Exploring the social anxiety of breast cancer survivors in a sociocultural context: a qualitative study

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An increasing number of breast cancer survivors will transition into the phase of chronic disease management, with reintegration into society constituting a crucial component of their overall recovery. Objective: To explore the social experiences of breast cancer survivors within a sociocultural context, with the aim of providing guidance for the development of social rehabilitation nursing support programs for this population. Methods: A descriptive study design was employed to select 14 breast cancer survivors who were treated at a tertiary A hospital in Jiangsu Province between June and December 2024. Semi-structured in-depth interviews were conducted based on an objective sampling method, and the data were analyzed and refined using content analysis. Results: The social experiences of breast cancer survivors were categorized into five themes: distress associated with physical symptoms, negative psychological experiences, navigating social and cultural challenges, multidimensional support needs, and social coping strategies. Conclusion: Breast cancer survivors experience social anxiety as a result of impaired physical health, poor psychological well-being, the influence of social and cultural environments, and insufficient social support. Medical professionals should enhance symptom management and psychological counseling for this population, improve family and social support, foster positive social coping strategies, and assist survivors in reintegrating into society. Breast cancer Social anxiety Qualitative research Content analysis Cancer nursing Figures Figure 1 1. Background According to data from the International Agency for Research on Cancer (IARC), breast cancer is the most prevalent malignancy among women, with 2.3 million new cases, representing 11.6% of all cancers, and its incidence continues to rise[ 1 ]. With the widespread implementation of standardized early breast cancer screening and the advancement of multidisciplinary diagnostic and treatment systems, the 5-year survival rate of breast cancer patients has significantly increased to 80.0%[ 2 ]. As a result, an increasing number of breast cancer survivors will enter chronic disease management. Social rehabilitation for breast cancer survivors plays a crucial role in achieving "whole cycle health management". Social rehabilitation is not only linked to individual mental health and quality of life, but also serves as a critical step in promoting reintegration into society and the restoration of social functioning[ 3 ]. Social anxiety refers to an individual's intense emotional response of anxiety, tension, or fear, accompanied by avoidance behavior during interpersonal interactions[ 4 ]. Social anxiety is not only a dependent variable of social alienation but also an independent and significant mental health issue that can markedly reduce an individual's quality of life[ 5 ]. A study has suggested[ 6 ] that social network information can serve as an indicator of disease prognosis. The larger the social network, the higher the overall survival rate of breast cancer. However, severe social anxiety can reduce individuals' participation in social activities[ 7 ], hinder the process of survivors' reintegration into society, and impede their social rehabilitation. With the rapid development of modern society and the dominance of visual culture in social media, women's body image is often influenced by highly idealized sociocultural standards[ 8 ]. For breast cancer survivors, physical changes such as breast loss, limb dysfunction, hair loss, and edema may occur during diagnosis and treatment, which sharply contrast with the "ideal" female image perpetuated by contemporary society[ 9 ]. Breast cancer survivors are vulnerable to body image disturbances during the process of disease adaptation, leading to various psychological crises, self-deprecation, and body shame. These experiences can cause significant discomfort and fear in social interactions, often prompting individuals to engage in social avoidance behaviors[ 9 ]. A cross-sectional study conducted in Turkey found moderate levels of social anxiety in the majority of patients undergoing breast-conserving surgery[ 12 ]. Li Jianghua[ 13 ] examined 325 breast cancer patients and found that 84% exhibited moderate to high levels of social anxiety. Factors such as patients' age, disability acceptance, whether their spouse was concerned about external appearance, and whether they had undergone radiotherapy or chemotherapy significantly influenced social anxiety. In the study by Songna Shen et al.[ 14 ], 83.9% of breast cancer survivors reported moderate to high levels of social anxiety, and the severity of social anxiety was significantly correlated with demographic variables, including age, education, residence, and family income.Similarly, Mao et al. found that illness-related stigma was positively associated with social anxiety, whereas psychological resilience levels showed a negative correlation with social anxiety symptoms[ 15 ]. According to a longitudinal study by Shaotong Wang et al.[ 16 ], the trajectory of social anxiety in patients following breast cancer surgery could be classified into five potential profiles, with factors such as the spouse's concern about postoperative appearance, ruminative thinking, and the type of surgical method being key contributors to their social anxiety profiles. However, most existing studies are quantitative and primarily focus on psychological aspects, often overlooking the complex sociocultural context. There is a lack of research exploring the real experiences of social anxiety among breast cancer survivors within their sociocultural context, making it difficult to fully understand their true feelings. This gap in understanding hinders the development and implementation of effective intervention strategies for healthcare professionals. Compared to quantitative studies, qualitative research can provide a deeper insight into the true thoughts and emotions of cancer patients, facilitating a better understanding of their social experiences within specific cultural context. Therefore, this study conducted in-depth interviews with breast cancer survivors to explore their authentic social experiences within the social environment, aiming to inform the development of social rehabilitation nursing support programs for breast cancer survivors and promote their successful reintegration into society. 2. Methods 2.1 Design 2.1 Study design This study constitutes a follow-up component of a cross-sectional investigation that examined the influencing factors of social anxiety among breast cancer survivors[ 17 ]. This qualitative study adopts the constructivist approach, which holds that perceived reality is constructed through individual, social, and historical context, and this mitigates the existence of an absolute shared truth[ 18 ]. The research employs thematic analysis and incorporates selected basic theoretical techniques, including comparison, iteration, and primarily inductive analysis. Utilizing purposive sampling, breast cancer survivors who were re-examined and treated in a tertiary grade A hospital in Jiangsu Province from June to December 2024 were selected as research participants in accordance with the principle of maximum variation. 2.2 Sample and procedure Inclusion criteria : ① Breast cancer survivors diagnosed by pathology or immunohistochemistry, aged 18 or older; ② Able to clearly understand their own condition; ③ Capable of accurately articulating personal views and voluntarily participating in the study; ④ Experiencing social anxiety (moderate or above), defined as a score ≥ 55 on the Social Anxiety Scale[ 19 ]. Exclusion criteria : ① Coexisting mental illnesses, cognitive dysfunction, bilateral breast cancer, or other cancers; ② Patients who withdraw midway due to changes in physical condition or subjective factors; ③ Concurrent participation in other research projects. The sample size for this study was determined based on data saturation. After collecting interview data from 12 participants, no new information emerged. To further confirm that data saturation had been reached, 2 additional interviews were conducted, and no new themes were introduced, prompting the decision to stop data collection. Therefore, a total of 14 participants were interviewed in this study, all of whom volunteered to participate. This study was approved by the Ethics Committee of the Affiliated Hospital of Nantong University (Ethics approval number: 2023-K066-01). 2.3 Data collection In alignment with the research purpose, an interview outline was initially formulated, and two cancer patients were selected for pre-interviews (the pre-interview data were not included in the final data analysis). After incorporating feedback from the interviewees and recommendations from professionals, including clinical nursing experts and psychology experts, the research team conducted a comprehensive discussion, revised the interview outline, and subsequently developed the final interview protocol. The researcher initiated each interview with an open-ended question: "Could you talk about your experience of being ill?" to establish rapport with the participant. The formal interview protocol comprised the following questions: ① What major changes have occurred in your life? (For example: daily lifestyle, psychological states, social roles, etc.) ② Following diagnosis, what changes have occurred in your mindset and thoughts regarding social participation? What factors contributed to these changes? ③ Have there been any changes in your interaction patterns or emotional connections with friends, colleagues, neighbors, and other social contacts? ④ What impact has breast cancer had on your social interactions? Could you describe one or two specific situations or events that significantly affected you? How did you respond to these circumstances? ⑤ What do you consider to be the most significant difficulty or challenge you currently face in social participation or interpersonal interactions? What specific support would be most beneficial to address these challenges? ⑥ Are there any additional perspectives or experiences related to your social interactions that were not addressed in the previous questions? This study employed a semi-structured face-to-face interview method to collect pertinent data from participants during their follow-up visits. Prior to the interviews, the researcher established rapport with the participants, provided a comprehensive explanation of the purpose and significance of the research, and obtained written informed consent. Interviews were conducted in private rooms within outpatient departments or wards to ensure a quiet and comfortable environment, minimize external disruptions, and safeguard participant privacy. During the interviews, audio recording devices were utilized, and non-verbal cues such as facial expressions and body language were documented through field notes. Each interview lasted between 30 and 60 minutes. Following each interview, the researcher immediately documented reflections and systematically organized the transcribed data. The analyzed transcripts were subsequently returned to participants for confirmation. 2.4 Data analysis Within 24 hours following each interview, the researchers transcribed the audio recordings verbatim and verified the accuracy of transcripts using field notes. Data organization and analysis were conducted concurrently. Given the limited literature on social anxiety among breast cancer survivors, this study employed conventional content analysis to analyze the interview data, with codes emerging inductively from the data. The analytical procedure comprised the following steps: First, 2 researchers immersed themselves in the interview transcripts through multiple readings to gain comprehensive understanding of the content; Second, line-by-line analysis was performed, identifying statements of significant importance and conducting open coding; Third, similar or related codes were systematically compared and categorized to develop themes and subthemes; Finally, each theme, subtheme, and code was comprehensively defined by the third researcher, with representative quotations extracted from the transcripts for illustration[ 19 ]。 3 Results The study included 14 breast cancer survivors who participated in semi-structured interviews, with a mean age of 48.07 years (SD = 11.24). Participant demographic and clinical characteristics are presented in Table 1 . The analysis yielded 5 themes and 15 categories. The conceptual framework of social anxiety experiences among breast cancer survivors is illustrated in Fig. 1 . Table 1 General information of the research subjects (n = 14) ID Age Educational level Surgery Pre -diagnosis occupational status Current occupational Status Living style state of disease IAS score P1 37 High School or College Mastectomy Employed Sick Leave Spouse+ Parents 1 year 62 P3 41 High School or College Mastectomy Employed Sick Leave Spouse 1 year 59 P6 37 Undergraduate and above Breast reconstruction Self -employed Leave of Absence Spouse+ Children 6 monthsཞ1 year 62 P7 49 Junior high school and below Breast conserving surgery Employed Employed Parents >1 year 60 P8 61 Junior high school and below Mastectomy Retired Retired Children >1 year 59 P9 52 High School or College Mastectomy Self -employed Self -employed Spouse >1 year 58 P10 32 Undergraduate and above Mastectomy Employed Sick Leave Live alone 6 monthsཞ1 year 68 P11 62 Junior high school and below Mastectomy Retired Retired Spouse+ Children >1 year 58 P12 56 Junior high school and below Breast conserving surgery Self -employed Leave of Absence Spouse+ Parents <6 months 56 P13 54 Junior high school and below Mastectomy Retired Retired Spouse 6monthsཞ1 year 59 P14 68 Junior high school and below Mastectomy Retired Retired Spouse 6 monthsཞ1 year 56 3.1 Theme 1: Distress Associated with Physical Symptoms 3.1.1 Changes in physical appearance During the treatment process, breast cancer survivors undergo considerable alterations in physical appearance resulting from surgical removal or damage of breast tissue, as well as hair loss, scarring, and skin discoloration induced by radiotherapy and chemotherapy. These alterations not only undermine survivors’ sense of bodily integrity but also impair their selfimage perception and acceptance, provoking social anxiety in interactions with relatives, friends, and colleagues and potentially leading to social avoidance or isolation. P1 : "I don’t dare to look in the mirror or go out; I always feel incomplete..." P4 : "I find it difficult to face my husband because I feel I have lost my femininity after the mastectomy, and I’m afraid he will see my ‘incomplete’ body." P10 : "I don’t want to take photos or see anyone now, and I don’t want others to see me looking pale with all my hair gone." P6 : "After chemotherapy, I gained approximately 10 kilograms and experienced generalized swelling. I don’t dare go out, and I even advise my friends not to visit." 3.1.2 Decline in physical functions Breast cancer survivors frequently experience abnormal limb sensations—including numbness, soreness, heaviness, and pain in the arms—after surgery, attributable to restricted shoulder joint mobility and lymphedema. Moreover, following radiotherapy, chemotherapy, or endocrine therapy, survivors commonly endure functional impairments such as decreased physical strength, fatigue, and immunosuppression. These sequelae not only diminish survivors’ capacity for daily activities but also exacerbate psychological stress in sociocultural context. Consequently, they may experience anxiety and feelings of inferiority, fearing an inability to engage in social interactions. Therefore, survivors often adopt avoidance strategies, gradually leading to social withdrawal and isolation. P 8 : "Following my surgery, my right arm frequently becomes numb, rendering me unable to lift it. It feels awkward, and I fear drawing attention from others, so I avoid going out." P5 : "I'm unable to raise my right shoulder above a normal range. I must request assistance from others when trying on clothes. This situation feels uncomfortable, leading me to avoid going out." P9 : " Following chemotherapy, I feel physically weakened. I become fatigued after walking for short periods. I worry that leaving early would disrupt the event, so I choose to stay home and avoid attending." P11 : " My immune function declined markedly. I experienced prolonged recovery from a common cold and feared that large crowds would increase my risk of infection, so I avoided going out. Subsequently, my friends ceased inviting me to social events." 3.2 Theme 2: Negative Psychological Experiences 3.2.1 Fear of disease progression After completing breast cancer treatment, survivors often become acutely attuned to their health, excessively focusing on bodily changes and concerns about disease recurrence or progression, which in turn leads to persistent anxiety and feelings of insecurity. Such fears not only impair their emotional and psychological well-being but also reduce social engagement, prompt avoidance of social activities, and hinder reintegration into daily life and work. P7 : "I remain perpetually anxious about recurrence. At the slightest discomfort, I experience acute anxiety, lose interest even in simple activities like walking or social gatherings, and feel compelled to seek medical examinations." P2 : "Though treatment has ended, I live in fear of relapse, feel insecure, and lack the drive to return to work or reintegrate socially." 3.2.2 Fear of negative comments Breast cancer survivors often suffer from pronounced anxiety in daily social interactions following treatment, fearing invasive inquiries or remarks from others and potential negative evaluations, thereby incurring a substantial psychological burden and developing a marked tendency to withdraw from social environments. Moreover, this fear of negative evaluation not only undermines their confidence in social interactions and interpersonal communication but also intensifies social isolation and diminishes overall quality of life. P13 : "Following my surgery, I seldom venture outdoors, concerned that neighbors might engage in private discussions about me—an overwhelmingly distressing experience." P2 : "The mere thought of resuming work elicits profound anxiety. I fear becoming the focal point of my colleagues’ conversations, certain that they will either pity me or privately deride me." P4 : "I often question whether my husband harbors private disapproval toward me. This generates considerable apprehension, leading me to avoid intimate interactions with him." 3.2.3 Fear of socializing Breast cancer survivors, having undergone treatment and subsequent alterations in appearance and physiological function, often develop social phobia characterized by profound anxiety and avoidance behaviors toward social interactions, resulting in considerable social stress and psychological distress. Over time, persistent social phobia leads these individuals to progressively curtail or even cease social activities and withdraw from interpersonal relationships, thereby diminishing their social support network and exacerbating psychological distress. P9 : "At my niece’s wedding last week, I wore a wig and remained in a secluded corner throughout the event, fearful that relatives might inquire about my health status." P7 : "My close friend has invited me to afternoon tea on multiple occasions, yet I consistently worry that dressing elegantly would appear contrived. After refusing each invitation, I feel inner sadness, yet I remain apprehensive about confronting the situation directly." 3.2.4 Disease-Related Shame During diagnosis and treatment, breast cancer survivors often experience profound illness-related shame, perceiving their disease as an embarrassing topic that they find difficult to discuss, eliciting self-criticism, self-deprecation, and even self-blame. This phenomenon is closely linked to the disease’s private nature, prevailing sociocultural biases, and resultant negative shifts in self-perception. Influenced by such shame, patients frequently elect to conceal their condition, avoid social interactions, and progressively withdraw from their social networks. P6 : "I hesitate to disclose my breast cancer diagnosis to others, as I consistently experience embarrassment regarding my condition. I believe that revealing my diagnosis would make others uncomfortable, so many people in my circle remain unaware of my illness." P12 : "I avoid social gatherings with friends and family, as this disease affects intimate areas of my body. I struggle to overcome this sense of embarrassment. I prefer solitude, avoiding the uncomfortable scrutiny of others’ gazes." 3.3 Theme 3: Navigating Social and Cultural Challenges 3.3.1 Conflict between social roles and expectations Breast cancer survivors frequently encounter significant pressures concerning social roles and responsibilities throughout recovery, giving rise to a tension between their post-treatment physical weakness and fatigue and the elevated societal expectations inherent in these roles. Society demands that they recover rapidly, reintegrate into their social roles, and uphold a positive demeanor, which frequently conflicts with their actual physical condition and psychological state, thereby generating intense pressure and anxiety and fostering self-blame and doubt. This tension further undermines their emotional well-being and impairs social engagement. P5 : "My primary concern is the requirement to interact with multiple clients each day at work. My supervisor anticipates that I will maintain my previous level of efficiency, which imposes considerable pressure, as I am unable to perform at the same capacity both mentally and physically." P7 : "Relatives and friends frequently admonish me with statements such as, “Cheer up, you’ll recover soon.” This only exacerbates my sense of inadequacy, as even a year post-treatment, I remain unable to re-engage in typical social interactions." P3 : "I’ m currently unable to manage numerous household tasks. Following chemotherapy, I struggle to perform basic activities such as rising from bed, let alone attending to childcare responsibilities. Consequently, when I encounter other mothers in the neighborhood, I intentionally avert my gaze." 3.3.2 Constraints of Social Norms Breast cancer survivors often encounter various constraints imposed by social norms during treatment and recovery, including stringent expectations about feminine appearance and familial roles. These social norms often clash with the physical and psychological changes induced by the disease, leading survivors to experience pronounced psychological distress, anxiety, feelings of inferiority, and even self-negation. To avoid contravening these norms, survivors frequently suppress their true emotions, reluctantly conform to societal expectations, or curtail social interactions, thereby intensifying social isolation and psychological burden. P10 : "Society enforces uniform standards for women, and I find myself unable to conform to these norms. In public, I fear that others will detect my differences and cast disapproving glances, to the extent that I opt for self-checkout kiosks when shopping at supermarkets." P4 : "Traditional beliefs dictate that women assume primary caregiving responsibilities within their families. I fear being branded a “negligent mother,” so I set my family WeChat group to Do Not Disturb and fabricate excuses to avoid family gatherings, as I wish to evade such encounters." 3.3.3 Widespread Influence of Social Media While social media platforms offer opportunities for information exchange and interaction, their widespread adoption may exacerbate the psychological burden experienced by breast cancer survivors. When survivors confront physical health challenges, social media content frequently depicts a highly idealized and curated version of life, engendering feelings of inadequacy and stark psychological contrast that undermine emotional well-being and may precipitate shame and social withdrawal. Moreover, the swift dissemination of personal information on these platforms fosters insecurity among survivors, prompting them to avoid or limit their engagement with social media. P5 : "Each time I view social media feeds, I perceive others leading glamorous lives, while I feel as though I am a defective product. Now, let alone posting photos, I do not even dare to like others’ posts for fear that they might inquire about my condition." P12 : "DouYin continually directs breast cancer–related content to me, and the more I consume, the more negativity I experience. Ultimately, I uninstalled all applications; however, I then became concerned about missing important treatment updates in my absence." P6 : "After falling ill, I feared meeting friends and resorted to expressing my emotions via an anonymous Weibo account. However, after each post, I simultaneously yearned for reassurance and feared being recognized by acquaintances. Ultimately, I deactivated this anonymous account as well and fully isolated myself." 3.4 Theme 4: Multidimensional Support Needs 3.4.1 Medical Resource Support Most breast cancer survivors necessitate a spectrum of medical resources throughout treatment and rehabilitation, including expert medical information interpretation, accessible healthcare services, psychological support, and interdisciplinary, holistic care. However, persistent gaps in medical resource availability, limited service accessibility, and inadequate psychological support precipitate patient distress and anxiety, thereby impeding rehabilitation progress and social reintegration. P9 : "I find it extremely challenging to arrange examinations and follow-up appointments. The necessity of frequent hospital visits has rendered it impossible to sustain my business operations...." P10 : "Frankly, psychological support services are limited. Doctors and nurses are often overextended, and few prioritize patients’ mental health. In reality, we urgently require professional psychological counseling to navigate the emotional challenges post-treatment." P8 : "I especially hope that hospitals can offer a broader array of support services—such as rehabilitative therapy and nutritional counseling—to expedite the restoration of my arm function and normalization of my weight, enabling me to resume everyday life promptly." 3.4.2 Peer Support Peer support serves as a vital resource in the rehabilitation of breast cancer survivors, ameliorating loneliness and anxiety through emotional support, experiential sharing, and social interaction, thereby bolstering psychological security and facilitating active social engagement. However, notable disparities persist in survivors’ access to peer support. While the majority of survivors attain emotional resonance and practical insights through interaction with fellow patients, a subset continues to encounter barriers to peer support. This issue is especially pronounced among younger survivors, who—owing to generational differences—find it challenging to identify peers with whom they can discuss social pressures and evaluative feedback, leading to diminished emotional affinity and adaptation difficulties. P10 : "As a younger survivor surrounded predominantly by older patients, I find it difficult to relate to them. I earnestly seek guidance on how to navigate others’ perceptions and stares." P9 : "Only when interacting with individuals who share similar experiences do I feel truly understood and liberated from loneliness." P11 : "During the initial treatment cycles, I experienced depression; however, a fellow ward patient provided support, taught me sideeffect management and followup coordination, and now I feel more optimistic." 3.4.3 Social Support Social support serves as a vital resource for breast cancer survivors’ rehabilitation, offering emotional and psychological assistance as well as guidance on rehabilitative practices across multiple domains—namely the workplace, community, and social organizations—thus significantly alleviating anxiety and loneliness and enhancing social adaptation. However, most survivors encounter insufficient support. Within the workplace, only a small proportion benefit from meaningful inclusion, whereas many experience feelings of inferiority and actively withdraw from social interactions due to superficial support and subtle exclusion. Although communities participate in chronic disease education, they often lack specialized rehabilitation resources for cancer patients, leaving survivors isolated when confronted with external stressors. P7 : "My supervisors and colleagues understand my condition, reduced my workload, and provided encouragement, making me feel valued and needed." P14 : "Although the community offers chronic disease education programs, there appear to be no initiatives specifically targeting cancer survivors." P4 : "My supervisor ostensibly advises me to ‘take my time’, yet consistently overlooks my input during meetings. Last week, I fabricated a fever to avoid the department’s team-building event, fearing that I would become a burden rather than because I was unwell." P6 : "Fellow patients in larger cities report the existence of organized rehabilitation associations, yet we lack any formal support group locally. There is no available resource for guidance or shared experience. Now, any whisper from my neighbors triggers anxiety, so I confine myself to my home all day." 3.5 Theme 5: Coping Strategies 3.5.1 Avoidance Strategy Selection Breast cancer survivors often adopt avoidance strategies to mitigate social pressures, such as curtailing or entirely foregoing social activities, declining discussions about their illness, avoiding intimate contact, and restricting their engagement with social media. Such avoidance strategies typically arise from concerns about negative evaluations, social anxiety, stigma associated with illness, and alterations in physical appearance. Although these strategies may temporarily alleviate psychological anxiety and social pressure, prolonged social avoidance ultimately constricts social networks and exacerbates feelings of isolation, thereby amplifying loneliness and psychological distress. P5 : "I find social interactions highly stressful, prompting me to habitually fabricate excuses to evade situations that necessitate leaving home. I even opt to take out the trash at night to minimize the likelihood of encountering others." P1 : "Even family members and friends inquire about my situation, I tend to deflect their questions, as I prefer not to disclose excessive personal information." P12 : "I have markedly curtailed my social media engagement and withdrawn from multiple social groups. Over time, my friendships have gradually become more distant." P6 : "Due to my fear of going out and encountering others, I now experience heightened isolation." 3.5.2 Self-Adjustment Self-adjustment constitutes a vital coping strategy for breast cancer survivors in managing the disease’s impact. Some survivors employ cognitive restructuring to redefine their body image and role identity, liberating themselves from traditional aesthetic standards and societal expectations to establish a more positive and multifaceted self-evaluation framework. Others foster self-adjustment via self-acceptance, actively embracing physical changes and emotional responses while refraining from rejecting negative emotions or bodily limitations. These strategies effectively mitigate stress and anxiety, thereby bolstering social adaptability and promoting social participation. P9 : "Initially, acceptance proved challenging; however, I eventually reminded myself that beauty is not singular—so what if my body has imperfections? Gradually, I began to embrace a renewed self-perspective." P5 : "Now I embraced my limitations and acknowledged my vulnerability. I am merely an ordinary individual and need not pursue perfection." P1 : "I should not reject my scars. They stand as testaments to my journey of overcoming the disease." P10 : "I permit myself to feel sadness and anxiety, reminding myself that these emotions are entirely normal." 3.5.3 Seek External Support Some breast cancer survivors proactively solicit assistance from family members, friends, healthcare teams, and social organizations, articulating their needs, obtaining emotional support, consulting medical professionals for advice, and engaging in patient support group activities. Proactively seeking external support constitutes a pivotal strategy for breast cancer survivors to manage their disease, aiding in the mitigation of stress and anxiety, bolstering psychological security and social confidence, enriching social experiences, and facilitating social role reconstruction and rehabilitation. P13 : "Now, I will proactively inform my family of my circumstances, particularly when I am fatigued or experiencing a low mood. I solicit their support to alleviate stress and enhance their understanding of my experience. I also frequently invite friends for conversation or walks, share my concerns with them, and they readily offer their support." P3 : "I regularly consult healthcare professionals, including doctors and nurses. Recently, I also sought support from a psychologist. Their professional guidance has been crucial to my well-being." P7 : "I became a member of the Cancer Companion Group. My fellow group members encouraged me and accompanied me in various activities, which gradually enabled me to regain my confidence..." 4 Discussion 4.1 Main findings This study thoroughly investigated the social experiences of breast cancer survivors within sociocultural context, utilizing qualitative interview methods, and synthesized several significant themes in survivors' social experiences following their diagnosis, including physiological symptom distress, negative psychological experiences, sociocultural challenges, diverse support needs, and social coping strategies, thereby expanding our understanding of the social experiences of breast cancer survivors. First, breast cancer survivors often face multiple physical challenges after surgery, including loss of bodily integrity, changes in appearance, limb dysfunction, and overall decline in physical functioning. These physiological changes not only significantly affect survivors' self-perception and quality of life, but also have a notable negative impact on their social interactions. As indicated by Hasan et al.[ 9 ], significant bodily changes cause breast cancer survivors to experience tremendous emotional pressure, alter their self-perception, and subsequently affect their social behavior and ability to establish relationships with others. Research by Koçan et al.[ 21 ]further emphasized that body image changes following mastectomy often induce intense feelings of inferiority and shame in patients. These psychological burdens not only exacerbate their emotional distress but also lead to reduced social activities and social interactions. The longitudinal study by Garcia et al.[ 22 ] also found that changes in body image among breast cancer survivors during chemotherapy not only substantially decreased their quality of life but also triggered significant changes in emotional distress and social adaptation capabilities. Secondly, breast cancer survivors commonly experience negative psychological responses after surgery, including fear of disease progression, apprehension about negative evaluation, social anxiety, and illness-related shame. This aligns with the research by Levesque et al., which found that breast cancer survivors' fear of illness, sensitivity to negative evaluation, and excessive reaction to shame often lead them to actively avoid social situations and reduce interactions with family, friends, and society. This social avoidance behavior intensifies patients' feelings of loneliness and social isolation, further exacerbating their emotional distress and creating a vicious cycle. Research by Ebru et al.[ 24 ] also indicates that a breast cancer diagnosis may trigger feelings of dejection in patients, leading to increased depressive symptoms. These patients often exhibit higher levels of pessimism, social isolation, shame, and hypersensitivity toward their illness, severely affecting their quality of life and psychological well-being. Finally, role conflicts and emotional constraints resulting from social expectations and norms significantly impact survivors' social experiences; they generally require diverse support, and their coping strategies show marked differences. This aligns with research by Ruiqi et al.[ 25 ], which found that survivors during the recovery phase struggle to meet traditional social expectations regarding female appearance, role responsibilities, and emotional expression, consequently experiencing guilt and anxiety during social interactions, choosing to actively avoid social engagement, and further falling into social isolation. Research by Lewis-Smith et al.[ 26 ] also indicates that the rapid and widespread dissemination of social media more easily exposes individuals to negative social evaluations and misunderstandings, increasing their perception of social isolation. However, a robust social support system can significantly improve breast cancer survivors' psychological state, reduce anxiety and depression, and enhance their social adaptation capabilities[ 27 ]. Research demonstrates that receiving multidimensional support (including medical, psychological, and integrated social resources) can significantly optimize cancer patients' rehabilitation process and play a decisive role in rebuilding their social functionality[ 28 ]. Additionally, research by Gu, Z et al.[ 29 ] found that strategies involving positive self-adjustment and actively seeking external support from society, family, and other sources can effectively promote breast cancer survivors' social integration, helping them reduce the distress caused by social anxiety. Nevertheless, this study also found that some patients adopt negative avoidance strategies; although avoidance strategies may alleviate social pressure in the short term, they lead to social network contraction and isolation in the long run. Meanwhile, some survivors employ positive self-adjustment strategies and seek external support, which helps them alleviate psychological pressure and rebuild social confidence. 4.2 Clinical implications Through an in-depth exploration of breast cancer survivors’ social experiences, this study offers comprehensive guidance for clinical practice. First, the findings underscore the importance of comprehensive assessment and intervention for physiological changes among breast cancer survivors. They highlight the necessity for integrated and systematic evaluation and management strategies to facilitate the restoration of bodily functions, such as phased decision-support protocols for breast reconstruction[ 30 ], cognitive interventions targeting body image[ 31 ], and multidisciplinary follow-up and rehabilitation systems[ 32 ], thereby enhancing social adaptation and mitigating physiological constraints.Second, the findings underscore the necessity of early identification and intervention for psychological distress. We advocate the implementation of personalized counseling services in clinical settings, such as cognitive behavioral therapy[ 33 ] and emotional regulation training[ 34 ],to help survivors modify negative thought patterns, bolster psychological resilience, and alleviate social anxiety and isolation.Finally, the results advocate the establishment of comprehensive social support systems, including peer support groups[ 35 ] and inclusive social environments, to enhance self-regulation, bolster social confidence, alleviate social anxiety, promote integration, and restore social functioning. 4.2 Study limitations While this study provides in-depth insights into the multidimensional aspects of breast cancer survivors' social experiences, it is not without limitations. Although qualitative interview methods facilitate a thorough exploration of individual experiences, the lack of long-term follow-up hinders the comprehensive capture of the evolving process of social experiences. Future research should adopt longitudinal designs to systematically track the trajectory of survivors' social experiences from diagnosis to long-term recovery, uncovering dynamic characteristics and key turning points in their adaptation process. Moreover, the current study predominantly focuses on a single cultural context, failing to adequately address the unique challenges and coping mechanisms across different cultural settings. Subsequent studies should conduct multicenter cross-cultural comparisons, incorporating survivor samples from diverse cultural backgrounds to explore how cultural factors influence social experiences and adaptation strategies. Additionally, the exploration of complex interactions between breast cancer and common comorbidities remains inadequate. Future research should systematically investigate the mechanisms of mutual influence between these comorbidity factors and social functioning, developing more integrated and comprehensive theoretical models to offer more targeted intervention strategies for clinical practice. 5. Conclusion Through in-depth qualitative interviews, this study investigated the social experiences of breast cancer survivors, uncovering the multidimensional challenges encountered by this population. Breast cancer survivors often experience distress associated with physical impairments, adverse psychological responses, sociocultural pressures, and postoperative support needs, which collectively contribute to social anxiety and avoidance behaviors. Based on these findings, healthcare professionals should strengthen symptom management and psychological support, develop targeted social rehabilitation programs, foster positive social coping strategies, and assist survivors in rebuilding social confidence and reintegrating into social life, thereby enhancing overall quality of life and long-term rehabilitation outcomes. Declarations Ethics approval and consent to participate This study was conducted in compliance with the Declaration of Helsinki and received ethical approval from theEthical Committee of Affiliated Hospital of Nantong University (2023-K066-01). Each participant signed a written informed consent before enrolling in the study. Only those who voluntarily agreed to participate were included in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding This study was funded by Nantong Municipal Health Commission (QNZ2023016) and Social and People’s Livelihood Science and Technology Projects of Nantong (MS22022063). Author Contribution Xiaofeng Chen, Chen Shen, Lihua Lu conceived and designed the study; Xiaofeng Chen, Ping Lu carried out the research interviews; Chen Shen, Yuan Zhuang, Yiju Li analysed the transcripts; Xiaofeng Chen, Chen Shen, Yuan Zhuang and Lihua Lu drafted a report of the findings, and all authors commented on the analysis; Xiaofeng Chen, Chen Shen drafted this manuscript, and all authors commented on revised versions. All authors read and approved the final manuscript. Acknowledgements We thank all the patients who participated in the study. Data availability The data presented in this study are available on request from the corresponding author. References Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. 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Stigma, Psychological Resiliency Level and lts lmpact on Social Anxiety folPatients with Breast Cancer. J Yueyang Vocat Tech Coll. 2019;34(01):43–7. Wang S, Hua Y, Zhang Y, Guo D, Tian L. Trajectories and influencing factors of social anxiety in postoperative breast cancer patients. BMC Psychiatry. 2024;24(1):357. Chen X, Dong C, Zhuang Y, Lu L, Lu P, Li Y, Gu Z, Shen C. The role of social comparative orientation in social anxiety among breast cancer survivors: a moderated mediation model of body image and self-concept clarity. BMC Psychiatry 2025, 25(1). Bengtsson M. How to plan and perform a qualitative study using content analysis. NursingPlus open. 2016;2:8–14. Peng C, Gong Y, Zhu X. The Applicabiliy of Interaction Anxiousness Scale in Chinese Undergraduate Students. Chin Mental Health J 2004(01):39–41. Elo S, Kyngäs H. The qualitative content analysis process. J ADV NURS. 2008;62(1):107–15. Koçan S, Gürsoy A. Body Image of Women with Breast Cancer After Mastectomy: A Qualitative Research. J Breast Health. 2016;12(4):145–50. Garcia S, Coelho R, Santos P, Maftum M, Mantovani M, Kalike L. Changes in social function and body image in women diagnosed with breast cancer undergoing chemotherapy. ACTA SCI-HEALTH SCI. 2017;39(1):57. Levesque JV, Gerges M, Girgis A. Psychosocial Experiences, Challenges, and Coping Strategies of Chinese-Australian Women with Breast Cancer. ASIA-PAC J ONCOL NUR. 2020;7(2):141–50. Özer E. Examınatıon of the Relatıonshıp of Depressıve Symptoms and Early Maladaptıve Schemas In Breast Cancer Patıents. Int J health Sci. 2022;6(S3):10802–16. Jin R, Xie T, Zhang L, Gong N, Zhang J. Stigma and its influencing factors among breast cancer survivors in China: A cross-sectional study. EUR J ONCOL NURS. 2021;52:101972. Primack BA, Shensa A, Sidani JE, Whaite EO, Yi Lin L, Rosen D, Colditz JB, Radovic A, Miller E. Social media use and perceived social isolation among young adults in the US. AM J PREV MED. 2017;53(1):1–8. Aizpurua-Perez I, Perez-Tejada J. Resilience in women with breast cancer: A systematic review. EUR J ONCOL NURS. 2020;49:101854. Flix-Valle A, Medina JC, Souto-Sampera A, Arizu-Onassis A, Juan-Linares E, Serra-Blasco M, Ciria-Suárez L, Feixas G, Ochoa-Arnedo C. Therapeutic alliance in a stepped digital psychosocial intervention for breast cancer patients: findings from a multicentre randomised controlled trial. BJPSYCH OPEN. 2025;11(1):e23. Gu Z, Li M, Liu L, Ban Y, Wu H. The moderating effect of self-efficacy between social constraints, social isolation, family environment, and depressive symptoms among breast cancer patients in China: a cross-sectional study. SUPPORT CARE CANCER. 2023;31(10):594. Di Pace B, Padley RH. Empowering Patients Through Shared Decision Making in Breast Cancer Consultations. AESTHET PLAST SURG; 2024. Lewis-Smith H, Jones A, White P, Byford S, Fairbrother P, Potter S, Harcourt D. Accepting your Body after Cancer (ABC), a group-based online intervention for women treated for breast cancer: study protocol for a feasibility randomised controlled trial. BMJ OPEN. 2025;15(1):e97817. Tang H, Zhang W, Shen H, Tang H, Cai M, Wang T, Yan P, Li L, Wang Y, Zhao H, et al. A protocol for a multidisciplinary early intervention during chemotherapy to improve dietary management behavior in breast cancer patients: a two-arm, single-center randomized controlled trial. BMC Cancer. 2024;24(1):859. Kim Y, Min HY, An HJ. Fear of cancer recurrence interventions for breast cancer survivors in the 2020s: a systematic review. J CANCER SURVIV 2025. Cinek BY, Varan MP, Yaprak G, Altıntaş M. Cognitive Emotion Regulation and Its Impact on Sexual Function, Body Image, and Depression in Breast Cancer Survivors. PSYCHIAT INVEST. 2025;22(3):330–9. Ruiz-Romeo M, Ciria-Suarez L, Medina JC, Serra-Blasco M, Souto-Sampera A, Flix-Valle A, Arizu-Onassis A, Moncada CM, Villanueva-Bueno C, Escudero-Vilaplana V, et al. Empowerment among breast cancer survivors using an online peer support community. SUPPORT CARE CANCER. 2024;33(1):56. Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":274810,"visible":true,"origin":"","legend":"\u003cp\u003eThe conceptual framework of social anxiety experiences among breast cancer survivors\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7003076/v1/6d3255dd6743b52ffb3964c6.png"},{"id":93719089,"identity":"8610a22d-2cde-4383-b311-66ace38a6ecf","added_by":"auto","created_at":"2025-10-16 21:16:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1371211,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7003076/v1/af4a14bc-23dc-47bb-8965-264ad4f9242b.pdf"},{"id":93718275,"identity":"c2c11b09-9003-4a93-a130-9af999981132","added_by":"auto","created_at":"2025-10-16 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Background","content":"\u003cp\u003eAccording to data from the International Agency for Research on Cancer (IARC), breast cancer is the most prevalent malignancy among women, with 2.3\u0026nbsp;million new cases, representing 11.6% of all cancers, and its incidence continues to rise[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. With the widespread implementation of standardized early breast cancer screening and the advancement of multidisciplinary diagnostic and treatment systems, the 5-year survival rate of breast cancer patients has significantly increased to 80.0%[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As a result, an increasing number of breast cancer survivors will enter chronic disease management. Social rehabilitation for breast cancer survivors plays a crucial role in achieving \"whole cycle health management\". Social rehabilitation is not only linked to individual mental health and quality of life, but also serves as a critical step in promoting reintegration into society and the restoration of social functioning[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSocial anxiety refers to an individual's intense emotional response of anxiety, tension, or fear, accompanied by avoidance behavior during interpersonal interactions[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Social anxiety is not only a dependent variable of social alienation but also an independent and significant mental health issue that can markedly reduce an individual's quality of life[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A study has suggested[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] that social network information can serve as an indicator of disease prognosis. The larger the social network, the higher the overall survival rate of breast cancer. However, severe social anxiety can reduce individuals' participation in social activities[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], hinder the process of survivors' reintegration into society, and impede their social rehabilitation.\u003c/p\u003e\u003cp\u003eWith the rapid development of modern society and the dominance of visual culture in social media, women's body image is often influenced by highly idealized sociocultural standards[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. For breast cancer survivors, physical changes such as breast loss, limb dysfunction, hair loss, and edema may occur during diagnosis and treatment, which sharply contrast with the \"ideal\" female image perpetuated by contemporary society[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Breast cancer survivors are vulnerable to body image disturbances during the process of disease adaptation, leading to various psychological crises, self-deprecation, and body shame. These experiences can cause significant discomfort and fear in social interactions, often prompting individuals to engage in social avoidance behaviors[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA cross-sectional study conducted in Turkey found moderate levels of social anxiety in the majority of patients undergoing breast-conserving surgery[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Li Jianghua[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] examined 325 breast cancer patients and found that 84% exhibited moderate to high levels of social anxiety. Factors such as patients' age, disability acceptance, whether their spouse was concerned about external appearance, and whether they had undergone radiotherapy or chemotherapy significantly influenced social anxiety. In the study by Songna Shen et al.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], 83.9% of breast cancer survivors reported moderate to high levels of social anxiety, and the severity of social anxiety was significantly correlated with demographic variables, including age, education, residence, and family income.Similarly, Mao et al. found that illness-related stigma was positively associated with social anxiety, whereas psychological resilience levels showed a negative correlation with social anxiety symptoms[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. According to a longitudinal study by Shaotong Wang et al.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], the trajectory of social anxiety in patients following breast cancer surgery could be classified into five potential profiles, with factors such as the spouse's concern about postoperative appearance, ruminative thinking, and the type of surgical method being key contributors to their social anxiety profiles.\u003c/p\u003e\u003cp\u003eHowever, most existing studies are quantitative and primarily focus on psychological aspects, often overlooking the complex sociocultural context. There is a lack of research exploring the real experiences of social anxiety among breast cancer survivors within their sociocultural context, making it difficult to fully understand their true feelings. This gap in understanding hinders the development and implementation of effective intervention strategies for healthcare professionals. Compared to quantitative studies, qualitative research can provide a deeper insight into the true thoughts and emotions of cancer patients, facilitating a better understanding of their social experiences within specific cultural context. Therefore, this study conducted in-depth interviews with breast cancer survivors to explore their authentic social experiences within the social environment, aiming to inform the development of social rehabilitation nursing support programs for breast cancer survivors and promote their successful reintegration into society.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Design\u003c/h2\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study design\u003c/h2\u003e\u003cp\u003eThis study constitutes a follow-up component of a cross-sectional investigation that examined the influencing factors of social anxiety among breast cancer survivors[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This qualitative study adopts the constructivist approach, which holds that perceived reality is constructed through individual, social, and historical context, and this mitigates the existence of an absolute shared truth[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The research employs thematic analysis and incorporates selected basic theoretical techniques, including comparison, iteration, and primarily inductive analysis. Utilizing purposive sampling, breast cancer survivors who were re-examined and treated in a tertiary grade A hospital in Jiangsu Province from June to December 2024 were selected as research participants in accordance with the principle of maximum variation.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Sample and procedure\u003c/h2\u003e\u003cp\u003e\u003cb\u003eInclusion criteria\u003c/b\u003e: ① Breast cancer survivors diagnosed by pathology or immunohistochemistry, aged 18 or older; ② Able to clearly understand their own condition; ③ Capable of accurately articulating personal views and voluntarily participating in the study; ④ Experiencing social anxiety (moderate or above), defined as a score\u0026thinsp;\u0026ge;\u0026thinsp;55 on the Social Anxiety Scale[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003cb\u003eExclusion criteria\u003c/b\u003e: ① Coexisting mental illnesses, cognitive dysfunction, bilateral breast cancer, or other cancers; ② Patients who withdraw midway due to changes in physical condition or subjective factors; ③ Concurrent participation in other research projects.\u003c/p\u003e\u003cp\u003eThe sample size for this study was determined based on data saturation. After collecting interview data from 12 participants, no new information emerged. To further confirm that data saturation had been reached, 2 additional interviews were conducted, and no new themes were introduced, prompting the decision to stop data collection. Therefore, a total of 14 participants were interviewed in this study, all of whom volunteered to participate. This study was approved by the Ethics Committee of the Affiliated Hospital of Nantong University (Ethics approval number: 2023-K066-01).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data collection\u003c/h2\u003e\u003cp\u003eIn alignment with the research purpose, an interview outline was initially formulated, and two cancer patients were selected for pre-interviews (the pre-interview data were not included in the final data analysis). After incorporating feedback from the interviewees and recommendations from professionals, including clinical nursing experts and psychology experts, the research team conducted a comprehensive discussion, revised the interview outline, and subsequently developed the final interview protocol. The researcher initiated each interview with an open-ended question: \"Could you talk about your experience of being ill?\" to establish rapport with the participant. The formal interview protocol comprised the following questions: ① What major changes have occurred in your life? (For example: daily lifestyle, psychological states, social roles, etc.) ② Following diagnosis, what changes have occurred in your mindset and thoughts regarding social participation? What factors contributed to these changes? ③ Have there been any changes in your interaction patterns or emotional connections with friends, colleagues, neighbors, and other social contacts? ④ What impact has breast cancer had on your social interactions? Could you describe one or two specific situations or events that significantly affected you? How did you respond to these circumstances? ⑤ What do you consider to be the most significant difficulty or challenge you currently face in social participation or interpersonal interactions? What specific support would be most beneficial to address these challenges? ⑥ Are there any additional perspectives or experiences related to your social interactions that were not addressed in the previous questions?\u003c/p\u003e\u003cp\u003e This study employed a semi-structured face-to-face interview method to collect pertinent data from participants during their follow-up visits. Prior to the interviews, the researcher established rapport with the participants, provided a comprehensive explanation of the purpose and significance of the research, and obtained written informed consent. Interviews were conducted in private rooms within outpatient departments or wards to ensure a quiet and comfortable environment, minimize external disruptions, and safeguard participant privacy. During the interviews, audio recording devices were utilized, and non-verbal cues such as facial expressions and body language were documented through field notes. Each interview lasted between 30 and 60 minutes. Following each interview, the researcher immediately documented reflections and systematically organized the transcribed data. The analyzed transcripts were subsequently returned to participants for confirmation.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Data analysis\u003c/h2\u003e\u003cp\u003eWithin 24 hours following each interview, the researchers transcribed the audio recordings verbatim and verified the accuracy of transcripts using field notes. Data organization and analysis were conducted concurrently. Given the limited literature on social anxiety among breast cancer survivors, this study employed conventional content analysis to analyze the interview data, with codes emerging inductively from the data. The analytical procedure comprised the following steps: First, 2 researchers immersed themselves in the interview transcripts through multiple readings to gain comprehensive understanding of the content; Second, line-by-line analysis was performed, identifying statements of significant importance and conducting open coding; Third, similar or related codes were systematically compared and categorized to develop themes and subthemes; Finally, each theme, subtheme, and code was comprehensively defined by the third researcher, with representative quotations extracted from the transcripts for illustration[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]。\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003eThe study included 14 breast cancer survivors who participated in semi-structured interviews, with a mean age of 48.07 years (SD\u0026thinsp;=\u0026thinsp;11.24). Participant demographic and clinical characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The analysis yielded 5 themes and 15 categories. The conceptual framework of social anxiety experiences among breast cancer survivors is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGeneral information of the research subjects (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eID\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEducational level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSurgery\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003cp\u003e-diagnosis occupational status\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCurrent occupational Status\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLiving style\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003estate of disease\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eIAS score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHigh School or College\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMastectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSick Leave\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSpouse+\u003c/p\u003e\u003cp\u003eParents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJunior high school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBreast conserving surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSick Leave\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHigh School or College\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMastectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSick Leave\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUndergraduate and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMastectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSpouse+\u003c/p\u003e\u003cp\u003eChildren\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6 monthsཞ1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHigh School or College\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMastectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUndergraduate and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBreast reconstruction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSelf\u003c/p\u003e\u003cp\u003e-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLeave of Absence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSpouse+\u003c/p\u003e\u003cp\u003eChildren\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6 monthsཞ1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJunior high school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBreast conserving surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eParents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJunior high school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMastectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eChildren\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHigh School or College\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMastectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSelf\u003c/p\u003e\u003cp\u003e-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSelf\u003c/p\u003e\u003cp\u003e-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUndergraduate and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMastectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSick Leave\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLive alone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6 monthsཞ1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJunior high school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMastectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSpouse+\u003c/p\u003e\u003cp\u003eChildren\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJunior high school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBreast conserving surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSelf\u003c/p\u003e\u003cp\u003e-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLeave of Absence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSpouse+\u003c/p\u003e\u003cp\u003eParents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJunior high school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMastectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6monthsཞ1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJunior high school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMastectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6 monthsཞ1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Theme 1: Distress Associated with Physical Symptoms\u003c/h2\u003e\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\u003ch2\u003e3.1.1 Changes in physical appearance\u003c/h2\u003e\u003cp\u003eDuring the treatment process, breast cancer survivors undergo considerable alterations in physical appearance resulting from surgical removal or damage of breast tissue, as well as hair loss, scarring, and skin discoloration induced by radiotherapy and chemotherapy. These alterations not only undermine survivors\u0026rsquo; sense of bodily integrity but also impair their selfimage perception and acceptance, provoking social anxiety in interactions with relatives, friends, and colleagues and potentially leading to social avoidance or isolation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eP1\u003c/b\u003e :\u003cem\u003e\"I don\u0026rsquo;t dare to look in the mirror or go out; I always feel incomplete...\"\u003c/em\u003e \u003cb\u003eP4\u003c/b\u003e :\u003cem\u003e\"I find it difficult to face my husband because I feel I have lost my femininity after the mastectomy, and I\u0026rsquo;m afraid he will see my \u0026lsquo;incomplete\u0026rsquo; body.\"\u003c/em\u003e \u003cb\u003eP10\u003c/b\u003e : \u003cem\u003e\"I don\u0026rsquo;t want to take photos or see anyone now, and I don\u0026rsquo;t want others to see me looking pale with all my hair gone.\"\u003c/em\u003e \u003cb\u003eP6\u003c/b\u003e: \u003cem\u003e\"After chemotherapy, I gained approximately 10 kilograms and experienced generalized swelling. I don\u0026rsquo;t dare go out, and I even advise my friends not to visit.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\u003ch2\u003e3.1.2 Decline in physical functions\u003c/h2\u003e\u003cp\u003eBreast cancer survivors frequently experience abnormal limb sensations\u0026mdash;including numbness, soreness, heaviness, and pain in the arms\u0026mdash;after surgery, attributable to restricted shoulder joint mobility and lymphedema. Moreover, following radiotherapy, chemotherapy, or endocrine therapy, survivors commonly endure functional impairments such as decreased physical strength, fatigue, and immunosuppression. These sequelae not only diminish survivors\u0026rsquo; capacity for daily activities but also exacerbate psychological stress in sociocultural context. Consequently, they may experience anxiety and feelings of inferiority, fearing an inability to engage in social interactions. Therefore, survivors often adopt avoidance strategies, gradually leading to social withdrawal and isolation.\u003c/p\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003cb\u003e8\u003c/b\u003e: \u003cem\u003e\"Following my surgery, my right arm frequently becomes numb, rendering me unable to lift it. It feels awkward, and I fear drawing attention from others, so I avoid going out.\"\u003c/em\u003e \u003cb\u003eP5\u003c/b\u003e: \u003cem\u003e\"I'm unable to raise my right shoulder above a normal range. I must request assistance from others when trying on clothes. This situation feels uncomfortable, leading me to avoid going out.\"\u003c/em\u003e \u003cb\u003eP9\u003c/b\u003e: \u003cem\u003e\" Following chemotherapy, I feel physically weakened. I become fatigued after walking for short periods. I worry that leaving early would disrupt the event, so I choose to stay home and avoid attending.\"\u003c/em\u003e \u003cb\u003eP11\u003c/b\u003e: \u003cem\u003e\" My immune function declined markedly. I experienced prolonged recovery from a common cold and feared that large crowds would increase my risk of infection, so I avoided going out. Subsequently, my friends ceased inviting me to social events.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Theme 2: Negative Psychological Experiences\u003c/h2\u003e\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\u003ch2\u003e3.2.1 Fear of disease progression\u003c/h2\u003e\u003cp\u003eAfter completing breast cancer treatment, survivors often become acutely attuned to their health, excessively focusing on bodily changes and concerns about disease recurrence or progression, which in turn leads to persistent anxiety and feelings of insecurity. Such fears not only impair their emotional and psychological well-being but also reduce social engagement, prompt avoidance of social activities, and hinder reintegration into daily life and work.\u003c/p\u003e\u003cp\u003e\u003cb\u003eP7\u003c/b\u003e: \u003cem\u003e\"I remain perpetually anxious about recurrence. At the slightest discomfort, I experience acute anxiety, lose interest even in simple activities like walking or social gatherings, and feel compelled to seek medical examinations.\"\u003c/em\u003e \u003cb\u003eP2\u003c/b\u003e: \u003cem\u003e\"Though treatment has ended, I live in fear of relapse, feel insecure, and lack the drive to return to work or reintegrate socially.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003e3.2.2 Fear of negative comments\u003c/h2\u003e\u003cp\u003eBreast cancer survivors often suffer from pronounced anxiety in daily social interactions following treatment, fearing invasive inquiries or remarks from others and potential negative evaluations, thereby incurring a substantial psychological burden and developing a marked tendency to withdraw from social environments. Moreover, this fear of negative evaluation not only undermines their confidence in social interactions and interpersonal communication but also intensifies social isolation and diminishes overall quality of life.\u003c/p\u003e\u003cp\u003e\u003cb\u003eP13\u003c/b\u003e: \u003cem\u003e\"Following my surgery, I seldom venture outdoors, concerned that neighbors might engage in private discussions about me\u0026mdash;an overwhelmingly distressing experience.\"\u003c/em\u003e \u003cb\u003eP2\u003c/b\u003e: \u003cem\u003e\"The mere thought of resuming work elicits profound anxiety. I fear becoming the focal point of my colleagues\u0026rsquo; conversations, certain that they will either pity me or privately deride me.\"\u003c/em\u003e \u003cb\u003eP4\u003c/b\u003e: \u003cem\u003e\"I often question whether my husband harbors private disapproval toward me. This generates considerable apprehension, leading me to avoid intimate interactions with him.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e3.2.3 Fear of socializing\u003c/h2\u003e\u003cp\u003eBreast cancer survivors, having undergone treatment and subsequent alterations in appearance and physiological function, often develop social phobia characterized by profound anxiety and avoidance behaviors toward social interactions, resulting in considerable social stress and psychological distress. Over time, persistent social phobia leads these individuals to progressively curtail or even cease social activities and withdraw from interpersonal relationships, thereby diminishing their social support network and exacerbating psychological distress.\u003c/p\u003e\u003cp\u003e\u003cb\u003eP9\u003c/b\u003e: \u003cem\u003e\"At my niece\u0026rsquo;s wedding last week, I wore a wig and remained in a secluded corner throughout the event, fearful that relatives might inquire about my health status.\"\u003c/em\u003e \u003cb\u003eP7\u003c/b\u003e: \u003cem\u003e\"My close friend has invited me to afternoon tea on multiple occasions, yet I consistently worry that dressing elegantly would appear contrived. After refusing each invitation, I feel inner sadness, yet I remain apprehensive about confronting the situation directly.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e3.2.4 Disease-Related Shame\u003c/h2\u003e\u003cp\u003eDuring diagnosis and treatment, breast cancer survivors often experience profound illness-related shame, perceiving their disease as an embarrassing topic that they find difficult to discuss, eliciting self-criticism, self-deprecation, and even self-blame. This phenomenon is closely linked to the disease\u0026rsquo;s private nature, prevailing sociocultural biases, and resultant negative shifts in self-perception. Influenced by such shame, patients frequently elect to conceal their condition, avoid social interactions, and progressively withdraw from their social networks.\u003c/p\u003e\u003cp\u003e\u003cb\u003eP6\u003c/b\u003e: \u003cem\u003e\"I hesitate to disclose my breast cancer diagnosis to others, as I consistently experience embarrassment regarding my condition. I believe that revealing my diagnosis would make others uncomfortable, so many people in my circle remain unaware of my illness.\"\u003c/em\u003e \u003cb\u003eP12\u003c/b\u003e: \u003cem\u003e\"I avoid social gatherings with friends and family, as this disease affects intimate areas of my body. I struggle to overcome this sense of embarrassment. I prefer solitude, avoiding the uncomfortable scrutiny of others\u0026rsquo; gazes.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Theme 3: Navigating Social and Cultural Challenges\u003c/h2\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003e3.3.1 Conflict between social roles and expectations\u003c/h2\u003e\u003cp\u003eBreast cancer survivors frequently encounter significant pressures concerning social roles and responsibilities throughout recovery, giving rise to a tension between their post-treatment physical weakness and fatigue and the elevated societal expectations inherent in these roles. Society demands that they recover rapidly, reintegrate into their social roles, and uphold a positive demeanor, which frequently conflicts with their actual physical condition and psychological state, thereby generating intense pressure and anxiety and fostering self-blame and doubt. This tension further undermines their emotional well-being and impairs social engagement.\u003c/p\u003e\u003cp\u003e\u003cb\u003eP5\u003c/b\u003e: \u003cem\u003e\"My primary concern is the requirement to interact with multiple clients each day at work. My supervisor anticipates that I will maintain my previous level of efficiency, which imposes considerable pressure, as I am unable to perform at the same capacity both mentally and physically.\"\u003c/em\u003e\u003cb\u003eP7\u003c/b\u003e: \u003cem\u003e\"Relatives and friends frequently admonish me with statements such as, \u0026ldquo;Cheer up, you\u0026rsquo;ll recover soon.\u0026rdquo; This only exacerbates my sense of inadequacy, as even a year post-treatment, I remain unable to re-engage in typical social interactions.\"\u003c/em\u003e\u003cb\u003eP3\u003c/b\u003e: \u003cem\u003e\"I\u0026rsquo; m currently unable to manage numerous household tasks. Following chemotherapy, I struggle to perform basic activities such as rising from bed, let alone attending to childcare responsibilities. Consequently, when I encounter other mothers in the neighborhood, I intentionally avert my gaze.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003e3.3.2 Constraints of Social Norms\u003c/h2\u003e\u003cp\u003eBreast cancer survivors often encounter various constraints imposed by social norms during treatment and recovery, including stringent expectations about feminine appearance and familial roles. These social norms often clash with the physical and psychological changes induced by the disease, leading survivors to experience pronounced psychological distress, anxiety, feelings of inferiority, and even self-negation. To avoid contravening these norms, survivors frequently suppress their true emotions, reluctantly conform to societal expectations, or curtail social interactions, thereby intensifying social isolation and psychological burden.\u003c/p\u003e\u003cp\u003e\u003cb\u003eP10\u003c/b\u003e: \u003cem\u003e\"Society enforces uniform standards for women, and I find myself unable to conform to these norms. In public, I fear that others will detect my differences and cast disapproving glances, to the extent that I opt for self-checkout kiosks when shopping at supermarkets.\"\u003c/em\u003e \u003cb\u003eP4\u003c/b\u003e: \u003cem\u003e\"Traditional beliefs dictate that women assume primary caregiving responsibilities within their families. I fear being branded a \u0026ldquo;negligent mother,\u0026rdquo; so I set my family WeChat group to Do Not Disturb and fabricate excuses to avoid family gatherings, as I wish to evade such encounters.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\u003ch2\u003e3.3.3 Widespread Influence of Social Media\u003c/h2\u003e\u003cp\u003eWhile social media platforms offer opportunities for information exchange and interaction, their widespread adoption may exacerbate the psychological burden experienced by breast cancer survivors. When survivors confront physical health challenges, social media content frequently depicts a highly idealized and curated version of life, engendering feelings of inadequacy and stark psychological contrast that undermine emotional well-being and may precipitate shame and social withdrawal. Moreover, the swift dissemination of personal information on these platforms fosters insecurity among survivors, prompting them to avoid or limit their engagement with social media.\u003c/p\u003e\u003cp\u003e\u003cb\u003eP5\u003c/b\u003e: \u003cem\u003e\"Each time I view social media feeds, I perceive others leading glamorous lives, while I feel as though I am a defective product. Now, let alone posting photos, I do not even dare to like others\u0026rsquo; posts for fear that they might inquire about my condition.\"\u003c/em\u003e \u003cb\u003eP12\u003c/b\u003e: \u003cem\u003e\"DouYin continually directs breast cancer\u0026ndash;related content to me, and the more I consume, the more negativity I experience. Ultimately, I uninstalled all applications; however, I then became concerned about missing important treatment updates in my absence.\"\u003c/em\u003e \u003cb\u003eP6\u003c/b\u003e: \u003cem\u003e\"After falling ill, I feared meeting friends and resorted to expressing my emotions via an anonymous Weibo account. However, after each post, I simultaneously yearned for reassurance and feared being recognized by acquaintances. Ultimately, I deactivated this anonymous account as well and fully isolated myself.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Theme 4: Multidimensional Support Needs\u003c/h2\u003e\u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\u003ch2\u003e3.4.1 Medical Resource Support\u003c/h2\u003e\u003cp\u003eMost breast cancer survivors necessitate a spectrum of medical resources throughout treatment and rehabilitation, including expert medical information interpretation, accessible healthcare services, psychological support, and interdisciplinary, holistic care. However, persistent gaps in medical resource availability, limited service accessibility, and inadequate psychological support precipitate patient distress and anxiety, thereby impeding rehabilitation progress and social reintegration.\u003c/p\u003e\u003cp\u003e\u003cb\u003eP9\u003c/b\u003e: \u003cem\u003e\"I find it extremely challenging to arrange examinations and follow-up appointments. The necessity of frequent hospital visits has rendered it impossible to sustain my business operations....\"\u003c/em\u003e \u003cb\u003eP10\u003c/b\u003e: \u003cem\u003e\"Frankly, psychological support services are limited. Doctors and nurses are often overextended, and few prioritize patients\u0026rsquo; mental health. In reality, we urgently require professional psychological counseling to navigate the emotional challenges post-treatment.\"\u003c/em\u003e \u003cb\u003eP8\u003c/b\u003e: \u003cem\u003e\"I especially hope that hospitals can offer a broader array of support services\u0026mdash;such as rehabilitative therapy and nutritional counseling\u0026mdash;to expedite the restoration of my arm function and normalization of my weight, enabling me to resume everyday life promptly.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003e3.4.2 Peer Support\u003c/h2\u003e\u003cp\u003ePeer support serves as a vital resource in the rehabilitation of breast cancer survivors, ameliorating loneliness and anxiety through emotional support, experiential sharing, and social interaction, thereby bolstering psychological security and facilitating active social engagement. However, notable disparities persist in survivors\u0026rsquo; access to peer support. While the majority of survivors attain emotional resonance and practical insights through interaction with fellow patients, a subset continues to encounter barriers to peer support. This issue is especially pronounced among younger survivors, who\u0026mdash;owing to generational differences\u0026mdash;find it challenging to identify peers with whom they can discuss social pressures and evaluative feedback, leading to diminished emotional affinity and adaptation difficulties.\u003c/p\u003e\u003cp\u003e\u003cb\u003eP10\u003c/b\u003e: \u003cem\u003e\"As a younger survivor surrounded predominantly by older patients, I find it difficult to relate to them. I earnestly seek guidance on how to navigate others\u0026rsquo; perceptions and stares.\"\u003c/em\u003e \u003cb\u003eP9\u003c/b\u003e: \u003cem\u003e\"Only when interacting with individuals who share similar experiences do I feel truly understood and liberated from loneliness.\"\u003c/em\u003e \u003cb\u003eP11\u003c/b\u003e: \u003cem\u003e\"During the initial treatment cycles, I experienced depression; however, a fellow ward patient provided support, taught me sideeffect management and followup coordination, and now I feel more optimistic.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section3\"\u003e\u003ch2\u003e3.4.3 Social Support\u003c/h2\u003e\u003cp\u003eSocial support serves as a vital resource for breast cancer survivors\u0026rsquo; rehabilitation, offering emotional and psychological assistance as well as guidance on rehabilitative practices across multiple domains\u0026mdash;namely the workplace, community, and social organizations\u0026mdash;thus significantly alleviating anxiety and loneliness and enhancing social adaptation. However, most survivors encounter insufficient support. Within the workplace, only a small proportion benefit from meaningful inclusion, whereas many experience feelings of inferiority and actively withdraw from social interactions due to superficial support and subtle exclusion. Although communities participate in chronic disease education, they often lack specialized rehabilitation resources for cancer patients, leaving survivors isolated when confronted with external stressors.\u003c/p\u003e\u003cp\u003e\u003cb\u003eP7\u003c/b\u003e: \u003cem\u003e\"My supervisors and colleagues understand my condition, reduced my workload, and provided encouragement, making me feel valued and needed.\"\u003c/em\u003e\u003cb\u003eP14\u003c/b\u003e: \u003cem\u003e\"Although the community offers chronic disease education programs, there appear to be no initiatives specifically targeting cancer survivors.\"\u003c/em\u003e\u003cb\u003eP4\u003c/b\u003e: \u003cem\u003e\"My supervisor ostensibly advises me to \u0026lsquo;take my time\u0026rsquo;, yet consistently overlooks my input during meetings. Last week, I fabricated a fever to avoid the department\u0026rsquo;s team-building event, fearing that I would become a burden rather than because I was unwell.\"\u003c/em\u003e\u003cb\u003eP6\u003c/b\u003e: \u003cem\u003e\"Fellow patients in larger cities report the existence of organized rehabilitation associations, yet we lack any formal support group locally. There is no available resource for guidance or shared experience. Now, any whisper from my neighbors triggers anxiety, so I confine myself to my home all day.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Theme 5: Coping Strategies\u003c/h2\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003e3.5.1 Avoidance Strategy Selection\u003c/h2\u003e\u003cp\u003eBreast cancer survivors often adopt avoidance strategies to mitigate social pressures, such as curtailing or entirely foregoing social activities, declining discussions about their illness, avoiding intimate contact, and restricting their engagement with social media. Such avoidance strategies typically arise from concerns about negative evaluations, social anxiety, stigma associated with illness, and alterations in physical appearance. Although these strategies may temporarily alleviate psychological anxiety and social pressure, prolonged social avoidance ultimately constricts social networks and exacerbates feelings of isolation, thereby amplifying loneliness and psychological distress.\u003c/p\u003e\u003cp\u003e\u003cb\u003eP5\u003c/b\u003e: \u003cem\u003e\"I find social interactions highly stressful, prompting me to habitually fabricate excuses to evade situations that necessitate leaving home. I even opt to take out the trash at night to minimize the likelihood of encountering others.\"\u003c/em\u003e \u003cb\u003eP1\u003c/b\u003e: \u003cem\u003e\"Even family members and friends inquire about my situation, I tend to deflect their questions, as I prefer not to disclose excessive personal information.\"\u003c/em\u003e \u003cb\u003eP12\u003c/b\u003e: \u003cem\u003e\"I have markedly curtailed my social media engagement and withdrawn from multiple social groups. Over time, my friendships have gradually become more distant.\"\u003c/em\u003e \u003cb\u003eP6\u003c/b\u003e: \u003cem\u003e\"Due to my fear of going out and encountering others, I now experience heightened isolation.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003e3.5.2 Self-Adjustment\u003c/h2\u003e\u003cp\u003eSelf-adjustment constitutes a vital coping strategy for breast cancer survivors in managing the disease\u0026rsquo;s impact. Some survivors employ cognitive restructuring to redefine their body image and role identity, liberating themselves from traditional aesthetic standards and societal expectations to establish a more positive and multifaceted self-evaluation framework. Others foster self-adjustment via self-acceptance, actively embracing physical changes and emotional responses while refraining from rejecting negative emotions or bodily limitations. These strategies effectively mitigate stress and anxiety, thereby bolstering social adaptability and promoting social participation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eP9\u003c/b\u003e: \u003cem\u003e\"Initially, acceptance proved challenging; however, I eventually reminded myself that beauty is not singular\u0026mdash;so what if my body has imperfections? Gradually, I began to embrace a renewed self-perspective.\"\u003c/em\u003e \u003cb\u003eP5\u003c/b\u003e: \u003cem\u003e\"Now I embraced my limitations and acknowledged my vulnerability. I am merely an ordinary individual and need not pursue perfection.\"\u003c/em\u003e \u003cb\u003eP1\u003c/b\u003e: \u003cem\u003e\"I should not reject my scars. They stand as testaments to my journey of overcoming the disease.\"\u003c/em\u003e \u003cb\u003eP10\u003c/b\u003e: \u003cem\u003e\"I permit myself to feel sadness and anxiety, reminding myself that these emotions are entirely normal.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section3\"\u003e\u003ch2\u003e3.5.3 Seek External Support\u003c/h2\u003e\u003cp\u003eSome breast cancer survivors proactively solicit assistance from family members, friends, healthcare teams, and social organizations, articulating their needs, obtaining emotional support, consulting medical professionals for advice, and engaging in patient support group activities. Proactively seeking external support constitutes a pivotal strategy for breast cancer survivors to manage their disease, aiding in the mitigation of stress and anxiety, bolstering psychological security and social confidence, enriching social experiences, and facilitating social role reconstruction and rehabilitation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eP13\u003c/b\u003e: \u003cem\u003e\"Now, I will proactively inform my family of my circumstances, particularly when I am fatigued or experiencing a low mood. I solicit their support to alleviate stress and enhance their understanding of my experience. I also frequently invite friends for conversation or walks, share my concerns with them, and they readily offer their support.\"\u003c/em\u003e \u003cb\u003eP3\u003c/b\u003e: \u003cem\u003e\"I regularly consult healthcare professionals, including doctors and nurses. Recently, I also sought support from a psychologist. Their professional guidance has been crucial to my well-being.\"\u003c/em\u003e \u003cb\u003eP7\u003c/b\u003e: \u003cem\u003e\"I became a member of the Cancer Companion Group. My fellow group members encouraged me and accompanied me in various activities, which gradually enabled me to regain my confidence...\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cdiv id=\"Sec30\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Main findings\u003c/h2\u003e\u003cp\u003eThis study thoroughly investigated the social experiences of breast cancer survivors within sociocultural context, utilizing qualitative interview methods, and synthesized several significant themes in survivors' social experiences following their diagnosis, including physiological symptom distress, negative psychological experiences, sociocultural challenges, diverse support needs, and social coping strategies, thereby expanding our understanding of the social experiences of breast cancer survivors.\u003c/p\u003e\u003cp\u003eFirst, breast cancer survivors often face multiple physical challenges after surgery, including loss of bodily integrity, changes in appearance, limb dysfunction, and overall decline in physical functioning. These physiological changes not only significantly affect survivors' self-perception and quality of life, but also have a notable negative impact on their social interactions. As indicated by Hasan et al.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], significant bodily changes cause breast cancer survivors to experience tremendous emotional pressure, alter their self-perception, and subsequently affect their social behavior and ability to establish relationships with others. Research by Ko\u0026ccedil;an et al.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]further emphasized that body image changes following mastectomy often induce intense feelings of inferiority and shame in patients. These psychological burdens not only exacerbate their emotional distress but also lead to reduced social activities and social interactions. The longitudinal study by Garcia et al.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] also found that changes in body image among breast cancer survivors during chemotherapy not only substantially decreased their quality of life but also triggered significant changes in emotional distress and social adaptation capabilities.\u003c/p\u003e\u003cp\u003eSecondly, breast cancer survivors commonly experience negative psychological responses after surgery, including fear of disease progression, apprehension about negative evaluation, social anxiety, and illness-related shame. This aligns with the research by Levesque et al., which found that breast cancer survivors' fear of illness, sensitivity to negative evaluation, and excessive reaction to shame often lead them to actively avoid social situations and reduce interactions with family, friends, and society. This social avoidance behavior intensifies patients' feelings of loneliness and social isolation, further exacerbating their emotional distress and creating a vicious cycle. Research by Ebru et al.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] also indicates that a breast cancer diagnosis may trigger feelings of dejection in patients, leading to increased depressive symptoms. These patients often exhibit higher levels of pessimism, social isolation, shame, and hypersensitivity toward their illness, severely affecting their quality of life and psychological well-being.\u003c/p\u003e\u003cp\u003eFinally, role conflicts and emotional constraints resulting from social expectations and norms significantly impact survivors' social experiences; they generally require diverse support, and their coping strategies show marked differences. This aligns with research by Ruiqi et al.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], which found that survivors during the recovery phase struggle to meet traditional social expectations regarding female appearance, role responsibilities, and emotional expression, consequently experiencing guilt and anxiety during social interactions, choosing to actively avoid social engagement, and further falling into social isolation. Research by Lewis-Smith et al.[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] also indicates that the rapid and widespread dissemination of social media more easily exposes individuals to negative social evaluations and misunderstandings, increasing their perception of social isolation. However, a robust social support system can significantly improve breast cancer survivors' psychological state, reduce anxiety and depression, and enhance their social adaptation capabilities[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Research demonstrates that receiving multidimensional support (including medical, psychological, and integrated social resources) can significantly optimize cancer patients' rehabilitation process and play a decisive role in rebuilding their social functionality[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Additionally, research by Gu, Z et al.[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] found that strategies involving positive self-adjustment and actively seeking external support from society, family, and other sources can effectively promote breast cancer survivors' social integration, helping them reduce the distress caused by social anxiety. Nevertheless, this study also found that some patients adopt negative avoidance strategies; although avoidance strategies may alleviate social pressure in the short term, they lead to social network contraction and isolation in the long run. Meanwhile, some survivors employ positive self-adjustment strategies and seek external support, which helps them alleviate psychological pressure and rebuild social confidence.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Clinical implications\u003c/h2\u003e\u003cp\u003eThrough an in-depth exploration of breast cancer survivors\u0026rsquo; social experiences, this study offers comprehensive guidance for clinical practice. First, the findings underscore the importance of comprehensive assessment and intervention for physiological changes among breast cancer survivors. They highlight the necessity for integrated and systematic evaluation and management strategies to facilitate the restoration of bodily functions, such as phased decision-support protocols for breast reconstruction[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], cognitive interventions targeting body image[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and multidisciplinary follow-up and rehabilitation systems[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], thereby enhancing social adaptation and mitigating physiological constraints.Second, the findings underscore the necessity of early identification and intervention for psychological distress. We advocate the implementation of personalized counseling services in clinical settings, such as cognitive behavioral therapy[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and emotional regulation training[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e],to help survivors modify negative thought patterns, bolster psychological resilience, and alleviate social anxiety and isolation.Finally, the results advocate the establishment of comprehensive social support systems, including peer support groups[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and inclusive social environments, to enhance self-regulation, bolster social confidence, alleviate social anxiety, promote integration, and restore social functioning.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec32\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Study limitations\u003c/h2\u003e\u003cp\u003eWhile this study provides in-depth insights into the multidimensional aspects of breast cancer survivors' social experiences, it is not without limitations. Although qualitative interview methods facilitate a thorough exploration of individual experiences, the lack of long-term follow-up hinders the comprehensive capture of the evolving process of social experiences. Future research should adopt longitudinal designs to systematically track the trajectory of survivors' social experiences from diagnosis to long-term recovery, uncovering dynamic characteristics and key turning points in their adaptation process. Moreover, the current study predominantly focuses on a single cultural context, failing to adequately address the unique challenges and coping mechanisms across different cultural settings. Subsequent studies should conduct multicenter cross-cultural comparisons, incorporating survivor samples from diverse cultural backgrounds to explore how cultural factors influence social experiences and adaptation strategies. Additionally, the exploration of complex interactions between breast cancer and common comorbidities remains inadequate. Future research should systematically investigate the mechanisms of mutual influence between these comorbidity factors and social functioning, developing more integrated and comprehensive theoretical models to offer more targeted intervention strategies for clinical practice.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThrough in-depth qualitative interviews, this study investigated the social experiences of breast cancer survivors, uncovering the multidimensional challenges encountered by this population. Breast cancer survivors often experience distress associated with physical impairments, adverse psychological responses, sociocultural pressures, and postoperative support needs, which collectively contribute to social anxiety and avoidance behaviors. Based on these findings, healthcare professionals should strengthen symptom management and psychological support, develop targeted social rehabilitation programs, foster positive social coping strategies, and assist survivors in rebuilding social confidence and reintegrating into social life, thereby enhancing overall quality of life and long-term rehabilitation outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e This study was conducted in compliance with the Declaration of Helsinki and received ethical approval from theEthical Committee of Affiliated Hospital of Nantong University (2023-K066-01). Each participant signed a written informed consent before enrolling in the study. Only those who voluntarily agreed to participate were included in the study.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis study was funded by Nantong Municipal Health Commission (QNZ2023016) and Social and People\u0026rsquo;s Livelihood Science and Technology Projects of Nantong (MS22022063).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eXiaofeng Chen, Chen Shen, Lihua Lu conceived and designed the study; Xiaofeng Chen, Ping Lu carried out the research interviews; Chen Shen, Yuan Zhuang, Yiju Li analysed the transcripts; Xiaofeng Chen, Chen Shen, Yuan Zhuang and Lihua Lu drafted a report of the findings, and all authors commented on the analysis; Xiaofeng Chen, Chen Shen drafted this manuscript, and all authors commented on revised versions. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eWe thank all the patients who participated in the study.\u003c/p\u003e\u003ch2\u003eData availability\u003c/h2\u003e\u003cp\u003eThe data presented in this study are available on request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA-CANCER J CLIN. 2024;74(3):229\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOng SK, Haruyama R, Yip CH, Ngan TT, Li J, Lai D, Zhang Y, Yi S, Shankar A, Suzanna E, et al. Feasibility of monitoring Global Breast Cancer Initiative Framework key performance indicators in 21 Asian National Cancer Centers Alliance member countries. 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Accepting your Body after Cancer (ABC), a group-based online intervention for women treated for breast cancer: study protocol for a feasibility randomised controlled trial. BMJ OPEN. 2025;15(1):e97817.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTang H, Zhang W, Shen H, Tang H, Cai M, Wang T, Yan P, Li L, Wang Y, Zhao H, et al. A protocol for a multidisciplinary early intervention during chemotherapy to improve dietary management behavior in breast cancer patients: a two-arm, single-center randomized controlled trial. BMC Cancer. 2024;24(1):859.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim Y, Min HY, An HJ. Fear of cancer recurrence interventions for breast cancer survivors in the 2020s: a systematic review. J CANCER SURVIV 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCinek BY, Varan MP, Yaprak G, Altıntaş M. Cognitive Emotion Regulation and Its Impact on Sexual Function, Body Image, and Depression in Breast Cancer Survivors. PSYCHIAT INVEST. 2025;22(3):330\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRuiz-Romeo M, Ciria-Suarez L, Medina JC, Serra-Blasco M, Souto-Sampera A, Flix-Valle A, Arizu-Onassis A, Moncada CM, Villanueva-Bueno C, Escudero-Vilaplana V, et al. Empowerment among breast cancer survivors using an online peer support community. SUPPORT CARE CANCER. 2024;33(1):56.\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":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, Social anxiety, Qualitative research, Content analysis, Cancer nursing","lastPublishedDoi":"10.21203/rs.3.rs-7003076/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7003076/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackgroud \u003c/strong\u003e:The global incidence of breast cancer is rising annually, yet the survival rate is also exhibiting an upward trend year by year. An increasing number of breast cancer survivors will transition into the phase of chronic disease management, with reintegration into society constituting a crucial component of their overall recovery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To explore the social experiences of breast cancer survivors within a sociocultural context, with the aim of providing guidance for the development of social rehabilitation nursing support programs for this population.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A descriptive study design was employed to select 14 breast cancer survivors who were treated at a tertiary A hospital in Jiangsu Province between June and December 2024. Semi-structured in-depth interviews were conducted based on an objective sampling method, and the data were analyzed and refined using content analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The social experiences of breast cancer survivors were categorized into five themes: distress associated with physical symptoms, negative psychological experiences, navigating social and cultural challenges, multidimensional support needs, and social coping strategies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eBreast cancer survivors experience social anxiety as a result of impaired physical health, poor psychological well-being, the influence of social and cultural environments, and insufficient social support. Medical professionals should enhance symptom management and psychological counseling for this population, improve family and social support, foster positive social coping strategies, and assist survivors in reintegrating into society.\u003c/p\u003e","manuscriptTitle":"Exploring the social anxiety of breast cancer survivors in a sociocultural context: a qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-16 20:52:05","doi":"10.21203/rs.3.rs-7003076/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"56564799530549039708819060096608354795","date":"2026-05-24T09:27:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-22T08:36:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"225062740043994239606356066284622297852","date":"2026-05-22T07:20:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-14T20:10:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295991485380008048860146231760215776075","date":"2025-10-03T11:43:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-03T08:37:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-12T07:41:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-30T00:59:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-30T00:57:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-06-29T13:45:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6e1bfe3c-4254-423d-b7a4-ee4572487c28","owner":[],"postedDate":"October 16th, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"56564799530549039708819060096608354795","date":"2026-05-24T09:27:17+00:00","index":91,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-22T08:36:05+00:00","index":89,"fulltext":""},{"type":"reviewerAgreed","content":"225062740043994239606356066284622297852","date":"2026-05-22T07:20:34+00:00","index":88,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-16T20:52:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-16 20:52:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7003076","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7003076","identity":"rs-7003076","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}