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Psychological concerns of Indian women with breast cancer in different national contexts: a systematic review and mixed-methods synthesis

Daniel, Sunitha; Clark, Joseph; Gnanapragasam, Sam; Venkateswaran, Chitra; Johnson, Miriam J.


Sunitha Daniel

Joseph Clark

Sam Gnanapragasam

Chitra Venkateswaran


Background: Breast cancer is becoming the most common cancer among women of Indian origin. Little is known about the psychological impact of the disease and its treatment among this population.
Aim: To improve understanding of psychological symptoms of Indian women with breast cancer.
Design: Systematic literature review and critical interpretative synthesis. Searches (7 May 2019;) used MeSH terms and keywords for breast cancer, psychological symptoms and treatment. Reference lists of included articles were examined. Search results were screened against inclusion criteria, data extracted, quality appraised by two independent researchers, with recourse to a third. Narrative (quantitative) and thematic qualitative syntheses were applied followed by critical interpretative synthesis.
Data sources: ProQuest; MEDLINE; Ovid EMBASE; EBSCO; CINAHL; PsycINFO
Results: 18/763 studies from India or Canada were included (13 quantitative; 5 qualitative). Critical interpretative synthesis found similar psychological concerns to “Western” women, but were framed by the common culture of Indian women in either country. Family structure, religion and community appears to protect against and cause distress in relation to the expected core roles of wife and mother, and male-dominance in decision-making. Stigma was amplified by poor knowledge about the nature of cancer. Migrant Indian women had additional problems due to language barriers.
Conclusions: Indian women with breast cancer living in India and Canada experience psychological morbidities which profoundly affect their role in the family and wider community. Culturally congruent care including accessible communication and information may help prevent and alleviate distressing symptoms whether in India or as part of a migrant community.

Journal Article Type Article
Journal BMJ supportive & palliative care
Print ISSN 2045-435X
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
APA6 Citation Daniel, S., Clark, J., Gnanapragasam, S., Venkateswaran, C., & Johnson, M. J. (in press). Psychological concerns of Indian women with breast cancer in different national contexts: a systematic review and mixed-methods synthesis. BMJ supportive & palliative care,
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