Journal of Cancer Therapy, 2012, 3, 793-796 Published Online October 2012 (
Feelings and Spiritual Practices of Patients with
Mastectomy: A Qualitative Study from Turkey
Gul Pinar
Department of Nursing, Faculty of Health Sciences, Yıldırım Beyazıt University, Ankara, Turkey.
Received August 15th, 2012; revised September 18th, 2012; accepted September 25th, 2012
Purpose: This study was conducted to describe feelings and spiritual practices of patients with mastectomy. Method:
The study was employed a qualitative design at a private university hospital oncology unit in Ankara, Turkey.
Interviews were performed with 20 mastectomized women. Results: The findings indicated that commonly used in
several spiritual practices; prayer was used by 96%, of the patients, and 94% requested that others pray for their health,
the practice to positive reframing (76%), the practice to planning for family-friends activities (74%), visiting
mosque-shrine (73%), and the practice to reading Quran (71%). The categorization of the data led to identification of
three thematic units. The first we described as “Experiencing the consequences of illness as a disorder”. The second was
“Restoring a sense of order to life”, and the third was “Living with the new condition”. Conclusion: We concluded that
a having mastectomy was difficult for the subjects. In this respect, nurses’ role is vital to help women with breast cancer
in such a difficult and modifying process as breast removal.
Keywords: Feelings; Mastectomy; Spiritual Practice; Qualitative Study
1. Introduction
Breast cancer is the most common cancer of women,
comprising 23% of all female cancers around the globe.
Breast cancer incidence has been increased three times in
last decades in Turkey, incidence in western part of Tur-
key (50/100,000) is more than two times in eastern part
of Turkey (20/100,000) due to “Westernizing life” (in-
creased early menarche, late menopause, first birth > 30
years, smoking, alcohol consumption, oral contraceptive
usage, use of hormone replacement therapy for 5 years or
more, having miscarriages, aware of breast screening-
earlier diagnosis, less breast feeding leads to higher the
incidence in western part of Turkey), and other related
factors [1]. The physical and psychological results of a
breast cancer diagnosis can result in many changes in
quality of life [2]. Mastectomy is a common treatment
for breast cancer and deeply influence the perception of
women’s sexuality, body image and femininity [3,4].
Spirituality involve feelings of hope, love, connection,
inner peace, power greater than self, a value system, God,
cosmic consciousness, comfort and support [5]. For some
people, their spiritual practices act as a source of comfort
and strength in dealing with life's difficulties. Especially
people living with the illness may find it through a con-
nection to nature, through music and the arts, through a
set of principles [6]. These are reflected in the quality of
an individual’s inner resources. In recovery from illness,
spiritual applications can be helpful and powerful coping
mechanism in the prevention of illness including de-
creased tension-depression, and negative physical out-
comes [5,7].
In this sense, spirituality has been identified as factors
that contribute to management of chronic illnesses and
has become an increasingly popular concept among the
health-related literature, is regarded as part of nursing
practice [8,9]. Nurses consider spirituality as an impor-
tant component of holistic care [10,11]. Although interest
in the concept of spirituality and, especially spiritual
needs in people with cancer has increased, limited re-
search has targeted women who had undergone mastec-
tomy [12-15].
The purpose of the study was to describe feelings and
spiritual practices with women breast cancer.
2. Material and Method
2.1. Sample and Setting
Qualitative descriptive study conducted to describe the
spiritual practices experienced in living with mastectomy
from the perspective of patients with breast cancer from
Copyright © 2012 SciRes. JCT
Feelings and Spiritual Practices of Patients with Mastectomy: A Qualitative Study from Turkey
January to December of 2010. Data were collected from
a convenience sample of 20 mastectomy patients par-
ticipated voluntarily at Baskent University Oncology
Unit in Ankara-Turkey.
2.2. Data Collection
A total of 20 mastectomized women at least 4 months
previously, had completed adjuvant cancer treatment and
had not experienced metastasis. In-depth semistructured
interviews using open-ended questions were carried out,
tape-recorded, and transcribed verbatim. The approxi-
mate duration of each interview was of about an hour and
a half. Data collection and inductive analysis occurred
concurrently. The research project was approved by the
Ethics in Research Committee of the Hospital of Baskent
University. Written consent was obtained from all par-
ticipants and the anonymity and privacy of the par-
ticipants were guaranteed.
2.3. Research Questions
In this paper, research question was as follows: cancer
experienced, feeling about the removal of your breast,
difficult times, meaning of spirituality, deeper own
spiritality, recognition of needs, spiritual coping stra-
tegies and practices, and interventions to respond to
spiritual needs, frequent use of spiritual behaviors or
3. Results
In all, 38% of the patients were premenopausal and <50
years (their ages varied from 36 to 70 years of age);
77.4% were married, 64.5% were housewives, 38.1%
were graduates of a basic education school, 68.8% had
children, 65.8% lived at home with her spouse and
children, and 60.4% had average incomes. The time since
mastectomy surgery varied between 4 months and 25
months. A majority (72%) had been diagnosed for more
than six months.
Histopathologic diagnoses were invasive ductal (76.2%),
invasive lobular (12%), and mixed type invasive cancer
(8.8%), respectively. Estrogen, progesteron, and HER-2
receptors were positive in 69.4%, 49.4%, and 18.2% of
The categorization of the data led to identification of
three thematic units. The first we described as “ex-
periencing the consequences of illness as a disorder”.
The second was “restoring a sense of order to life”, and
the third was “living with the new condition”. Patients
conveyed positive spiritual changes as a result of their
experience with breast cancer, and the women counted
on their spirituality to help them cope and derive mean-
ing from their disease experience. Most women (87%)
believed that spirituality was an important part of their
cancer treatment.
The findings indicated that several coping strategies;
prayer was used by 96% of the patients, and 94%
requested that others pray for their health, the practice to
positive reframing (76%), the practice to planning for
family-friends activities (74%), visiting mosque-shrine
(73%), the practice to reading Quran (71%), the practice
to go to a quite place (68%), the practice to use of
instrumental support/helping others (66%), the practice
to listening to or playing music (65%), the practice to do
exercises (44%), meditation and yoga (13%). Comple-
mentary and alternative medicine (CAM) was used by
nearly half of women (48%) after being diagnosed with
breast cancer. The most commonly used CAM practices
were herbal (94%), relaxation techniques (35%), and
vitamin and minerals (67%).
Looking at the Three Thematic Units
1) Experiencing the consequences of illness as a disorder;
losing a breast, feelings of shame, rejection and in-
feriority, a component and essential element of individu-
ality. Self-image was mentioned by all subjects as the
most important change. Psychological reactions related
to mastectomy and the subsequent functional losses
suffered have been noted. When confronted with breast
cancer, experience of women was very difficult and they
mostly felt grief. This behavior can be understood and
justified in our society we live in.
One respondent stated, “…Initially, I was in shock.
When I heard it first, I got rude awakening. I was so
anxious and afraid of dying. The doctor and nurse
convinced me to think pos itively. I knew that things were
not going to be the same anymore. I felt reducing the
sense of control on me. I thought about my children, how
are they going to handle this, then I thought that I need
to be stronger for them. I tried to look at this situation in
other perspectives, but of course it is not an easy
experience for me.
Another respondent stated, “…The truth is, nothing is
like the way they were used to be before. Being not able
to change this situation makes me feel desperate. And
this feeling is too much for me to handle. Whenever I go
outside, I feel naked and ugly. I feel like people are
staring at me. So, I started to spend most of my time at
home. I prefer not to talk about it. My family were the
only ones who knew ab o ut my probl em”.
Another respondent stated, “…It really changed my
life. I used to love doing make up. But I can’t do it
anymore because of my disorder. After mastectomy, I
started to avoid to look at the mirror for several weeks. I
couldnt feel like a women. I thought that no man would
ever like me again. I used to love to swim, but now I feel
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Feelings and Spiritual Practices of Patients with Mastectomy: A Qualitative Study from Turkey 795
shame of that because I scared to get negative reaction
from others. So , I gave up doing it”.
Another respondent stated, “…I used to find myself
beautiful and positive. But I cant see these sides of me
anymore. I dont feel special as a person. I become a shy
person after mastectomy, even when Im with my
husband. This had never happened to me before. Im
afraid my husband divorcing me. I feel that my
husbands thoughts has been changed since (she began
to cry)”.
2) Restoring a sense of order to life; this section
illustrates and demonstrates through the statements of the
participants being able to restore their lives.
One participant described, “…When it comes to health
care, I think its better for me to remove the breast
instead of remain ing the cancer. So, I prepared myself to
lose my breast. After that operation, I thanked God for
helping met o get rid of cancer. My family and my friends
had supported me a lot. In the main time, I have started
to go to work. Now I am using breast prosthesis. I feel
much better now ”.
Another participant described, “…I was nervous when
I heard that my breast is going to removed. But now, I
am okay with it. I’ve just started to see the good sides of
Another participant described, “…I passed experience
discomfort due to pain, fatigue sleep disturbance, and
nausea etc. But, I am still strong, so I think I can handle
this problem. Of course itll be hard for me to lose my
breast but I can move on”.
3) Living with the new condition; the participants of
the study, express clearly that the beginning was difficult
for them to accept their new condition.
One participant described, “…In the beginning it was
very difficult. I have been bothered because the cancer
and/or treatments have interfered with my ability to
perform activities. But in time I had some experiences
and now it is not that hard anymore. I learned lots of
things after mastectomy. My life has be en more meaning-
Another participant described, “…I thought my life
was ruined. Because mastectomy affected my body image
in negative ways. My breasts were not equal so I couldnt
wore light clothes a while. But then I started to fill my
bra and made them look normal. Now I dont think that
my life is over.
4. Conclusion and Recommendation
The results of this study concluded that a having mastec-
tomy was difficult for the women, and their perception of
functioning is closely related to emotional state. In
general, very few women believed in the possibility of
recovering and getting back to a normal life. They
concerned about their partner's and public’s reaction. The
most common feeling is anxiety, fear, disappointment,
alters patients’ body image and self esteem, impaired
sexual functioning, decreased social activities, with-
drawal and shame. Hence, nurses should physically,
emotionally and socially support these women and her
family before mastectomy for the adaptation process.
Also, nursing education should enhance nurses’ under-
standing and awareness of spiritual issues as part of their
daily routines. Future research could expand the research
to include a larger, more diverse group of women of all
ages who had underwent mastectomy with breast cancer.
5. Acknowledgements
The author wishes to thank all the nurses and doctors in
this study for their kind assistance to the present study.
The author thanks the patients for their cooperation.
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