Confronting the Unexpected: Temporal, Situational, and Attributive Dimensions of Distressing Symptom Experience for Breast Cancer Survivors

Purpose/Objectives: To describe women's unexpected and distressing symptom experiences after breast cancer treatment.

Research Approach: Qualitative and descriptive.

Setting: Depending upon their preference, participants were interviewed in their homes or in a private office space in a nearby library.

Participants: Purposive sample of 13 women 1-18 years after breast cancer treatment.

Methodologic Approach: Secondary analysis of phenomenologic data (constant comparative method).

Main Research Variables: Breast cancer symptom distress, ongoing symptoms, and unexpected experiences.

Findings: Women described experiences of unexpected and distressing symptoms in the years following breast cancer treatment. Symptoms included pain, loss of energy, impaired limb movement, cognitive disturbance, changed sexual experience, and lymphedema. Four central themes were derived: living with lingering symptoms, confronting unexpected situations, losing precancer being, and feeling like a has-been. Distress intensified when women expected symptoms to disappear but symptoms persisted instead. Increased distress also was associated with sudden and unexpected situations or when symptoms elicited feelings of loss about precancer being and feelings of being a hasbeen. Findings suggest that symptom distress has temporal, situational, and attributive dimensions.

Conclusions: Breast cancer survivors' perceptions of ongoing and unexpected symptoms have important influences on quality of life. Understanding temporal, situational, and attributive dimensions of symptom distress empowers nurses and healthcare professionals to help breast cancer survivors prepare for subsequent ongoing or unexpected experiences in the years after breast cancer treatment.

Interpretation: Follow-up care for breast cancer survivors should foster dialogue about ways that symptoms might emerge and that unexpected situations might occur. Prospective studies are needed to examine symptom distress in terms of temporal, situational, and attributive dimensions and explore the relationship between symptom distress and psychological distress after breast cancer treatment.