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“So, when a woman becomes ill, the total structure of the family is affected, they can’t do anything…” Voices from the community on women with breast cancer in India: a qualitative focus group study

Daniel, Sunitha; Venkateswaran, Chitra; Singh, Charu; Hutchinson, Ann; Johnson, Miriam J.


Sunitha Daniel

Chitra Venkateswaran

Charu Singh


Background: Psychological symptoms are common in women with breast cancer and profoundly affect their role in the family and wider community, varying across cultural backgrounds. Breast cancer is becoming the most common cancer among women in India. We aimed to understand the cultural context within which Indian women with breast cancer living in India, experience psychological concerns from the perspectives of healthcare professionals, volunteers and church members. Methods: Five focus groups were conducted in South India (clinicians (2 groups)) lay public (3 groups). A topic guide was explored: understanding of breast cancer, experiences of patients with regard to diagnosis and treatment and psychological impact. Groups were audio-recorded and verbatim transcribed. Lay groups were conducted in Malayalam with translation and back-translation. Transcripts were subjected to thematic analysis using “cultural task analysis” as a lens for analysis. Results: Forty-five (oncologists (5), nurses (10), church members (16) and community volunteers working in a palliative care unit (14)participated. Three major themes psychosocial issues related to diagnosis, psychosocial impact of cancer treatment and coping with diagnosis and treatment and nine subthemes emerged from the two groups. All described psychological impact on women with breast cancer including body image, change of family role and their need for support. Family and faith were recognised as the major framework providing key support but also significant stress. Clinicians were also concerned about financial implications and issues around early cancer detection. Laypeople and nurses also commented that poor communication and lack of empathy from doctors aggravated distress. Conclusion: Clinical and lay communities were aware of the widespread psychological impact affecting women with breast cancer which are amplified by the patriarchal context within which they live, which extends into clinical practice. Family and faith provide a strong support structure and are a cause of distress, as core roles and expectations are challenged by this disease of womanhood.


Daniel, S., Venkateswaran, C., Singh, C., Hutchinson, A., & Johnson, M. J. (in press). “So, when a woman becomes ill, the total structure of the family is affected, they can’t do anything…” Voices from the community on women with breast cancer in India: a qualitative focus group study. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer,

Journal Article Type Article
Acceptance Date Jul 27, 2021
Online Publication Date Aug 22, 2021
Deposit Date Jul 28, 2021
Publicly Available Date Aug 23, 2021
Journal Supportive Care in Cancer
Print ISSN 0941-4355
Electronic ISSN 1433-7339
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Keywords Breast neoplasms; Psychological; Distress; Indian; Body image; Hair loss; Patriarchy; Family; Culture
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© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

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