Conj • 17 / 4 / 07 Rcsio • 17 / 4 / 07

Cancer rates for Canadian women between the ages of 22 and 44 are increasing. Improved survival times and more treatment choices, however, create new challenges. Little research has been done to uncover the lived experience of long-term survival. This pilot study describes the meaning of living with cancer for three Canadian women who were diagnosed more than four years ago. The process of inquiry was Giorgi’s descriptive phenomenological method for analysis-synthesis of a general structural description (the meaning of the experience). The findings have been interpreted creatively through poetry in an effort to enhance understanding of the experience of living with cancer. Each section of the poem is discussed in relation to the literature to encourage nurses and other health professionals to consider the importance of understanding patients’ lived experiences and the meanings they ascribe, in order to provide quality, holistic, and individualized care. More women between the ages of 20 and 44 are diagnosed with cancer and survival rates are generally increasing (National Cancer Institute of Canada, 2003). While this apparent success in cancer outcomes is welcomed, longer life and more treatment choices bring new challenges to patients and care providers. Management and rehabilitation of cancer can entail complex and painful interventions that extend over time, often resulting in uncomfortable and undesirable side effects and complications that impact all areas of life (Hilton & Henderson, 2003; Kuo & Ma, 2002; Landmark & Wahl, 2002; Pasacreta, 1997; Rose-Ped et al., 2002). Izask and Medalie (1971, as cited in Pelusi, 2001) stated, “Survival rates, while justifiably important in themselves, cover only a portion of the total problem. These rates do not relate to how the patient survives” (p. 265). While it appears that diagnosis and treatment options for Canadians are improving (National Cancer Institute of Canada, 2003), in epidemiological discussions of people living longer after a cancer diagnosis, quality of life issues are often ignored. This is where a qualitative approach to research can enhance statistical reports that fail to put human faces to the disease and the numbers. Breaden (1997) discussed themes from a linear view of “survival as time” and that “watching the months pass by is one of the objective parameters used by the medical community (and very often the sufferers themselves)” (p. 979). Breaden’s review of the literature found that much of the writing reinforced a biomedical model of health and illness. Cancer has the ability to spread or metastasize in the body through various routes. The possibility of this occurring, and the continued focus on follow-up and testing brings a degree of uncertainty related to the healing process that is not necessarily a part of other disease trajectories. Howell, Fitch, and Deane (2003) qualitatively examined Toronto women’s experiences with recurrent ovarian cancer. Four themes that emerged were: waiting for recurrence, facing the diagnosis, managing treatment-related concerns, and attempting to gain control. The women in the study experienced considerable anxiety and anticipatory fear before checkups and felt shock and despair when faced with the news. Mahon and Casperson (1997) studied the meaning of recurrence among 20 persons living in the United States and found three emerging themes related to differences between the initial diagnosis and the recurrence. Some were similar to Howell et al.’s (2003) findings, but one theme focussed on both positive and negative changes in the health care system since the time of the first diagnosis. Dirksen (1995) explored the search for meaning in survivors of malignant melanoma using the Search for Meaning scale. Dirksen (1995) found that 52% of the participants did search for meaning that was often related to finding a cause as they blamed themselves for their condition. This search was more prevalent in younger participants with Dirksen (1995) describing the search for meaning as “a thinking process related to why the cancer occurred and its impact on life” (p. 633). Utley (1999) reported that women over the age of 65 with breast cancer viewed cancer as sickness and death, as an obstacle, and as transforming. The lived experience of women who survived breast cancer longer than five years was captured by Carter (1993) in a qualitative descriptive study. Participants described “going through” a survival process that involved several evolving phases involving psychosocial issues that, Carter (1993) noted, are rarely focused on in long-term survival studies. With few studies examining the meaning of the cancer experience from a female perspective, further qualitative studies are important. Zebrack (2000b) stressed that quality of life (QOL) questionnaires are “less sensitive than probing interviews” and, therefore, these tools “do not adequately capture the total essence of an individual’s QOL” (p. 1397). Understanding the experience of women who live with cancer, finding out what it is like for them, and illuminating their meaning will expand the knowledge base for nursing. Only the women themselves can begin to describe what it is like. In practice, “enhancing understanding...leads to an openness that can change the ways nurses interrelate with persons” (Mitchell & Heidt, 1994, p. 119).