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Abstract

Breast cancer is a significant public health concern globally, and its impact extends beyond physical survival. Survivors often grapple with a myriad of challenges, including psychological distress, social isolation, and financial hardship. These challenges are often exacerbated in low-resource settings like Nigeria, where limited access to quality healthcare, socioeconomic disparities, and cultural stigma surrounding cancer can significantly impact the quality of life for survivors. This study aims to explore the suffering perceived by long-term breast cancer survivors in Nigeria, focusing on their lived experiences during and after treatment. Using a phenomenological approach, in-depth interviews were conducted with 22 women who have survived breast cancer for over 5 years. Data were analyzed using thematic analysis to capture the essence of their suffering, allowing for a deep understanding of their lived experiences. Five main domains emerged: (1) Physical Suffering, (2) Emotional Distress, (3) Social Suffering, (4) Financial Strain, and (5) Spiritual and Resilient Coping. Participants described their suffering as a multifaceted journey marked by physical pain, emotional turmoil, social stigma, financial challenges, and resilience fostered through spirituality and support systems. The phenomenological analysis revealed that the participants’ suffering extended beyond the physical, touching every aspect of their lives and reshaping their identities and perceptions of self. The findings highlight the complex nature of suffering among breast cancer survivors in Nigeria, underscoring the need for comprehensive survivorship care that addresses physical, psychosocial, and spiritual dimensions. By understanding the essence of their suffering, healthcare providers can develop more compassionate, context-specific care strategies that validate and support the holistic needs of survivors.

Keywords

breast cancer survivors suffering Nigeria

Introduction

Worldwide, breast cancer accounts for the highest mortality in women, with over 1.7 million new cases and 18% of deaths every year.¹ Breast cancer is undoubtedly the most common cancer in women globally, and 22.7% of new cancer cases in Nigeria is breast cancer.² It is the most prevalent cancer among women globally and a leading cause of cancer-related deaths, particularly in low- and middle-income countries like Nigeria. Advances in biomedical technology have improved survival rates, but the journey of survivorship often brings its own set of challenges that extend far beyond medical treatment. Cancer survivorship may be described as breast cancer patients with a previous diagnosis of cancer and are either presently living with it or haven’t had any recurrence of cancer for a significant period of time.³ Survivors are frequently left to navigate complex, multilayered suffering that profoundly impacts their quality of life.

The greater population of cancer patients in Nigeria present with late diagnosis, which ultimately leads to poor prognosis and a low survival rate among cancer patients.⁴ Phenomenologically, suffering in the context of cancer extends beyond mere physical symptoms; it encompasses a broader existential struggle where individuals confront disrupted life narratives, altered body images, and the loss of previously held roles and identities. In Nigeria, most breast cancer patients present at advanced stages due to factors such as low awareness, poor screening uptake, and socioeconomic barriers. This late presentation not only complicates treatment but also heightens the emotional and social suffering experienced by survivors. The lack of adequate access to healthcare resources across low- and middle-income countries (LMICs), especially Nigeria, had a negative impact on the ability of their health system to promote effective evaluation and support during remission to breast cancer survivors.³

The phenomenological approach emphasizes understanding suffering as a lived experience, moving beyond quantitative measures of pain or distress to uncover how survivors perceive and make sense of their suffering. This perspective is particularly relevant in contexts where cultural, social, and spiritual dimensions of suffering are deeply intertwined and cannot be fully captured through traditional biomedical frameworks. While much of the existing literature has focused on clinical outcomes, there is a significant gap in understanding the lived experiences of breast cancer survivors, particularly in Nigeria. This study seeks to fill this gap by exploring the perceived suffering among long-term breast cancer survivors in Lagos, Nigeria, highlighting the multifaceted and deeply personal nature of their experiences. By employing a phenomenological lens, this study delves into the complexities of survivorship, capturing the essence of suffering articulated by the survivors.

Methods

Theoretical Lens

This study utilized a phenomenological approach, which is particularly suited to exploring individuals’ lived experiences and uncovering the essence of their perceptions. Phenomenology, grounded in the philosophical traditions of Husserl⁵ and Heidegger,⁶ seeks to explore how individuals make sense of their lived experiences, emphasizing the subjective nature of reality. In this study, the phenomenological approach allowed the researcher to understand the suffering of breast cancer survivors as it was lived, experienced, and articulated by the participants themselves. Within this framework, the concept of “essence” refers to the underlying structures, patterns, and shared meanings that constitute a particular phenomenon. In this study, the aim was to identify the core domains and patterns that characterized the suffering experienced by Nigerian female breast cancer survivors. By centering on the unique perspectives, narratives, and interpretations of the participants, the research sought to uncover the essence of their suffering, transcending individual variations to identify the shared, underlying structures of their lived experiences.

Participants

Participants were recruited from oncology clinics and breast cancer support groups in Lagos, Nigeria. Recruitment strategies included collaboration with healthcare professionals at major oncology clinics, outreach to established breast cancer support groups, and utilizing word-of-mouth referrals from existing participants. Inclusion criteria included being a woman diagnosed with breast cancer, having completed treatment at least 5 years prior, and being willing to share their experiences. A purposive sampling strategy was employed to select 22 participants aged 35 to 67, ensuring diverse perspectives in terms of age, socioeconomic background, and time since diagnosis. This approach aligns with phenomenological research's emphasis on depth rather than breadth, focusing on capturing the essence of the lived experience. Recruiting primarily from oncology clinics and support groups might have introduced a selection bias, as participants from these sources may represent a specific subgroup of survivors with greater access to healthcare resources and potentially better overall health outcomes compared to those who do not seek treatment at specialized cancer centers or engage with support groups. Additionally, participants who volunteered to participate in the study who are more likely to be open to sharing their experiences, which may differ in their perspectives and experiences from those who declined to participate, potentially introduced a self-selection bias.

Data Collection

Data were collected through semi-structured, in-depth interviews conducted in private settings to ensure confidentiality and encourage openness. Each interview lasted approximately 60 to 90 min and was audio-recorded with participants’ consent. The interview guide included open-ended questions designed to explore participants’ experiences of physical, emotional, and social suffering and coping mechanisms. In line with phenomenological traditions, the interviews were conversational and fluid, allowing participants to narrate their stories in their own words and at their own pace, reflecting the centrality of their lived experiences.

Data Analysis

Data analysis proceeded using thematic analysis guided by Van Manen⁷ interpretive phenomenological approach, emphasizing the interpretation of lived experiences. An inductive approach was employed, where initial codes were generated directly from the data. Codes were then refined, categorized, and grouped into broader domains. The research team engaged in rigorous discussions and debates to ensure inter-rater reliability and refine the coding framework. Key domains emerged, representing core aspects of the participants’ lived experiences of suffering. These domains were further developed and refined through a process of constant comparison and cross-checking with the raw data, allowing the essence of suffering to emerge organically. Member checking was conducted throughout the research process to enhance the credibility and trustworthiness of the findings. Preliminary findings, including key domains, themes and their interpretations, were presented to a subset of participants for feedback. Participants were asked to review the findings and provide feedback on whether the findings accurately reflected their lived experiences. This feedback was carefully considered by the research team, leading to refinements in the interpretation and presentation of the findings. In some cases, participants provided additional insights or nuances that were not initially captured in the analysis, enriching the understanding of their lived experiences. Throughout the analysis, the research team engaged in reflexive practices, including regular team meetings, maintaining a research journal, and consulting with external experts to ensure the rigor of the analysis and mitigate potential biases.

Rigor

This study prioritized rigor through a multifaceted approach aligned with the principles of phenomenological inquiry. Data collection and analysis were conducted iteratively, with emerging domains informing subsequent data collection and participant selection. Saturation was determined through ongoing analysis, with data collection continuing until no new themes or insights emerged. Data triangulation was achieved through multiple data sources, including in-depth interviews, field notes from researcher observations, and review of participants’ personal journals (where available). Reflexivity was deeply embedded throughout the research process, involving regular team discussions, maintaining research journals, and consulting with external qualitative experts to critically examine researcher biases and assumptions. Member checking involved sharing preliminary findings with participants and seeking their feedback to ensure the findings resonated with their lived experiences. The analysis involved a rigorous process of team discussion, debate, and peer debriefing to refine interpretations and ensure inter-rater reliability. An audit trail was maintained, documenting all research procedures, decisions, and modifications to ensure transparency and replicability within the phenomenological paradigm. By prioritizing iterative data collection, reflexive practices, and collaborative analysis, this study aimed to ensure the findings were credible, authentic, and deeply grounded in the participants’ lived experiences. While acknowledging the subjective nature of phenomenological inquiry, the study strived for a balance between capturing the unique perspectives of each participant and identifying the shared, underlying structures of their lived experiences.

Results

According to data in Table 1, the participants, aged between 27 and 61 at diagnosis, were mostly diagnosed with Stage 2 breast cancer between 2014 and 2020. Ten of the participants have a Bachelor's Degree, 3 holding a HND qualification and only 3 holding a high school diploma or SSCE. Most hold a Bachelor's or higher degree, while a few have lower qualifications such as HND or SSCE. Most are married, with a few being single, divorced, or widowed.

Table 1.

Participants’ Demographic Characteristics of Participants.

Participant code	Age at diagnosis in years	Year of diagnosis	Age at now	Stage at diagnosis	Educational qualification	Marital status
Participant 1	30	2015	38	2	BSc	Married
Participant 2	27	2015	35	2	BSc	Single
Participant 3	49	2016	56	3	HND	Married
Participant 4	41	2015	49	2	BSc	Married
Participant 5	38	2014	47	2	BSc	Married
Participant 6	49	2015	57	2	BEd	Married
Participant 7	36	2016	43	2	HND	Married
Participant 8	47	2015	55	Unsure	MSc	Married
Participant 9	36	2016	43	2	MSc	Married
Participant 10	47	2020	53	2	BEdu	Married
Participant 11	40	2016	47	3	HND	Married
Participant 12	39	2015	47	2	MSc	Married
Participant 13	61	2020	67	3	SSCE	Widowed
Participant 14	49	2016	46	3	BSc	Married
Participant 15	50	2020	56	2	BSc	Married
Participant 16	35	2016	44	2	BSc	Married
Participant 17	31	2015	39	2	MSc	Married
Participant 18	45	2015	53	2	SSCE	Divorced
Participant 19	49	2020	55	2	BSc	Married
Participant 20	50	2020	56	2	BSC	Married
Participant 21	39	2016	46	2	BSc	Married
Participant 22	49	2015	57	3	SSCE	Married

The analysis revealed 5 major domains and 10 subdomains that capture the multifaceted nature of suffering among breast cancer survivors in Lagos, Nigeria (See Table 2). These domains and themes highlight the complex interplay of physical, emotional, social, financial, and spiritual dimensions of their experiences.

Table 2.

Domains and Themes.

Domains	Themes	Description
Physical suffering	Persistent pain and fatigue	Chronic pain, fatigue, and ongoing physical limitations hinder daily activities and impact quality of life.
	Lymphedema and physical limitations	Physical restrictions caused by lymphedema and other long-term treatment side effects, leading to reduced functionality and body image concerns.
Emotional distress	Fear of recurrence and anxiety	Persistent fear of cancer returning, heightened by physical symptoms, routine check-ups, and uncertainty about the future.
	Depression and feelings of isolation	Emotional burden characterized by sadness, loneliness, and disconnection from others due to the cancer experience.
Social suffering	Stigma and judgment	Social isolation and discrimination stemming from cultural stigma and misconceptions about cancer.
	Altered relationships and marital strain	Changes in familial and marital dynamics, including strained relationships and loss of social roles within the family and community.
Financial strain	Economic burden of treatment	Significant financial challenges due to high costs of cancer treatment, leading to debt, asset depletion, and economic instability.
	Impact on family and education	Financial difficulties affecting family dynamics, including disruption to children's education and overall household well-being.
Spiritual and resilient coping	Faith as a source of strength	Reliance on spirituality and faith as a crucial coping mechanism, providing hope, comfort, and meaning during the cancer journey.
	Support systems and peer resilience	The importance of peer support groups in providing emotional support, shared experiences, and fostering resilience among survivors.

Physical Suffering

Physical suffering emerged as a pervasive and enduring theme, deeply impacting the daily lives of these survivors. The experience of cancer and its treatment left an indelible mark on their bodies, resulting in a constellation of physical challenges that profoundly affected their sense of self and their ability to navigate the world. The persistence of physical symptoms not only affected the survivors’ functional abilities but also had profound psychological implications, serving as constant reminders of their cancer experience.

Persistent Pain and Fatigue: Participants described an unrelenting battle against chronic pain and fatigue. These were not fleeting discomforts but constant companions, overshadowing their daily lives and robbing them of their energy. Simple activities, such as climbing stairs, became arduous tasks, while the joy of playing with children was often replaced by debilitating exhaustion. Participant 10 revealed, “I feel tired all the time. Even simple tasks like climbing the stairs feel like climbing a mountain. My body is always sore, and I have to rest so much.” Participant 19 also expressed that, “The fatigue is overwhelming. It's not like being tired; it's like my whole body is shutting down. I can’t even keep up with my kids.”

Lymphedema and Physical Limitations: Lymphedema emerged as a significant source of both physical and emotional distress. For many, it was more than just a medical condition; it was a constant reminder of their altered bodies and a source of ongoing frustration and grief This was evidence in participant 15's description of lymphedema; “lymphedema makes me feel like my body is not my own anymore. I can’t even wear my favorite clothes because of the swelling.” Similar was also expressed by participant 20 who revealed, “I can’t move my arm properly, and it hurts every time I try to lift something. It's frustrating because I used to be very active.”

Emotional Distress

Emotional distress was deeply embedded in the survivors’ narratives, often intertwining with their physical suffering. Fear, anxiety, and depression were prevalent, fueled by the ongoing threat of recurrence and the lasting impact of their cancer experience. This fear was not merely a fleeting worry, but a pervasive presence that profoundly impacted their sense of security and their ability to fully engage in life.

Fear of Recurrence and Anxiety: The fear of cancer returning loomed large in the minds of many survivors, affecting their ability to feel secure and enjoy their lives fully. This hypervigilance, this constant fear of the unknown, created a state of chronic anxiety, leaving many survivors feeling perpetually on edge. This fear was evidence in participant 17 who shared that, “every time I have a headache or a pain in my chest, I think it's back. It's a constant fear that never leaves me.” This pervasive anxiety not only impacted their emotional well-being but also significantly disrupted their daily lives, affecting their relationships, their work, and their overall quality of life. According to participant 22, “I live my life in a state of anxiety. I am always thinking, ‘What if it comes back?’ It's like a shadow that follows me everywhere.” Many survivors reported difficulty concentrating, experiencing sleep disturbances, and withdrawing from social activities due to the constant fear of recurrence.

Depression and Feelings of Isolation: Several participants described a profound sense of sadness and loneliness, often exacerbated by their perceived inability to relate to others who had not experienced cancer. According to participant 8, “I feel disconnected from everyone. People try to understand, but they don’t really get what it's like to live with this constant weight” (Participant 8). Beyond the immediate physical and emotional trauma of treatment, many survivors grappled with a profound sense of grief and loss. This grief was multifaceted, encompassing the loss of their health, their former selves, and the disruption of their life plans. The experience of cancer irrevocably altered their lives, leaving them feeling disconnected from their pre-diagnosis selves and the lives they had envisioned for themselves. This sense of loss often led to feelings of depression, isolation, and a pervasive sense of disconnection from the world. As participant expressed, “sometimes, I just want to stay in bed and not face the world. It's hard to explain to my family why I feel this way because I know they think I should be happy to be alive.”

Social Suffering

Social suffering encompassed the stigma, altered relationships, and changes in social roles that affected the survivors’ interactions with their families, friends, and communities. The experience of breast cancer was deeply intertwined with social suffering, extending beyond the physical and emotional challenges. Many survivors felt stigmatized, misunderstood, and isolated within their communities. This social suffering manifested in various ways, from subtle judgments and avoidance to significant disruptions in their personal relationships. Many felt misunderstood and ostracized.

Stigma and Judgment: Participants described feeling judged and stigmatized by their communities, which often led to social isolation and a sense of being misunderstood. Participant 18 expressed the stigma experienced from society, “people act like I did something wrong to deserve this. They avoid me, and some don’t even want to be near me, like it's contagious.” Furthermore, many survivors felt the weight of societal expectations and the pressure to appear “positive” and “strong.” This perceived pity, often unintentionally conveyed, could be deeply hurtful and further exacerbate feelings of isolation and inadequacy. According to participant 9, “I feel ashamed sometimes because of the way people look at me. They don’t say it, but you can see the pity in their eyes.”

Altered Relationships and Marital Strain: The impact of cancer on personal relationships was profound, with some survivors experiencing changes in marital dynamics and distancing from loved ones. Many survivors also experienced a sense of disconnection from their friends and social circles. The fear of burdening others, the discomfort of discussing their illness, and the changes in their own personalities often led to social withdrawal and a sense of isolation. This was felt largely by Participant 4 who reported that; “My husband tries to be supportive, but I know he's tired. He doesn’t see me the same way anymore. It's like there's this invisible barrier between us.” Also by participant 16 who expressed, “I lost touch with many friends during my treatment. They didn’t know how to be around me, and I didn’t know how to explain what I was going through.”

Financial Strain

Financial strain was a major theme, highlighting the economic toll of cancer treatment. The cost of care often forced survivors into difficult financial decisions, compounding their overall suffering. The financial burden of cancer treatment emerged as a central theme, casting a long shadow over the lives of many survivors. The high costs associated with diagnosis, treatment, and ongoing care proved to be a significant source of stress and hardship, often pushing survivors and their families to the brink of financial ruin.

Economic Burden of Treatment: Participants frequently described how the high costs of diagnosis, treatment, and follow-up care drained their financial resources, leaving them in dire straits. According to participant 12* “I had to borrow money from everyone I know. Now, I’m struggling to pay back the loans. It feels like cancer didn’t just take my health; it took my future.” The economic impact of cancer extended far beyond medical expenses. Many participants described the devastating impact on their livelihoods, forced to make agonizing choices between their health and their financial stability. It was chaotic for participant 13 who reported, I lost my job because I couldn’t keep up with work during treatment. Now, I have no steady income, and the bills keep piling up.” The loss of income, coupled with mounting medical bills, plunged many survivors into a cycle of debt and financial insecurity, leaving them feeling trapped and hopeless.

Impact on Family and Education: The financial impact extended to the participants’ families, affecting their children's education and the overall household stability. According to participant 7, “Cancer put a strain on our entire family. We sold our two cars and our land just to keep up with the medical bills.” The financial strain often had a ripple effect, impacting not only the survivors themselves but also their families. Children's education was frequently disrupted, as families were forced to make difficult choices, prioritizing medical expenses over educational needs. In the words of participant 14, “we had to make tough choices, like skipping meals so we could afford my medications. My children's school fees were delayed because we had no money left.”

Spiritual and Resilient Coping

Despite their immense suffering, many survivors found solace in spirituality, drawing strength from faith, support groups, and personal resilience. These coping mechanisms provided a crucial counterbalance to their distress. While the journey of breast cancer survivorship was often fraught with challenges, many women demonstrated remarkable resilience, drawing strength from a variety of sources to navigate their experiences. Spirituality emerged as a significant source of solace for many, providing a sense of meaning, hope, and connection in the face of adversity.

Faith as a Source of Strength: Spirituality played a pivotal role in helping survivors cope with their challenges, providing hope and a sense of purpose even in their darkest moments. According to participant 6, “praying gave me peace when nothing else could. I felt God's presence with me, and that kept me going when I wanted to give up.” This sense of divine guidance and support provided a crucial sense of meaning and purpose, helping survivors to find strength and acceptance in the face of their illness. This belief in a higher power, coupled with a sense of spiritual acceptance, enabled many survivors to find a deeper sense of meaning and purpose in their experiences, transforming their suffering into a source of growth and personal transformation. Participant 12 also expressed that, “my faith taught me to be strong. I believe that everything happens for a reason, and that belief helped me accept what was happening to me.”

Support Systems and Peer Resilience: Beyond individual spirituality, the power of human connection played a vital role in fostering resilience. Support groups emerged as crucial lifelines for many survivors, providing a safe and supportive space to share their experiences, fears, and hopes. Support groups offered survivors a sense of community and understanding that was often missing in their broader social circles. According to participant 3, “the support group was my lifeline. We shared our stories, cried together, and celebrated each other's small victories. It felt like a safe space.” Similar was also experienced by participant 1 who shared that, talking to others who had been through the same thing made me feel less alone. It gave me hope to see others who were living full lives after cancer.These connections were vital in rebuilding their sense of self-worth. Witnessing the resilience and strength of other survivors offered inspiration and hope, demonstrating that it was possible to thrive despite the challenges of cancer.

Discussion

This study sheds light on the complex and deeply personal suffering experienced by long-term breast cancer survivors in Lagos, Nigeria. Using a phenomenological lens allowed us to delve into the lived experiences of these women, capturing the essence of their struggles and resilience. The findings reveal the interconnectedness of physical, emotional, social, financial, and spiritual challenges that extend far beyond the initial cancer treatment phase, illustrating the need for a more comprehensive approach to survivorship care.

Physical Suffering: A Lingering Presence

Physical suffering was not confined to the period of active treatment but continued to shape the daily lives of survivors long after treatment had ended. This in line with study by Petrova et al,⁸ which stated that almost all cancer survivors suffer from single or multiple physical conditions, either as a result or cancer diagnosis or exacerbated by cancer. Chronic pain, fatigue, and treatment side effects such as lymphedema were common, leading to significant physical limitations and an ongoing sense of battle with the disease. These findings align with previous studies that highlight the long-term physical sequelae of cancer treatments, including chemotherapy, radiation, and surgery, which often result in neuropathy, joint pain, and muscle weakness. One such study by Schmidth et al,⁹ argued that a large number of cancer survivors experience long-term effects of cancer diagnosis and treatment, such as loss of physical performance, fatigue, sexual problems, sleep problems, arthralgia, anxiety, neuropathy, and memory problems.

However, the impact of these physical symptoms in low-resource settings like Nigeria may be further exacerbated by limited access to pain management and rehabilitation services, leaving survivors with few options for relief. This is related to a study by Martin et al,¹⁰ which revealed that cancer-related fatigue (CRF) among cancer survivors is certainly the most common side effect of cancer treatment, and types of interventions that can be used to reduce its impact include physical activity, psychosocial, and mind–body interventions. This is supported by a study by Maass et al¹¹ which reported that a significant number of breast cancer survivors suffer from CRF during and shortly after treatment; which negatively impacts their quality of life. This ongoing physical suffering highlights a gap in post-treatment care, where the focus often shifts away from symptom management once active treatment concludes. Addressing this gap requires the integration of long-term follow-up care that includes pain management, physiotherapy, and tailored exercise programs to help survivors regain strength and improve their quality of life.

Emotional Distress: The Invisible Burden

Emotional distress emerged as a pervasive theme, with participants frequently describing ongoing anxiety, depression, and fear of recurrence. Cancer survivors experience significantly high levels of psychological and emotional distress in their daily living.¹² These emotional burdens were often compounded by the lack of psychological support during and after treatment, reflecting a critical area of unmet need in survivorship care. Moreso, this can be supported with findings from a study by Boscher et al,¹³ which discovered that cognitive effects such as anxiety, depression and post traumatic syndrome are commonly experienced by breast cancer survivors as negative effects of cancer treatment, which ultimately affects normal coping with life and work. Fear of recurrence, in particular, was a dominant psychological stressor, influencing survivors’ daily thoughts and behaviors and affecting their ability to feel secure and optimistic about the future. This is in line with a study by Tran et al¹⁴ which reported that the fear of cancer recurrence (FCR) is among the most common and aggressive psychological effects experienced by cancer survivors.

The phenomenological analysis revealed that fear was not just an occasional worry but a pervasive and intrusive element of survivors’ lives, often triggered by physical sensations, routine medical check-ups, or even media portrayals of cancer. This fear underscores the need for psychological interventions specifically designed to address the unique anxieties of cancer survivors, such as Cognitive Behavioral Therapy (CBT), mindfulness-based stress reduction, and psychoeducational support groups. A study by Zhao et al¹⁵ emphasized that the use of Acceptance and Commitment Therapy is an effective psychological intervention in helping cancer survivors in navigating their mental health difficulties. These interventions can help survivors develop coping strategies to manage fear and anxiety, promoting mental well-being and enhancing their overall quality of life.

Moreover, the feelings of isolation and sadness reported by many participants highlight the broader impact of cancer on their sense of self and social identity. This is associated with a study by Kang et al,¹⁶ which reported that cancer survivors often struggle with the loss of their pre-cancer identity, feeling disconnected from who they were before their diagnosis. Cancer survivors may experience cancer stigma from diagnosis and treatment, which could lead to loss of identity, poor psychosocial adjustment, and emotional difficulties. This identity disruption can contribute to a prolonged grieving process that extends beyond the loss of physical health to include the loss of roles, relationships, and life plans. Similar findings were made by Bjerkeset et al,¹⁷ which stated that breast cancer survivors typically experience emotional and psychological distress, leading to a loss of self-identity and purpose, as part of the symptom cluster from cancer treatment. Addressing these emotional challenges requires a more holistic approach to survivorship care that includes routine mental health screenings and access to counseling services tailored to the unique needs of cancer survivors.

Social Suffering: Navigating Stigma and Relationship Changes

Social suffering, characterized by stigma, judgment, and altered relationships, reflects the profound impact of cultural and social dynamics on the survivorship experience in Nigeria. The stigma surrounding cancer, often fueled by cultural misconceptions and fear, led many participants to feel isolated and rejected by their communities. This is in line with a study by Jin et al¹⁸ who emphasized that sociocultural factors are the strongest association to social stigma among breast cancer survivors. Survivors reported that they were sometimes viewed with suspicion, pity, or even contempt, which significantly affected their social reintegration and self-esteem. In a study by Solikhah et al,¹⁹ social stigma is experienced by breast cancer survivors is rooted in the belief that cancer ultimately leads to death and also being the most unpredictable disease in the world. This social stigma can be deeply damaging, as it not only isolates survivors but also diminishes their access to social support, which is crucial for emotional recovery.

The impact of stigma was particularly evident in altered familial and marital relationships, with some participants noting that their partners distanced themselves or viewed them differently after their diagnosis. These relational shifts can compound emotional distress, as survivors lose critical sources of support and intimacy at a time when they are most vulnerable. As emphasized by Shen et al,²⁰ social support, hope, and self-efficacy are important predictors of understanding social suffering among cancer survivors and are also significantly associated with their quality of life.

Community education and advocacy are essential to addressing social suffering. Public health campaigns that demystify cancer, challenge myths, and promote positive narratives about survivorship can help reduce stigma and foster a more supportive environment for survivors. This is in line with study by Kang et al¹⁶ which stated that there is a great need for interventions to mitigate cancer stigma among cancer survivors, towards alleviating social support and improving social support. Healthcare providers also have a role in advocating for patients, encouraging open conversations about cancer within families, and facilitating access to family counseling or support services that can help repair strained relationships.

Financial Strain: The Cost of Survival

Financial strain was a prominent theme, highlighting the severe economic impact of cancer diagnosis and treatment on survivors and their families. The concept of “financial toxicity” captures the devastating financial burden faced by many participants, who reported depleting their savings, selling assets, and accruing significant debt to afford their care. This is further emphasized in a study by Mols et al,²¹ which stated that financial toxicity is strongly associated with the rising costs of cancer treatment with a negative impact on the finances of cancer survivors due to their loss/unstable employment status and low-income level.²² The long-term financial implications extended beyond direct medical costs to include lost income, unemployment, and reduced economic opportunities, which had ripple effects on survivors’ overall quality of life.

In low-resource settings like Nigeria, where health insurance coverage is limited and out-of-pocket expenses are high, the financial burden of cancer can be catastrophic. This is in line with a study by Yabroff et al²³ which revealed that due to the growing out of pocket expenses, cancer survivors may adopt behaviors such as letting go of high-cost medical treatments and nonadherence to chemotherapy or other medications. This financial strain exacerbates the stress of survivorship, as the constant struggle to meet basic needs competes with the need for ongoing medical and psychological care. This is in line with Santoyo-Olsson et al,²⁴ who stated that cancer survivors with greater medical and nonmedical financial hardships typically experience financial shame which affects their self-rated health, as well as significantly related to more emergency interventions and reduced uptake of necessary preventive services.

Survivors frequently described the shame and guilt associated with their financial dependence on others, highlighting how financial toxicity not only affects their material well-being but also their sense of dignity and self-worth. Addressing financial strain requires systemic changes, including expanding access to health insurance, providing financial assistance programs, and implementing policies that reduce the costs of cancer treatment. This is in line with the study by Gupta et al,²⁵ which stated that it is important for healthcare professionals to provide support to cancer survivors regarding financial difficulties, especially by understanding financial stress related to their developmental life in improving their quality of life. Additionally, integrating financial counseling into survivorship care can help survivors navigate the complexities of healthcare costs, plan for ongoing expenses, and access available resources and support services.

Spiritual and Resilient Coping: Sources of Strength

Despite the profound challenges they faced, many survivors demonstrated remarkable resilience, often drawing strength from spirituality, faith, and peer support networks. Spirituality emerged as a critical coping mechanism, providing comfort, hope, and a sense of purpose amid the uncertainties of cancer survivorship. This is emphasized in a study by Sira et al,²⁵ which stated that adaptive coping among cancer survivors is strongly associated with their biopsychosocial-spiritual and developmental needs, which include spiritual support and reliance. For many participants, faith was not merely a passive belief but an active practice that shaped their response to suffering and provided a framework for meaning-making. This is in line with the study by Garduño-Ortega et al,²⁶ which states that spiritual well-being positively influences that ability for cancer survivors to develop meaning to life and have peace; therefore it is a significant predictor to an improved quality of life during survivorship among breast cancer survivors. It is also emphasized in the study by Yilmaz & Cengiz²⁷ which showed that across cancer survivors, it was seen that self-faith and faith in God is greatly associated with the meaning, purpose, and life fulfillment.

Hamilton et al²⁸ revealed that women with cancer, especially breast cancer are known to have more spiritual coping and reliance, especially in dealing with psychosocial issues related to cancer treatment and survivorship. Therefore, the role of spirituality in coping highlights the importance of addressing the spiritual needs of cancer survivors as part of holistic care. This is in lieu with study by Ciria-Suarez et al²⁹ which states that the effects of spirituality and optimism have a positive impact on cancer survivors, especially during cancer treatment and psychological adjustments. Healthcare providers should acknowledge and respect the spiritual beliefs of their patients, incorporating spiritual assessments and referrals to chaplaincy or spiritual care services when appropriate. Peer support groups also played a vital role, offering survivors a sense of community and belonging that was often missing in their broader social circles. This was found to be crucial in a study by Zielger et al,³⁰ who reported that cancer peer support is important in not only providing psychological support for cancer survivors but also provide information, emotional relief, and boosting self-empowerment. These groups provided not only emotional support but also practical advice, shared experiences, and a space where survivors felt understood and validated.

Limitations

The study's findings are subject to certain limitations, including the small sample size typical of phenomenological research, which may limit the generalizability of the results. The focus on survivors one state in Nigeria may not capture the experiences of those in rural or less urbanized areas of Nigeria, where access to healthcare and social support may differ. Additionally, the reliance on self-reported data introduces the possibility of recall and social desirability biases, which may have influenced participants’ accounts. Finally, recruitment through oncology clinics may have introduced a potential selection bias. Participants recruited from these settings may represent a specific subgroup of survivors with greater access to healthcare resources and potentially better overall health outcomes compared to those who do not seek treatment at specialized cancer centers. This could limit the representativeness of the findings and potentially underestimate the challenges faced by survivors with limited access to healthcare.

Recommendations for Future Research

Future research should expand on this study by exploring the experiences of breast cancer survivors in other regions of Nigeria and other low- and middle-income countries. Comparative studies that examine how cultural, economic, and healthcare system differences impact the survivorship experience would provide valuable insights. Additionally, intervention studies that test the effectiveness of integrated survivorship care models, including psychological, financial, and spiritual support, are needed to develop evidence-based approaches that improve the quality of life for cancer survivors.

Recommendation	Rationale
Expand Survivorship Care Programs: Implement comprehensive survivorship care programs that address the multifaceted needs of breast cancer survivors, including physical, psychological, social, and spiritual support.	Survivors face a range of challenges beyond physical treatment, including emotional distress, social isolation, and financial hardship.
Integrate Mental Health Services: Integrate mental health services, such as counseling and psychotherapy, into cancer care pathways to address anxiety, depression, and other mental health concerns experienced by survivors.	Many survivors experience significant emotional distress, including anxiety, depression, and fear of recurrence.
Enhance Social Support Networks: Foster the development of strong social support networks for survivors, such as support groups and peer-to-peer mentoring programs.	Social support plays a crucial role in promoting resilience and improving quality of life for survivors.
Address Socioeconomic Disparities: Implement strategies to address socioeconomic disparities that impact access to care and quality of life for survivors. This may include financial assistance programs, job training initiatives, and support for childcare and transportation.	Socioeconomic factors, such as poverty and lack of access to resources, can significantly impact the quality of life for survivors.
Promote Cultural Sensitivity: Tailor survivorship care programs to the specific cultural and social contexts of different communities to ensure culturally sensitive and appropriate support.	Cultural beliefs and practices can significantly influence how survivors cope with their illness and access care.

Conclusion

The findings of this study reveal the profound and multifaceted suffering experienced by long-term breast cancer survivors in Lagos, Nigeria. Their suffering extends beyond the physical realm, deeply affecting emotional, social, financial, and spiritual well-being. To address these complex needs, survivorship care must move beyond the traditional biomedical model to incorporate holistic, patient-centered approaches that validate and support all aspects of the survivor experience. By recognizing and addressing the interconnected dimensions of suffering, healthcare providers can help survivors not only to live but to thrive beyond cancer, enhancing their quality of life and supporting their ongoing journey toward recovery and resilience.

Supplemental Material

sj-docx-1-jpx-10.1177_23743735251314858 - Supplemental material for The Lived Experience of Suffering by Nigerian Female Breast Cancer Survivors: A Phenomenological Perspective

Supplemental material, sj-docx-1-jpx-10.1177_23743735251314858 for The Lived Experience of Suffering by Nigerian Female Breast Cancer Survivors: A Phenomenological Perspective by Chinomso Ugochukwu Nwozichi, Margaret Olutosin Ojewale, Omolabake Salako, Deliverance Brotobor and Elizabeth Olaogun in Journal of Patient Experience

Footnotes

Acknowledgments

The authors would like to thank Mrs Paulina Ahuchuba for her support during this study. The authors also thank Chioma Ibeabuchi and Amarachi Madu for their assistance during data collection and analysis of the interview. The APC charges is being covered by Kennesaw State University, Wellstar College of health and Human Services.

Author Contributions

CN conceptualized the study, led the research design, and coordinated data collection and analysis. CN also contributed significantly to drafting and revising the manuscript, ensuring the intellectual content of the paper aligns with the study's objectives. MO contributed to data analysis and interpretation. MO assisted in drafting sections of the manuscript, particularly in relation to the study findings and discussion, and participated in the critical review of the final manuscript. OS was involved in literature review, data curation, and supported in data collection. OS also contributed to the initial draft of the introduction and methods sections, and participated in the revision process of the manuscript. DB was involved in literature review, data curation, and supported in data collection. OS also contributed to the initial draft of the introduction and methods sections, and participated in the revision process of the manuscript. EO contributed to data analysis and interpretation. MO assisted in drafting sections of the manuscript, particularly in relation to the study findings and discussion, and participated in the critical review of the final manuscript.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval

The Health Research Ethics Review Committee at Babcock University approved this study before commencement (approval: BUHREC635/22). All participants provided written informed consent prior to enrollment and participating in the study. Participants were informed that their participation was absolutely voluntary and that they had the right to withdraw from the study at any time without any consequences. This manuscript conforms to Tong et al (2007) Consolidated criteria for reporting qualitative research (COREQ).

ORCID iD

Chinomso Ugochukwu Nwozichi

Supplemental Material

Supplemental material for this article is available online.

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