1–9. https://doi.org/10.1155/2014/403473 Alfano CM, Leach CR, Smith TG, Miller KD, Alcaraz KI, Cannady RS, Wender RC, Brawley OW. Equitably improving outcomes for cancer survivors and supporting caregivers: A blueprint for care delivery, research, education, and policy. Cancer J Clin. 2019;69(1):35–49. https://doi.org/10.3322/caac.21548 . Teye-Kwadjo E, Goka AS, Ussher YAA. Unpacking the psychological and physical well-being of Ghanaian patients with breast cancer. Dialogues Health. 2022;1:100060. https://doi.org/10.1016/j.dialog.2022.100060 . Tan Y, Qin M, Liao B, Wang L, Chang G, Wei F, Cai S. Effectiveness of peer support on quality of life and anxiety in breast cancer patients: a systematic review and meta-analysis. Breast Care. 2023;18(1):49–59. Ussher JM, Perz J, Gilbert E, Kirsten L. Women's sexuality after cancer: A qualitative analysis of sexual changes and negotiations. Women Therapy. 2014;37(3–4):205–21. https://doi.org/10.1080/02703149.2014.897547 . Benson R, Cobbold B, Opoku Boamah B, Akuoko E, C. P., Boateng D. (2020). Challenges, coping strategies, and social support among breast cancer patients in Ghana. Advances in Public Health, 2020, 1–11. https://doi.org/10.1155/2020/4817932 Sefogah PE, Attah DA, Swarray-Deen A, Nsaful J, Oppong SA, Moyer CA. Perspectives on fertility preservation among women living with breast cancer in Ghana. BMC Womens Health. 2025;25:409. https://doi.org/10.1186/s12905-025-03963-1 . Additional Declarations No competing interests reported. Supplementary Files QualitativeInterviewGuideBreastCnacerstudy.docx Cite Share Download PDF Status: Published Journal Publication published 18 Mar, 2026 Read the published version in BMC Cancer → Version 1 posted Editorial decision: Revision requested 05 Jan, 2026 Reviews received at journal 17 Dec, 2025 Reviews received at journal 10 Dec, 2025 Reviewers agreed at journal 17 Nov, 2025 Reviewers agreed at journal 17 Nov, 2025 Reviewers agreed at journal 16 Nov, 2025 Reviewers invited by journal 14 Nov, 2025 Editor assigned by journal 12 Nov, 2025 Editor invited by journal 23 Oct, 2025 Submission checks completed at journal 21 Oct, 2025 First submitted to journal 21 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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14:12:06\",\"extension\":\"docx\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":85662,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"QualitativeInterviewGuideBreastCnacerstudy.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7834537/v1/9938a279d4852e658dddba2f.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Coping with Breast Cancer in Ghana: A Qualitative Study of Women’s Lived Experiences Following Breast Cancer Diagnosis\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eBreast cancer is a critical public health challenge globally, significantly impacting the health and overall well-being of many middle-aged women and contributing substantially to cancer-related mortality [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. In the year 2022, 157 out of 185 countries recorded breast cancer as the most commonly diagnosed cancer among women [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. In 2020, Ghana recorded 4,645 new cases of breast cancer and 2,233 fatalities [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. In low- and middle-income countries (LMICs) countries such as Ghana, a lack of awareness, late-stage detection, inadequate access to quality healthcare and resources, cultural beliefs and stigma adversely affect health-seeking behaviour, adherence to treatment and ultimately, survivorship of the disease [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eResearch shows that individuals diagnosed with breast cancer often face challenges in their daily activities, such as self-care, household tasks, and mobility, due to physical symptoms caused by the disease and its treatment [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. Cognitive impairments are also commonly experienced by women with breast cancer [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Financially, breast cancer imposes significant costs, including medical expenses and lost income [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. Disparities in the financial burden can exacerbate existing inequalities in gaining access to care [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eNotably, breast cancer is a difficult condition that can pose considerable physical and emotional obstacles. Lazarus and Folkman's Transactional Model of Stress and Coping sheds light on how women perceive and respond to many aspects of breast cancer diagnosis and treatment [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. For example, upon receiving a breast cancer diagnosis, women appraise the significance and implications of their condition, including the perceived threat to their health and well-being [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. In essence, they evaluate their condition and the potential impact of this on their physical, mental, or overall quality of life. In response to their diagnosis and its ramifications for their future, women may experience a variety of emotions, such as shock, anger, fear and despair. The appraisal is crucial in determining how women will cope with their diagnosis and treatment.\\u003c/p\\u003e\\u003cp\\u003eFollowing the initial evaluation, women proceed to secondary appraisal, where they conduct an assessment of their coping resources and analyse the available options for managing breast cancer-related stressors, such as treatment decisions and emotional discomfort [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. This evaluation includes determining how effectively a person feels they can handle the difficulties presented by their illness as well as utilize coping mechanisms, useful resources, and social support. In addition to employing external resources like assistance from friends, family, medical experts, and support groups, women may also rely on internal resources like optimism, resilience, and self-efficacy.\\u003c/p\\u003e\\u003cp\\u003eWomen may use a combination of emotion-focused coping strategies, like reaching out to family and friends and finding purpose in their cancer experience, and problem-focused coping strategies, including adopting healthy lifestyle choices, such as diet and exercise, searching available treatment programmes and also making decisions about medical care, to manage the complex stressors associated with breast cancer [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. Accordingly, dealing with breast cancer is considered a dynamic process in which each person's assessment and coping mechanisms may change over time in response to the illness's shifting demands [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eDespite the high prevalence of breast cancer in Ghana as the leading cancer in women, research on the experiences of women living with breast cancer in Ghana appears limited [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e], creating a major knowledge gap. This study therefore explored the lived experiences of these women, with the view to generating scientific data that informs the development of tailored policy, interventions and support systems for improving their quality of life.\\u003c/p\\u003e\"},{\"header\":\"METHOD AND MATERIALS\",\"content\":\"\\u003cp\\u003eThe findings presented here are drawn from a broader mixed-methods research study on breast cancer and fertility preservation [\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]. Women receiving treatment between November 2023 and January 2025 at the Breast Clinic of Korle Bu Teaching and the National Radiotherapy, Oncology \\u0026amp; Nuclear Medicine Center in Ghana were purposively sampled and recruited into the study. A total of 300 women were conveniently sampled and participated in a cross-sectional survey. Out of this number, 15 women willingly agreed to participate in a qualitative semi-structured interview that explored their experiences of living with breast cancer. We explored the experiences of women living with breast cancer using a semi-structured interview schedule guide purposely developed and designed by the research team (see supplementary file 1). This guide was pretested with two women and revised and refined for final use. Details of this guide have previously been published [\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eInterviews were audio-taped. Audiotaped and transcribed, with each audiotape played repeatedly to ensure the accuracy and correctness of each transcript.\\u003c/p\\u003e\\u003cp\\u003eA content analysis was conducted to identify emerging themes and sub-themes, using the NVIVO analysis software. The coding process involved creating a code book based on the interview guide and research questions, followed by inductive coding to capture emergent themes from the data]. To ensure rigor, two members of the research team with a background in qualitative research coded the transcripts independently, and subsequent the inter-coder reliability was assessed. Discrepancies between the researchers were resolved through discussion and consensus. The resulting data is presented using themes and sub-themes, in a thematic table, supported with direct quotes from participants.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eEthical approval\\u003c/strong\\u003e\\u003cp\\u003e was obtained from the Institutional Review Board of the Korle Bu Teaching Hospital (KBTH-IRB/00039/2023). Prior to their involvement in the study, all participants gave informed consent, and appropriate measures were put in place to uphold privacy and anonymity. All interviews were held in private secured rooms to ensure adequate privacy and the participants\\u0026rsquo; comfort.\\u003c/p\\u003e\\u003c/p\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003eOf the 300 participants surveyed, 15 women willingly agreed to share their lived experiences of receiving a confirmed diagnosis of breast cancer from a medical practitioner. The study results show a profile of women aged between 32 - 49 years with the majority (7) of them having a basic level of education. Participants\\u0026rsquo; occupations included businesswomen, nurses, policewomen, caterers, administrators, and traders, among others. Some participants reported\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003ehaving no children, while others had up to four children. The timeline of receiving a diagnosis of breast cancer ranged from 2016 to 2023 (See Table 1). \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 1: Participants\\u0026rsquo; Demographic Characteristics\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"633\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNo.\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIdentity\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eYear diagnosed\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOccupation\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEducational level\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eChildren\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;Undisclosed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2016\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eUndisclosed\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTertiary\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2022\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eUndisclosed\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;Undisclosed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eUndisclosed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2023\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eUnemployed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eJSS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e42\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2019\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eBusinesswoman\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eJSS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eUndisclosed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2020\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNurse\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTertiary\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2021\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eBusinesswoman\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eJSS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2022\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePolicewoman\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTertiary\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eUndisclosed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2017\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eBusinesswoman\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eJHS 3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e46\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2021\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eUnemployed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eJSS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e43\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2023\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eEntrepreneur\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSHS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eUndisclosed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2022\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCaterer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eJHS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eUndisclosed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2018\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eUnemployed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eUneducated\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNone\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e49\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2021\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eAdministrator\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTertiary\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNone\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e49\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2021\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eUnemployed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSHS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePatient 15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2022\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTrader\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eJSS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2: Symptom that alerted possible breast cancer across participants\\u0026rsquo; marital status\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cimg src=\\\"https://myfiles.space/user_files/69519_bce2c0439cd956a6/69519_custom_files/img1764161113.png\\\"\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThree major themes were identified from the qualitative data. The first theme, \\u0026ldquo;Initial reactions\\u0026rdquo; reveals the preliminary reactions of the participants upon receiving a diagnosis of breast cancer. \\u0026nbsp;The second theme, \\u0026ldquo;emerging challenges and disabilities,\\u0026rdquo; describes the effects and impairments these women experienced due to the disabling nature of their condition. Finally, the third theme \\u0026ldquo;healthy adaptation, coping and hope\\u0026rdquo; showcases the growth and the ability of these women to adapt to living with breast cancer. (Table 3)\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3: Summary of Thematic Analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"673\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTHEME\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSUBTHEMES\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eInitial reaction\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCatastrophic thinking\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePreoccupation with sadness and anxiety\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eEmerging disabilities: The reduced capacity to work and reproduce\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eThe reduced capacity to work: The impact of fatigue, pain and stress\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;reproductive health concerns\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eHealthy adaptation, living and coping\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eHealthy adaptation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eLiving and coping\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSelective disclosure\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eTheme 1: Initial reaction\\u0026nbsp;\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTwo main sub-themes emerged to describe the initial reaction of participants upon receiving a diagnosis of breast cancer: Catastrophic thinking, and preoccupation with sadness and anxiety.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u003cu\\u003eSubtheme 1: Catastrophic thinking\\u003c/u\\u003e\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eReceiving a diagnosis of breast cancer can be incredibly daunting, particularly in the light of how it is appraised. Participants initial reactions were characterised by catastrophic thinking, marked by shock and the imagining of worst-case scenarios. Exemplifying the initial shock and disbelief, one woman shared:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eI was most worried in the beginning because I didn\\u0026rsquo;t think it would happen to me (Patient-11, 44years, 2022).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eWorrying was a prominent reaction for these women \\u0026ldquo;Hmm at the time, \\u0026hellip;. I used to think about it a lot.\\u0026rdquo; (Patient-4, 42years, 2019).\\u0026nbsp;\\u003c/em\\u003eAnother woman echoed similar sentiments, describing the preoccupation of negative thoughts which was founded on societal myths about breast cancer progression and treatment:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eWhat people say about this disease, they say that treatment can either kill you or spoil your chances of ever having children. So as soon as someone is diagnosed, their mind is immediately filled with several thoughts (Patient-9, 46years, 2021).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eIn the early stages, participants were preoccupied with thoughts about treatment implications, including mortality, body disfigurement and possible recurrence:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eI used to think that I will not stay long in this world, ... that I would die early since I have cancer. Those were the particular thoughts in my mind (Patient-8, 48years, 2017).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eMy breast, that\\u0026rsquo;s what I think about often because I don\\u0026rsquo;t want them to cut it (Patient-15, 32years, 2022).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eEven though I knew how it can affect others, I wasn\\u0026rsquo;t really scared. Aside losing one breast, (Patient-11, 44years, 2022)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003ePsychologically too, it\\u0026apos;s been stressful. Like, you are always thinking of it that it might even recur. I\\u0026rsquo;m not comfortable at all; it\\u0026apos;s been so stressful, generally (Patient-13, 49 years, 2021).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInterestingly, some women were overlyconcerned, particularly regarding their children, both born and unborn.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eI think of the fact that I may not be able to take care of my children further in their lives. That thought comes to mind a lot (Patient-3, 44years, 2023)\\u003c/em\\u003e.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAnother who was pregnant at the time of diagnosis recounted:\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eIn the beginning phases my mind was just floating, so, I didn\\u0026apos;t really pick up a lot of the things that were said. I was pregnant during diagnosis, and I was more concerned if the pregnancy would still hold (Patient-1, undisclosed age, 2016).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eUnhealthy thought patterns regarding the diagnosis of breast cancer and its implications contributed to subsequent experiences of sadness and anxiety.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u003cu\\u003eSubtheme 2: Preoccupation with sadness and anxiety\\u003c/u\\u003e\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eParticipants also reported an overwhelming sense of sadness, anxiety and feelings of abandonment upon receiving the diagnosis.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eOh, it wasn\\u0026rsquo;t easy. I cried that day, I really cried. And I was greatly sad in this world I came to. (Patient-2, 41years, 2022).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eI was anxious, I was afraid\\u0026hellip;I thought was just going to die (Patient-5, 37years, 2020).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eWell, you know, from the beginning, when you are told you have cancer, not all people will sympathize with you but, you know, the people you think will be there for you might not be there. (Patient-13, 49years, 2021)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eTheme 2: Emerging disabilities: The reduced capacity to work and reproduce\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFor these women living with cancer was life-changing, resulting in impaired daily functioning and disabling effects that affected work and reproduction.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u003cu\\u003eSubtheme 1: The reduced capacity to work: The impact of fatigue, pain and stress\\u003c/u\\u003e\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eRecounting their experiences of treatment, some participants shared:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eI\\u0026apos;m not strong like I used to be. (Patient-13, 49years, 2021).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003ebefore I went through chemo, I was strong but now I get tired when I walk for a bit. (Patient-15, 32years, 2022).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eWhen I was taking chemo, I saw some of the women who came out of surgery. I saw how drained they were.\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eReferring to her previous work functioning, one participant reported:\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003ehow I could work previously, I can\\u0026apos;t work like that now. It\\u0026rsquo;s like strength now is not how it was before (Patient-14, 49years, 2021)\\u003c/em\\u003e. The pain associated with chemotherapy caused a decline in work functioning:\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003ebecause of the pains, how I used to work at first isn\\u0026rsquo;t the same now. I am managing bit by bit (Patient-3, 44years, 2023).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOthers reported the pain was so disabling that they reported not being able to work\\u003cem\\u003e,\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eIt\\u0026rsquo;s the pain that has affected me the most. I\\u0026rsquo;m in so much pain that I can\\u0026rsquo;t even work again (Patient-9, 46years, 2021).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe stress of going through extended breast cancer treatment can affect one\\u0026rsquo;s ability to continue working.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eit\\u0026rsquo;s a long process of treatment, so I ended up not working. I\\u0026apos;m not working again because of the process and then physically too.\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eExplaining the impact of the breast cancer treatment on their daily lives, one woman shared:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eIt has changed my life drastically, I would say. Yeah, in a lot of ways, dealing with... I mean, you have a plan, and then later you realize you have cancer. So, then everything has come to a standstill, because you have to go through treatments, and it takes a while (Patient-10, 43years, 2023).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFor some, living with breast cancer diagnosis seemed to impair one\\u0026rsquo;s capacity to work, such that they had to stop working. \\u0026nbsp;One woman shared how she had to close down her business because of her condition.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eI used to have a provisions shop at first, but when it happened like that, I couldn\\u0026rsquo;t do it. Because when I was sick, I couldn\\u0026rsquo;t do anything to help myself, so I even sold it. Like it brought me a lot of issues that pushed me back (Patient-8, 48 years, 2017).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAnother participant narrated how she could no longer pursue her dreams as dealing with breast cancer was stressful.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eYeah. I was planning to go back to school. I was planning to get a job. All these things had to change. Because some of them are time-bound. Like going to school now, I can\\u0026apos;t go to school again. Because you can\\u0026apos;t do those. It\\u0026apos;s stressful. I mean, so it has affected my future. (Patient-13, 49 years, 2021).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot only did it affect their lives but also family as they had to make some sacrifices to take care of them, one woman explained:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eMy firstborn was supposed to be in the boarding house in 2017, but because of my illness, he went to day school so that he could take care of me. (Patient-8, 48years, 2017)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u003cu\\u003eSubtheme 2: Reproductive health concerns\\u0026nbsp;\\u003c/u\\u003e\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eIn addition to affecting participants\\u0026rsquo; work and school plans, some patients described how their fertility was affected, due to treatment.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eThey couldn\\u0026rsquo;t give me protection for the womb. And so, for mine they said that I will have to become menopausal do you understand? And so, I agreed for me to go menopausal for the treatment to happen. (Patient-2, 41years, 2022)\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOne participant, only realized the impact on her fertility, after chemotherapy\\u003cem\\u003e,\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eIt was after the chemo that I told the doctor that my menses was not coming and he said that it would not come (Patient-6, 44years, 2021)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAnother participant expressed confusion about the medical implications of treatment and egg storage, she stated:\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eI remember the doctor telling us that the treatment can attack the womb and when that happens, the womb and ovaries would have to be removed. What I don\\u0026rsquo;t understand is, how can the eggs be stored if the womb and ovaries are to be removed? \\u0026nbsp;(Patient-9, 46years, 2021).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe quotes cited above suggest that some women may not have been fully prepared for the potential effects of treatment on their reproductive health.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eTheme 3: Healthy adaptation, living and coping\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u003cu\\u003eSubtheme 1: Healthy adaptation\\u003c/u\\u003e\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSome women demonstrated the ability to experience growth and healthy adaptation, despite the struggles associated with breast cancer.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eAh with me, nothing has changed. I\\u0026rsquo;ve been doing the same things I was doing before my diagnosis, like working in the house. (Patient-12, 39 years, 2018).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOthers regained physical strength and restoration of functional abilities, during treatment:\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eOh, there was some weakness when I first started chemo, where you get tired after doing something. But God being so good, after my first rounds of chemo, I saw that I had recovered. It hasn\\u0026rsquo;t really affected my day-to-day dealings. It didn\\u0026rsquo;t really weaken me or change a lot of things in my life. (Patient-11, 44years, 2022)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eThe trauma I went through it wasn\\u0026rsquo;t okay but now it\\u0026rsquo;s okay. (Patient-7, 44years, 2022)\\u003c/em\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eI am okay. I am strong. I am fit. My life is fine. There is nothing wrong going on. You see at first when I did the surgery \\u0026hellip;, I couldn\\u0026rsquo;t lift things but now I can do so (Patient-6, 44years, 2021).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eSo yes, I had to stop work for some time just to take treatment and all of that, and I resumed. So, in the beginning, it was a little rough but then, we\\u0026rsquo;ve come so far. (Patient-1, 2016)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u003cu\\u003eSubtheme 2: Living and coping\\u003c/u\\u003e\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eDrawing on three major factors, women disclosed how they had coped with their illness: through the use of religion, social connections and following the doctors\\u0026rsquo; recommendations. Some participants indicated their religious belief helped to create a positive outlook despite the cancer diagnosis, address negative thinking patterns and fear, and minimize functional impairments suffered.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eAlthough I had heard of it, but I didn\\u0026rsquo;t think it would happen to me. I\\u0026rsquo;ll say because of my standing in Christ, I began to worry and fear less, and because I had made up my mind to defeat the disease, it didn\\u0026rsquo;t weaken me as much. (Patient 11, 44years, 2022)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eOh, what I think is that God is the healer and so He is the one I am looking up to (Patient-3, 44years, 2023).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eHaving strong social connections with family and friends helped to buffer patients from the stress associated with breast cancer:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eClose family members and friends supported me physically and spiritually, so it didn\\u0026rsquo;t have that much of an effect on me. (Patient 11, 44years, 2022).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eMy sisters actually take good care of me. (Patient-12, 39years, 2018).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eMy family was a great support. My mother, my siblings, my external relations, they all supported me throughout the process of the treatment. Yeah. (Patient-13, 49years, 2021)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOne woman reported her diagnosis had created an opportunity for growth, and also strengthened her social relationships in this time of adversity.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eIt has strengthened the relationships I have with friends, relationship with family. I had a lot, a lot of support, massive love. So, if anything, it has strengthened the relationship. (Patient-10, 43years, 2023)\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOthers leveraged the recommendations from their doctors to navigate the challenges resulting from their cancer diagnosis:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eI had hope that no matter what this illness meant, what I could do was to follow the recommendations of the doctor to help myself. (Patient-2, 41years, 2022)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eThe doctors made me aware that when you do the chemo, it affects your system. So, it isn\\u0026rsquo;t a hundred percent sure that you can give birth afterward. The doctors made me aware of that. (Patient-8, 48years, 2017)\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eThe doctor told me when they found out that, I would have to undergo chemo for eight months, then undergo surgery. \\u0026nbsp;He reassured me that the surgery was safe and I would come out alive to take care of my family. So, I thanked him for reassuring me. What he told me really made me happy, and made me so calm because I knew God would see me through every situation (Patient-9, 46years, 2021)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOn the whole, the narratives of these women with breast cancer revealed their resilience in the face of breast cancer diagnosis, treatment and life after that.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eSubtheme 3: Selective disclosure.\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eMany survivors chose to keep their condition private sharing their diagnosis with a few trusted persons, mainly close family:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026nbsp;I didn\\u0026rsquo;t really tell that many people. It was private for me. (Patient 11, 44 years, 2022)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eI didn\\u0026rsquo;t tell many people; just my family and siblings. Even where I work, all they know is that my breast hurt. They don\\u0026rsquo;t know what became of that or what I was diagnosed with. (Patient-12, 39years, 2018)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eFor one participant, the decision to remain secretive was driven by the desire to maintain privacy and avoid unsolicited advice on healthcare.\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026nbsp;I also didn\\u0026rsquo;t tell others. You see when you tell people around what it is, someone may tell you to do such medication, go to herbal medications and others and so I didn\\u0026rsquo;t want anyone to give me such ideas. What I knew to do was to go to the hospital but I was fine with everyone. It was just my sister, mother and sister who knew I had such a problem. (Patient-2, 41years, 2022)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSelective disclosure seemed to allow the participant to maintain control over their health status, while allowing them privacy and autonomy over their recovery process.\\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eThis study examined the lived experiences of women undergoing breast cancer treatment. The ages of women diagnosed with breast cancer highlight a significant peak in the 40\\u0026ndash;45 age group, (38.0% of participants). This is consistent with global trends indicating an increased incidence of breast cancer with age [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. Also, research by Jedy-Agba et al. [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e] had revealed that the median age at diagnosis of breast cancer in Sub-Saharan Africa, including Ghana, is notably lower compared to high-income countries, emphasizing the disproportionately higher burden of breast cancer among younger women in this region. These underscore the importance of targeted screening and early detection efforts among middle-aged women in Ghana to enhance outcomes and alleviate the burden of breast cancer on this economically viable population.\\u003c/p\\u003e\\u003cp\\u003eA significant proportion of participants (29.3%) had attained basic education, while 25.3% had completed secondary school. This underscores the importance of tailored health education and awareness programmes for different educational levels to ensure equitable access to essential breast cancer information and screening services for all women. From this study, although a considerable proportion of women in Ghana took the initiative to seek medical assistance when they detected breast cancer symptoms, a significant group either postponed seeking professional help or chose alternative remedies.\\u003c/p\\u003e\\u003cp\\u003eFor example, previous studies have revealed that some Ghanaian women may adopt the strategy of incorporating traditional healing practices, including herbal remedies and traditional medicine, in conjunction with conventional breast cancer treatments [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. This finding underscores the need for culturally sensitive approaches to health education and promotion in Ghana. Understanding the preferences and beliefs of Ghanaian women regarding healthcare practices can help inform the development of effective interventions. This intervention may involve collaboration with traditional healers or community leaders to promote the benefits of early detection and evidence-based treatment options for breast cancer.\\u003c/p\\u003e\\u003cp\\u003eUnderstanding healthcare preferences and needs are important when diagnosing and treating breast cancer as women have to make complex decisions about their health, often influenced by various factors including societal pressure and personal relationships. Interestingly, qualitative results from our study indicate the resistance to disclosing a diagnosis of breast cancer to maintain privacy and to avoid unsolicited health advice from people other than trusted connections. This finding illustrates that some women are initiating attempts to control potential social influence over their healthcare, which appeared empowering and a helpful coping mechanism. This outcome underscores the need for health professionals to respect the privacy and autonomy of clients and provide them the needed guidance and support to make informed decisions, while they seek care.\\u003c/p\\u003e\\u003cp\\u003eMany women in this current study primary appraisal of breast cancer was catastrophic, characterised by excessive rumination, and the imagining of worst possible outcomes. These women initially perceived the diagnosis as a threat to their wellbeing and health and in turn these negative thoughts evoked a range of negative emotions such as sadness, feelings of abandonment and anxiety. These reactions are consistent with Lazarus and Folkmans (1984) transactional model of stress and coping, which explains how people process and cope with difficult situations such as a breast cancer diagnosis and treatment [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThis study also found that receiving a cancer diagnosis and commencing treatment was life changing and often characterised with functional impairment and emerging disabilities. Many women reported a decline in their working ability as they grappled with the fatigue, pain and stress caused by their illness and treatment. Previous studies report similar findings with medical procedures including surgery, chemotherapy, and radiation therapy, causing patients physical discomfort, fatigue, and changes in appearance [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. Other research work highlights the difficulties survivors have preserving their careers, balancing work and personal obligations, and encountering unsupportive managers and colleagues [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eIn this study, participants also reported experiencing educational setbacks due to their breast cancer diagnosis. Some women were unable to pursue their educational goals, and so had to forgo their educational aspirations. This is consistent with findings by Maggio et al. (2020), who examined the educational repercussions of breast cancer among younger women with academic or vocational ambitions [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]. Other studies also report that patients encounter obstacles in their educational pursuits, such as schooling and career progression disruptions and difficulties maintaining satisfactory academic performance [\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eIn this present study fertility loss seemed a major concern faced by the participants particularly because they did not seem well informed or prepared for the potential effects of treatment on their reproductive health. Previous reports suggest breast cancer and its treatments present significant obstacles to fertility in reproductive-age women, potentially resulting in ovarian dysfunction, premature ovarian insufficiency, or infertility [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. According to Bonsu et al., (2014) some Ghanaian women report failed dreams of marriage and motherhood due to their experience of breast cancer [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]. The lack of clear communication between healthcare professionals and some of these women was apparent as they recounted loss and still seemed to grapple with unanswered questions about fertility preservation options. This underscores the significance of comprehensive support and survivorship care plans for patients [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe coping strategies employed by the women in this study included a reliance on religious beliefs, social support networks, and advice from medical professionals. Some patients found solace in their faith and subsequently found purpose to live, and the strength to persevere despite the grim prognosis. Related studies highlight the importance of patients drawing strength and comfort from religious and spiritual convictions as a coping mechanism. This involves engaging in prayer, meditation, and religious practices in Ghana [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]. Studies have shown that seeking support from family, friends, spiritual leaders, medical experts and support groups is a common coping mechanism for women with breast cancer, providing them with emotional reassurance, understanding, and practical assistance [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]. Consistent with Lazarus and Folkman\\u0026rsquo;s model of transactional stress, these women seem to rely on both emotional and problem coping strategies sourced from family, friends, spiritual leaders and medical experts. Previous studies report that these strategies help breast cancer patients maintain a sense of control, resilience, and emotional well-being [\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe results also indicated that, as a coping strategy, these women are selective of who they disclose their illness to. An earlier study in Ghana highlighted the importance of seeking social support from trusted persons as a prevalent coping strategy for women facing cancer [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e][\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]. The emotional and psychological benefits of having a strong support system during the challenging journey of breast cancer treatment cannot be overemphasized. Women who felt supported by their loved ones reported feeling less anxious, depressed, and isolated, and were better able to maintain a positive outlook on their recovery.\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eThe diagnosis of breast cancer invoked a cascade of physical and psychological responses, including catastrophic thinking and overwhelming preoccupation with anxiety, sadness and feelings of abandonment. The dynamics of breast cancer treatment further compounded the patients\\u0026rsquo; experiences of emotional and physical distress stemming from particularly fertility complications, impaired daily activities, and diminished social, occupational, and educational functioning. Religious beliefs, social connections, and professional medical advice played vital roles in helping the patients to cope, and therefore, underscore the need for incorporating these tenets into routine breast cancer management.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eImplications\\u003c/b\\u003e f\\u003cb\\u003eor Healthcare Practices and Support Services\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe overall quality of life, encompassing physical, psychological, and social well-being, can greatly impact a woman's ability to navigate the difficulties associated with breast cancer. The findings highlight the urgent need for tailored psychosocial support services in Ghana's healthcare system to address the significant psychological effects of breast cancer diagnosis and treatment. Healthcare professionals need to be aware of these emotional reactions and provide appropriate support and interventions to help women cope with their diagnosis and treatment. It is also important to be mindful of individual preferences and beliefs, incorporating culturally sensitive approaches that include religious and social support into the care framework to assist with adjustment and recovery. By amplifying the voices and experiences of women dealing with breast cancer, culturally sensitive interventions can be developed to enhance support, education, and resources for affected individuals and communities in Ghana.\\u003c/p\\u003e\\u003cp\\u003eAdditionally, proactive discussions and access to fertility preservation services are crucial in empowering women to make informed decisions about their reproductive health, after receiving a diagnosis of cancer.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eLimitations and Future Research Directions\\u003c/h2\\u003e\\u003cp\\u003eThis qualitative study provides valuable insights among women with a lived experience of breast cancer in Ghana. However, few women were willing to take part in the qualitative study, thus the results are limited by the small sample size of 15 participants which may not fully capture the diversity of experiences. Future research could explore conducting a cross-sectional study with a larger sample to enhance the generalizability of the findings. The sampling method may have introduced a selection bias of participants. Similarly, the reliance on self-report is subject to other biases related to recall and social desirability.\\u003c/p\\u003e\\u003cp\\u003eFurther research is warranted to explore the factors influencing the healthcare-seeking behaviours of Ghanaian women with breast cancer. By identifying barriers and facilitators to timely medical intervention, targeted interventions can be developed to improve outcomes and reduce disparities in breast cancer care in Ghana. Ultimately, by addressing the unique needs and preferences of Ghanaian women, strides can be made towards improving breast cancer outcomes and promoting overall health and well-being in the community.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthical Approval and Consent to participate\\u003c/strong\\u003e\\u003cp\\u003e Ethical approval was obtained from the Institutional Review Board of the Korle Bu Teaching Hospital (KBTH-IRB/00039/2023). Prior to their involvement in the study, all participants gave informed consent, and appropriate measures were taken to uphold their privacy and anonymity. All participants provided informed consent prior to being enrolled in the study. The study was implemented in compliance with the ethical principles outlined in the Declaration of Helsinki, and the ethical guidelines and applicable laws and regulations in Ghana.\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eConsent for Publication\\u003c/strong\\u003e\\u003cp\\u003e All participants provided informed consent prior to being enrolled in the study, as well as consent for publication of the study findings without any identifiers or personal information.\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003ch2\\u003eCompeting Interests\\u003c/h2\\u003e\\u003cp\\u003eAll authors have declared no conflict of interest.\\u003c/p\\u003e\\u003c/p\\u003e\\u003ch2\\u003eFunding Statement\\u003c/h2\\u003e\\u003cp\\u003eThis study received no funding or grant support.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eConceptualization: PES and DAA. Methodology: PES, DAA, and JN. Investigation: PES, JN, and DAA. Data curation and analysis: DAA. Data validation: PES, JN. Drafting of manuscript: DAA and PES. Editing of manuscript: JN, PES, and DAA. Final revision and approval of manuscript: All authors have read and approved the manuscript for submission. Correspondence Author: PES\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgement\\u003c/h2\\u003e\\u003cp\\u003eThe authors are grateful to the staff of the Breast Clinic, Korle Bu Teaching Hospital and the National Radiotherapy, Oncology and Nuclear Medicine Center for their support during the data collection for this study.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eThe detailed data supporting the findings presented here are available upon reasonable request from the corresponding author[PES].\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eWorld Health Organisation. Breast cancer. 2024. 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Advances in Public Health, 2020, 1\\u0026ndash;11. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1155/2020/4817932\\u003c/span\\u003e\\u003cspan address=\\\"10.1155/2020/4817932\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSefogah PE, Attah DA, Swarray-Deen A, Nsaful J, Oppong SA, Moyer CA. Perspectives on fertility preservation among women living with breast cancer in Ghana. BMC Womens Health. 2025;25:409. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1186/s12905-025-03963-1\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s12905-025-03963-1\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cancer\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcan\",\"sideBox\":\"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcan/default.aspx\",\"title\":\"BMC Cancer\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"lived experiences, breast cancer, diagnosis, women, psychological, coping\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7834537/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7834537/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eObjective\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eBreast cancer remains a global concern as the most commonly diagnosed cancer and the leading cause of cancer death among women. In Sub-Saharan Africa, although breast cancer accounts for the highest burden of mortality in women, there is little documentation on the experience of having breast cancer. This article explores the lived experiences of a group of Ghanaian women diagnosed with breast cancer.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMaterials And Methods\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe findings presented here, are drawn from a broader mixed-methods study on breast cancer and fertility preservation. Women receiving treatment between November 2023 and January 2024 at two study sites – Korle Bu Teaching Hospital and the National Radiotherapy, Oncology and Nuclear Medicine Center in Ghana were purposively sampled for recruitment. A total of 300 women were conveniently sampled to participate in a cross-sectional survey. Out of this number, 15 willingly agreed to participate in a semi-structured interview to explore their experiences of living with breast cancer. The interviews were audio-recorded, transcribed, and analyzed for key themes and patterns.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe diagnosis of breast cancer marked a pivotal point in the lives of these women, characterized by acute focus on survival. This diagnosis seemed to precipitate a cascade of psychological responses, including catastrophic thinking and an overwhelming preoccupation with mortality, anxiety and sadness. The ramifications of cancer treatment further compounded the experience of emotional and physical toll, manifesting in a myriad of challenges such as fertility complications, impaired daily activities, and diminished social, occupational, and educational functioning. Despite this life-changing circumstance, some participants demonstrated a subsequent healthy adaptation as they navigated the recovery journey using coping skills largely influenced by the tenets of religion, trusted social ties and medical expertise.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe women’s narratives highlight a journey of recovery characterized by initial grief reactions, subsequent acceptance, adaptation, and the hope of recovery. Religious beliefs and social connections played vital roles in the recovery process, underscoring the need to incorporate these into existing service delivery care models.\\u003c/p\\u003e\\n\\u003cp\\u003eImpact Statement: By amplifying the voices and experiences of women living with breast cancer, we can culturally inform routine services and targeted strategies to enhance support, education, and resources for individuals and communities affected by breast cancer in Ghana.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Coping with Breast Cancer in Ghana: A Qualitative Study of Women’s Lived Experiences Following Breast Cancer Diagnosis\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-11-26 12:46:03\",\"doi\":\"10.21203/rs.3.rs-7834537/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-01-05T06:50:12+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-12-17T19:49:39+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-12-10T14:29:13+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"82440082334004452323957229899464091815\",\"date\":\"2025-11-17T07:22:01+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"222500309991187686583915495715671649601\",\"date\":\"2025-11-17T05:51:27+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"32476357539937844073755766728577702852\",\"date\":\"2025-11-16T19:55:55+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-11-14T19:02:21+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-11-12T11:56:21+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-10-23T06:40:33+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-10-21T11:55:18+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Cancer\",\"date\":\"2025-10-21T11:52:06+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cancer\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcan\",\"sideBox\":\"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcan/default.aspx\",\"title\":\"BMC Cancer\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"fce19327-33e0-49d8-86da-383071345d3d\",\"owner\":[],\"postedDate\":\"November 26th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-03-23T16:10:26+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-7834537\",\"link\":\"https://doi.org/10.1186/s12885-026-15857-y\",\"journal\":{\"identity\":\"bmc-cancer\",\"isVorOnly\":false,\"title\":\"BMC Cancer\"},\"publishedOn\":\"2026-03-18 15:59:45\",\"publishedOnDateReadable\":\"March 18th, 2026\"},\"versionCreatedAt\":\"2025-11-26 12:46:03\",\"video\":\"\",\"vorDoi\":\"10.1186/s12885-026-15857-y\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12885-026-15857-y\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7834537\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7834537\",\"identity\":\"rs-7834537\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}