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Results of plagiarism analysis from 2018-05-20 23:29 UTC

embracing the journey of cancer plagscan.docx


6.5%
Date: 2018-05-20 22:47 UTC

 All sources 100  Internet sources 57  Organization archive 21  Plagiarism Prevention Pool 22

 journals.sagepub.com/doi/full/10.1177/0898010112462066
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 "BASATAN DISSERTATION CAREGIVING FI...ot; dated 2017-05-22


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 "Lived Experiences of Caregivers of...ot; dated 2017-05-23


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 "PLAGSCAN_INTRO TO RECOMMENDATION.docx" dated 2017-09-18


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 https://www.science.gov/topicpages/i/intact nursing home.html


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 https://dshah.journalism.wisc.edu/files/JMCQ2017.pdf
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 from a PlagScan document dated 2018-02-13 17:42


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 from a PlagScan document dated 2017-10-22 03:08


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 https://www.reddit.com/r/DestinyTheGame/...e_5_stages_of_grief/
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 from a PlagScan document dated 2017-09-28 06:21


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 europepmc.org/articles/PMC4267253
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 www.freerepublic.com/focus/f-news/3513734/posts
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 https://link.springer.com/article/10.1007/s10730-015-9288-2
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 docshare.tips/journal_575018e7b6d87f24a08b4e20.html
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 https://www.cancer.gov/about-cancer/coping/feelings/stress-fact-sheet
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 www.mining.com/web/the-mining-supercycle-and-its-demise/
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 from a PlagScan document dated 2017-09-08 16:39


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 "COLLABORATIVE-NURSING-PRACTICE-OF-...ot; dated 2017-05-26


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 https://www.ncbi.nlm.nih.gov/pubmed/26228870
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 https://quizlet.com/113017169/psychiatry-flashcards/
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 "CNP-and-QPC-mas-final-xD.docx" dated 2017-05-17


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 "FinalOutputFeb1ESMENA,STEPH.docx" dated 2017-02-01


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 https://www.cancer.net/sites/cancer.net/files/vignette/IOM_Executive_Summary.pdf
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 from a PlagScan document dated 2017-07-26 04:34


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 https://www.tumblr.com/search/becauseblack
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 "FInal draft suicide research for plagscan.docx" dated 2018-05-15


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 www.healthcarechaplaincy.org/userimages/...ement-Guidelines.pdf
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 https://www.ncbi.nlm.nih.gov/books/NBK4011/?report=printable
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 "Final-17.doc" dated 2017-05-23


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 digitalcommons.unomaha.edu/cgi/viewcontent.cgi?article=1006&context=studentwork
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 "Life-or-Limb Experience of Diabeti...ot; dated 2017-05-24


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 pdfsr.com/pdf/illness-perception-and-hopelessness-in-hemodialysis
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 https://reincarnationresearch.com/the-ex...-by-walter-semkiw-2/
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 "final output_1 (1).docx" dated 2017-12-31


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 https://quizlet.com/50859778/kubler-ross-model-flash-cards/
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 https://www.newsmax.com/health/health-ne...018/02/21/id/844596/
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 "THESIS-REVISED-Body.docx" dated 2018-01-01


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 "grammarly and plag.doc" dated 2018-01-09


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 https://www.quora.com/What-are-the-steps-of-grief
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 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409868/
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 www.informationng.com/2014/01/how-anger-affects-your-health-and-mind.html
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 from a PlagScan document dated 2017-11-23 12:16


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 "Final Manuscript wo appendices.pdf" dated 2017-05-18


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 https://www.cancerandwork.ca/healthcare-...rk/effects-physical/
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 www.resourcenter.net/images/SNRS/Files/SOJNR_articles2/Vol09Num01Art01.html
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 www.rochestermarriagecounseling.com/anger.html
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 https://www.oncologynurseadvisor.com/bre...mage/article/560458/
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 https://www.researchgate.net/publication...ursing_home_patients
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 "SINGLE SPACE.docx" dated 2017-06-15


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 https://www.mayoclinic.org/healthy-lifes.../denial/art-20047926
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 www.loveshack.org/forums/breaking-up-rec...54422-5-stages-grief
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 "plagscan file.docx" dated 2017-12-25


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 https://www.researchgate.net/publication...Social_Support_Group
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 www.qualres.org/HomeMaxi-3803.html
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 journals.sagepub.com/doi/full/10.1177/1077699016687724
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 https://ipos-society.org/wp-content/uplo...entGuideline2010.pdf
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 "THESISclaudine.docx" dated 2018-05-09


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 "EBP Organizational Implementation ...ot; dated 2018-01-08


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 https://rd.springer.com/content/pdf/10.1007/s10730-015-9288-2.pdf
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 https://www.marilynkelley.net/
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 "Effectiveness.docx" dated 2017-05-19


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 https://www.ncbi.nlm.nih.gov/pubmed/690624
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 "Asiatico_Kyle_Manuscript.doc" dated 2018-03-26


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 https://www.researchgate.net/profile/Gor...ng-Home-Patients.pdf
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 "Final manuscript for plagscan with...ot; dated 2017-05-21


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 https://www.researchgate.net/publication...elf_for_Human_Beings
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 onlinelibrary.wiley.com/doi/10.1002/cncr.23448/full
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 "Saint Louis University.docx" dated 2017-12-31


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65 pages, 30774 words

PlagLevel: selected / overall


194 matches from 113 sources, of which 62 are online sources.

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[12]
EMBRACING THE JOURNEY: LIVING WITH CANCER 1

INTRODUCTION

The Phenomenon

Cancer is an umbrella term for a wide range of diseases characterized by the growth of
abnormal cells beyond their usual size that can then invade various parts of the body and/or spread
to other organs and systems. Cancer can be managed and treated, but sometimes it never
completely goes away, (World Health Organization, 2017; American Cancer Society, 2017).
These changes can exert a great impact on the lives of patients psychologically and physically.

Cancer
[37]
can afflict any individual of any age and may cause physical and psychological
challenge. A plethora of research indicates that physical
[37]
changes resulting from cancer and its
treatment—such as vision problems and hearing loss; endocrine
[37]
disturbances resulting in shortness
of height, delayed puberty, and reproductive problems; and impaired sexual functioning —can
occur at any age and interfere with successful development, (National Cancer Institute, 2004).
Digesting news of cancer and experiencing it can bring a flood of emotions and instances of being
overwhelmed, (American Psychological Association, 2013). Facing cancer and its treatment exert
an effect on the different dimensions of the human being. This needs to be explored to understand
the whole cancer experience.

According to the statistical data of the National Cancer Institute, (2011) those aged 20 below
comprises 1% of new cases of cancer, 20-34-year-olds make up 2.7%, 35-44-year-olds make up
14.1%, 55-64-year-olds make up 24.1%, 64-74-year-olds make up 25.4%, 75-84 make up 19.6%
and those aged higher than 84 make up 7.8%, (Laudico et al., 2010). With the present lifestyle of
people and countless factors that contribute to the contraction of cancer, there is an increasing
incidence of cancer. Worldwide, it was estimated that there were 14.1 million new cancer cases in
2012, (Bray, 2014). And in the Philippines alone, as evidenced in the 2010 statistics of the
Philippine Cancer Society, it reveals that: “13 out of 100 males and 12 out of 100 females would
have had some form of cancer if they would have survived up to age 75. Ten out of 100 males and
7 out of 100 females would have died from cancer sooner than the age of 75.” (Philippine Cancer
Society, 2010). Also, according to the international agency for research on cancer, there is an
estimated 59,000 deaths every year, (Cancer Index 2012).

However, in those diagnosed with cancer, in a study done in Metro Manila and in the Rizal
Province, between the years of 1993 and 2002, the five-year relative survival rate of cancer (breast
59% lung 12% liver 8.5% colorectal 40.2 cervix 45.4%, leukemia 5.2% stomach cancer 27.3%,
prostate 43%, ovarian 49.5%, thyroid 82%, NHL 50% oral cavity 27%) averages at 37.425%. This
includes all Filipinos of all ages as cancer can affect anyone at any stage of life, (Laudico, et al.,
2010).
[21]
Adding up, nearly half (47%) of survivors are 70 years of age or older, while only 11% are
younger than 50, (American Cancer Society, 2017). These findings, however, are contrary to the
statistics in the Philippines in 2002, wherein there is an estimated 176 per 100,000 cancer deaths
among males and 215.1 per 100,000 cancer deaths among females who were aged 45-54. With a
EMBRACING THE JOURNEY: LIVING WITH CANCER 2

higher mortality rate of 1,155/100,000 and 710.1/100,000 among males and females who were
aged 65 and above, (Laudico et al. 2010).

Therefore, regardless of its poor prognosis, alarming effects and unpredictability, there are
still individuals who survived cancer. Many of us think of cancer as a terminal illness, but due to
the advancement of treatments, people lived longer even with cancer, so it is becoming a[4]chronic
condition similar to diabetes and other cardiovascular problems, (Ford, 2015). Some
improvements on cancer-directed therapies and management strategies have led to significant
gains [4]
in survival over the past several decades, (Gilbert, Hollenbeck, Miller, Montie, & Wei1,
2008). With continued innovations in cancer diagnosis and management, it is expected that the
number of cancer patients going past the illness will increase.
[32]
Though, cancer survivorship has a lot of definitions. Cancer survivorship is described by
Hewitt, Greenfield, and Stovall (2006) as a distinct phase of cancer that follows primary treatment
and lasts until recurrence or end-of-life, (cited by de Guzman, Jimenez, Jocson, Junio, Jurado &
Justiniano, 2013). From this definition, it can be defined that a cancer survivor is someone who is
not exhibiting any signs of cancer or at present in the stage of remission.

Although there are a multitude of literature that studies upon the different conceptual
frameworks and improvements to the quality of survivor care, systematic qualitative research that
has been conducted to explore the experiences of those undergoing the process of survivorship,
specifically Filipino cancer survivors, are limited in amount, (Gilbert, et. al., 2008). As
recommended by Benito et al., (2013) further research can be conducted encompassing other
cancer types, genders, demographic and cultural populations. Moreover, survivorship is a multi-
faceted aspect of cancer that needs to be studied further. There is a need to explore the health and
life experiences of a person with cancer past diagnosis and treatment with an emphasis on
understanding the multi-dimensional aspects a cancer survivor goes through. Thus, it is essential
that the researchers create a vivid image of the journey of these cancer survivors with varying
conditions to present a better representation of the experience of cancer. This research study
explores what they go through during the course of illness and treatment, with goals to explore the
holism of the journey living with cancer.
[33]
This study aimed to determine the meaning of experiences of cancer survivors. Particularly,
the core of this study was to answer the question: How was your journey living with cancer?

Significance

This research study could support or contribute to existing theories which could be used in
rendering care to cancer patients. This study helps identify the aspects that have to be addressed
when making a plan of care for patients in the clinical area. This could also help in promoting or
enhancing the quality of care professionals' render cancer patients. The results of the study can
inspire nurses to develop humanistic and altruistic care through understanding the meaning and
challenges of varied experiences cancer patients go through.
EMBRACING THE JOURNEY: LIVING WITH CANCER 3

This could be helpful in serving as a guide specifically to nursing students who are currently
studying and undergoing training. It can help in understanding the course, the disease and what
the patient goes through during treatment. Understanding the meaning of life experiences of cancer
patients could help student nurses develop and enhance nursing values and attitudes that would
mold them to become more therapeutic in dealing with patients.

This study could benefit the respondents regarding ventilation of feelings and reinforcement
of positive attitude and confidence. Realizing that sharing their story can be an emotional
[65]
healing,
and many people will benefit by learning from the wisdom of their experience. This can be
especially powerful for people who do not always feel that they have the chance to help others.
[65]
Resilience is strengthened by recognizing that the participants are all experts in their own lives
and they all have something to share with others.

This study may spread awareness not only to the cancer patients but for the people of the
Philippines, for them to correct
[1]
preconceptions, appreciate the cancer treatment and help in the
early diagnosis of cancer.

This study could also help organizations that cater to cancer patients such as the Philippine
Cancer Institute and Cancer Warriors Foundation of the Philippines, as well as government
agencies such as the Department of Health and Department of Social Welfare and Development
to develop programs to raise awareness of cancer patients in managing their illness, provide
funding for treatment and improve their state of health.

Researcher's Background

There were several factors that affected a researcher's approach towards a study situation.
These factors came from their past experiences or some literature they have come across with.
These past experiences, whether personal or from a close friend or relative's perspective,
influenced a researcher's attitude, beliefs, and understanding on the phenomenon that is yet to be
studied on.

Among the researchers, three have close relatives who were diagnosed with cancer and
witnessed their[49]
journey living with cancer. They had some role in their care and their experience
of the disease. It may greatly affect their understanding
[2]
and may cause psychological and
emotional discomfort during the conduct of the study. On the other hand, the other researchers
have experienced dealing with cancer patients, which may influence their perception of cancer
patients and what they go through during
[41]
the course of the disease. These biases may affect a
researcher's attitude towards the study. Also, the student researchers do not have experiences in
conducting research and interviews and have limited practical knowledge [6]
in dealing with
emotional and psychological outbursts that may arise during interviews.

Despite these limitations, the researchers chose this study to find ways on how to help cancer
patients deal with the possible effects of the disease and its treatment and for other cancer patients
to benefit from the study. The researchers are determined to fill the gap in knowledge and take the
EMBRACING THE JOURNEY: LIVING WITH CANCER 4

necessary steps to gather credible data and possibly construct a program to help other cancer
patients.

To overcome these biases and limitations, the researchers were guided by their promoters
during the research process, since their promoters have experiences in qualitative research.
Moreover, their promoters are adept at interacting with patients and dealing with their emotional
and psychological responses. The student researchers have a background in Fundamentals of
Nursing which involved training them in communicating with patients therapeutically which they
can use as a springboard in conducting interviews. The researchers underwent training under their
research promoters to further enhance their skills in interviewing and to help them develop skills
in dealing with emotional and psychological outbursts. The researchers also underwent a peer
briefing session and bracketing to eradicate their bias or preconceptions that can affect their data
gathering.
[49]
EMBRACING THE JOURNEY: LIVING WITH CANCER 5

METHODS AND PROCEDURES

Research Design

The Qualitative Interpretive Phenomenological Analysis design was utilized to understand


the meaning of life experiences from the perspective of cancer patients, taking into consideration
the existence of multiple realities. Interpretive Phenomenological Analysis is very useful since the
cancer experience is dynamic, contextual and subjective. The interpretive approach centers on the
way in which human beings make sense of their subjective reality and attach meaning to it,
(Holloway and Galvin, 2017). This design emphasizes human experience in which the simple
description of thoughts
[1]
and essences of the meanings rooted in common life practices are explored
(Solomon, 1987).

Settings and Participants

The study was conducted in Baguio City, Philippines. Specifically, the interview was done
considering the most convenient time and place for the participants such as their home, office
conference room, office, restaurants, assembly hall, and bakeshop. The researchers ensured that
the place had minimal disturbances and distractions as much as possible that could have hindered[100]
the participants from fully expressing their feelings or might cause delays in the interview process.

The participants of the study were 12 individuals previously diagnosed of cancer, of any
type and stage, who had their last treatment at least 6 months from the date of interview, either
male or female, ages 18 years old and above, willing [74]
to participate in the interview, and able to
understand and communicate in Filipino or English. Participants were selected using Maximum
Variation Sampling method, where the researcher selects a small number of cases [74]
that maximizes
the diversity relevant to the research question (Cohen & Crabtree, 2006). In the maximum
variation sampling used, the researchers tried to [74]understand how a phenomenon is seen and
understood by different people, in different settings. and at different times. Participants were coded
according to the names of different chemotherapeutic drugs namely Bortezomib, Rituximab,
Methotrexate, Siltuximab, Folfiri, Streptozocin, Nolvadex, Jakafi, Doxorubicin, Adriamycin,
Sonidegib, and Cisplatin.

Each participant was chosen based on the inclusion criteria set and given full informed
consent whereby an environment was maintained to allow expression and verbalizing of feelings
towards their respective journey living with cancer.

Description of Participants
EMBRACING THE JOURNEY: LIVING WITH CANCER 6

Bortezomib is a 46-year-old female, diagnosed with stage 2 breast cancer in the year 2015,
who had undergone her last chemotherapy in the year 2015. The first and second interview was
done in the participant's home specifically at the second floor of their house, at the dining/kitchen
area by the window. The main interviewer was seated infront of the participant with a distance of
1.5 meters away from each other. However, once the water delivery outside was making noise, the
participant and the interviewers moved the interview to the 3rd floor of their house. It was well lit,
spacious around, with a table near the window where she found it convenient, comfortable, and
free from any disturbances during the interview process.

Rituximab is a 30-year-old male who was diagnosed with Hodgkin's lymphoma in the year
2012. He underwent his last chemotherapy in the year 2012. The first and second interview was
done at the participant's house, particularly in their living room. The room was small but enough
to maintain a professional distance of 1.5 meters away from each other. There main interviewer
and the participant were facing each other, there was a small table between them.The wife of the
participant was also present during the interview. She was sitting in front of their bedroom, which
was approximately 3 meters away from the participant.

Methotrexate is a 47-year-old female, diagnosed with stage 2 thyroid cancer in the year 2008,
who had not undergone chemotherapy but had undergone surgery in the year 2008. The first and
second interview were done at the participant's workplace specifically in the conference room of
her office approximately 1.5x4 meters with six mono-block chairs surrounding the[13]long table. The
main interviewer and the participant were facing each other during the interview. There were no
other people in the room. She found this setting convenient, comfortable and free from any
disturbances during the interview process.

Siltuximab is a 51-year-old female, diagnosed with breast cancer in the year 2010, who had
undergone her last chemotherapy in May 2011. The interview was done at the participant's office
specifically inside the library. There was a long table with comfortable seats. The participant was
seated at the edge of the table, and the interviewers were sitting beside her (1 meter away), left and
right. The library had excellent lighting; the door was closed to minimize noise.

Folfiri is a 47-year-old female who was diagnosed with stage 3 breast cancer in the year
2012. She had her last chemotherapy in the year 2015. The interview was done at one of the
participant's transient houses, particularly in the dining area, in which the participant and
researchers were seated face-to-face with three feet in between them. The room was quiet and free
from any disturbances.

Streptozocin is a 40-year-old female, diagnosed with stage 2 cervical cancer in the year 2016,
who had undergone her last chemotherapy in March 2017. The interview took place at the
assembly hall. The assembly hall was spacious and there were drum sets and guitars at the corner.
The interviewers and the participant were seated around a table located at the quarter third of the
hall near the exit. The participant sat at the edge of the table and the interviewers were seated on
the sides. The interviewers and the participant maintained a professional distance about 5-6 feet
away. Some people were passing by, but the quiet environment was maintained.
EMBRACING THE JOURNEY: LIVING WITH CANCER 7

Nolvadex is a 56-year-old female, diagnosed with HER 2+++ stage 2 Lymphoma in the year
2014, who underwent her last chemotherapy in December 2014 and finished her Herceptin in April
2015. The interview was done in the participant's bakeshop. There was excellent lighting. The
workers were there; customers were also there chitchatting. The researchers were seated at a dining
table at the far end, two tables away from the closest customer. The main interviewer sat facing
the participant. There were cars passing by, traffic noise was slightly disturbing. Also, there was a
construction going on at the second floor of the Bakery so there was slight environmental noise
from the carpenters working with their equipments, but it did not bother the patient since according
to her, she was already used to it, and she can hear very well.

Jakafi is a 43-year-old female, diagnosed with Non-Hodgkin's lymphoma stage 2 in the year
2007, which had undergone her last chemotherapy in the year 2008. The interview was done inside
a faculty room of the school she was currently working in. The interviewers were seated at a table
at the center of the room while facing the participant with a distance of 1.5 metters away from each
other. There was good lighting and ventilation. There were other instructors inside with their
respective students, conversing with each [67]
other. There was little noise from other people inside the
room, but it did not bother the participant.

Doxorubicin is a 46-year-old female, diagnosed with stage 3 breast cancer in the year 2008,
who had undergone her last chemotherapy in the year 2009. The interview was done at a restaurant
in Baguio City, around 2x5 meters in dimension, slightly crowded and several people kept on
passing through the table. The interviewer and the participant were facing each other. Despite that,
she found it convenient and comfortable for the interview process to continue and wasn't
concerned with other customers at the periphery.

Adriamycin is a 49-year-old female, diagnosed with stage 3 breast


[1]
cancer in the year 2015,
who had undergone her last chemotherapy in the year 2016. The interview was done at the
participant's home. The interviewers were seated on the couch inside their home, the main
interviewer was seated beside the participant maintaining 1-meter distance. They had a dog which
[10]
kept barking so we had to stop for some time during the interview to let the dog calm down. The
children and other relatives were there; they were doing laundry, so we had to close the door to
keep the sound of the washing machine to a minimum.

Sonidegib is a 73-year-old male who was diagnosed with prostate cancer in the year 2007
and underwent surgery in the same year. The interview took place at the participant's terrace,
wherein there is a mini sofa, where the interviewers were seated. The distance maintained by the
interviewers and the participant was about 4 feet. The main interviewer faced the participant with
a distance of 2 meters away. The wife of the participant was in and out of their house to participate
in the interview. In the setting, there was a dog that barks sometimes but wasn't seen as a hindrance
during the interview.

Cisplatin is an 83-year-old male, diagnosed with stage 2 colon cancer in the year 2012, who
had not undergone chemotherapy but had undergone surgery in the year 2012. The interview was
done at the participant's home in Baguio City, with a distance of 1.5 meters away from each other;
wherein it was well-lit, well ventilated but cluttered with household items and furniture that made
EMBRACING THE JOURNEY: LIVING WITH CANCER 8

it hard to navigate through and settle into the seats. In hindsight, he found it convenient as it was
closer to the project site he was working.

Data Gathering Tool

The researchers utilized the unstructured in-depth interview as a tool in data gathering.
According to McLeod [10](2014), unstructured interviews generate qualitative data through the use of
open-ended questions. In-depth interviewing is a qualitative research technique that involves
conducting intensive individual interviews with a small [14]
number of respondents to explore their
perspectives on a particular idea, program, or situation. An interview guide was developed based
on the forestructure of understanding, the objectives of the study, and the research questions. The
researchers started the interview with the question: “How was your journey living with cancer?”
(“Anu-ano ang iyong mga pinagdaanan sa pagharap ng kanser?”). To be able to generate richer
data, the following guide questions were used; "What were your feelings towards these
experiences? [41]
"What were your insights on your experience?", "How did you cope[1]with all these
experiences?” Other subsequent questions were based on the participant's answers.

Data Gathering Procedure

Before the actual data gathering, [38] the manuscript was submitted to the Research Ethics
Committee for review and approval. While the researchers waited for the approval, the researchers
had undergone activities to ensure that data gathering will not be compromised. The researchers
went through peer debriefing under their research promoters to remove or limit biases towards the
study. The researchers also went through a simulation on how to properly conduct an interview.
Training was conducted on how to address emotional breakdowns or unexpected occurrences
during the interview. Upon receiving the approval from REO, the researchers started to get consent
from the initially identified participants. The consent was taken in both verbal and written form in
which veracity was taken into consideration, researchers provided truthful information to the
participants which included the purpose of the research, what the researchers will be doing and for
how long, offer to withdraw at any time for any reason, potential benefits to participant/society,
potential harm or risk or discomfort, the assurance of anonymity and confidentiality.[10]The consent
also includes permission to use voice recorders and field notes to record the interview. Researchers
also informed the participants about autonomy in which participants have the right to make one's
own decision whether they want to be included in the study or not. Establishing rapport was the
initial goal of the researchers to gain the participant's confidence and trust that ensured a smooth
flow of the interview process. To establish rapport, the researchers have applied the basics of good
communication. This was not seen as a problem since they already have a background in
Fundamentals of Nursing which included[77]
therapeutic communication. Additionally, they were
guided by their research promoters. Finding common ground was helpful to the researchers to get
the trust of the participants. The researchers also maintained a comfortable environment for both
the participant and the researchers. The researchers established a contract which includes the days
and time of the interview, how long it will last and what would possibly transpire during the
interview. The interviews were conducted during the days that both the researchers and the
participants were free and the duration of the interview depended on how the participant answered
the questions. The interviews lasted at an average of one hour. The researchers asked permission
EMBRACING THE JOURNEY: LIVING WITH CANCER 9

to use voice recorders and explained the necessity of its use. The principle of confidentiality was
taken into account by assuring the participants that the information obtained from and about the
participants during the interviews was kept in private amongst the researchers and their promoters.
[84]
Also, proper safekeeping of the transcript files was ensured to keep the confidentiality of this
information as well as the use of pseudonyms to keep the identity of the participants ensuring their
anonymity. The researchers also informed the participants of the instances wherein they will need
to come back to further explore their previous story or answers and make the data more accurate.
The data gathering period started from the last week of January 2018 to the last week of March
2018.

The interview team composed of three to four members. One member performed the
interview, the other worked on the field notes, and the third and/or fourth member recorded the
whole interview and observed the non-verbal cues of the participant.

The interview began by asking the main question which is “How was your journey living
with cancer?” to guide the researchers and the participants towards the satisfaction of research
objectives.

The researchers encountered some of the participants who had sudden emotional breakdown
manifested by some pauses in verbalization and crying. At those cases, the researchers stopped for
a moment to give the participant some time to recover and offered to continue the interview some
other time. Also, the researchers asked the participant if they would want to be referred to a
professional counselor.

The data gathered were transcribed, analyzed and interpreted by the researchers until they
have reached data saturation, which is an instance were no new data emerges, used for ensuring
that adequate
[58]
and quality data are collected to support the study.

Data Management
[58]
Benner explicates a hermeneutic method, which she says[58]
is Heideggerian in nature.
The method uses[58]the hermeneutic circle and three strategies: paradigm cases, exemplars, and
thematic analysis. These strategies are useful for allowing the particular claims of the text to stand
out and for presenting configurational and transactional relationships.

To manage and analyze the data, the researchers utilized the hermeneutic analysis by
Benner (as cited by Wojnar and Swanson, 2007), the steps are summed up as:

(a) Isolating paradigm cases, this was accomplished by reading each transcription as a
"case"; some cases immediately stood out as paradigmatic because these statements
described the meaning of cancer experience, feelings, emotions and thoughts of the
cancer survivors; those cases were used to draw the investigator's attention to various
aspects (themes) of the cancer survivors' experience. Other cases may be of
paradigmatic importance because of their similarities with other statements form other
cancer survivors' verbatim; each case was a source of themes;
EMBRACING THE JOURNEY: LIVING WITH CANCER 10

(b) Identifying repetitious themes for within and between cases, wherein the researchers
reread the transcripts of the cancer survivors to isolate repetitious themes and the
researchers validated their works with each other by peer scrutiny technique among
the researchers.
(c) Selecting exemplary quotes to illustrate themes. After working with the identification
of different themes, the
[1]
researchers identified outstanding quotes to better illustrate or
represent the themes. Member checking was done by going back to the cancer
survivors and validating the findings.
[44]

Rigor and Trustworthiness

In the conduct of the study, the researchers [1]


considered the credibility, transferability,
dependability, and confirmability of the study. This was done to ensure the over-all truthfulness
and validity of the research.

Credibility is one of the criteria that should be noted beforehand when conducting qualitative
research to ensure the reliability of the study. This requires ample immersion of the researchers in
the research setting to be able to accurately identify and verify recurrent patterns in the data
gathered, (Krefting, 1991 p.217). This factor was enhanced by spending extended time with the
informants, which allowed a building of better rapport and a prolonged engagement of both the
researchers and the participants, (Lincoln & Guba, 1985). However, this strategy also led to having
a close relationship that[3]made it difficult for the researchers to separate their own experiences from
that of the participants. In this case, a reflexive analysis or reflexivity, (Good, Herrera, Good &
Cooper, 1985) was practiced by the researchers through the use of a bracketing journal that enabled
them to keep track of their role as a researcher also of their insights in the conduct of the study.
[2]
Also, the researchers subjected their works, ideas, and bias under inquiry of other members of the
research team through peer scrutiny. In this strategy, each of the members voiced out their insights
that may affect the study and deduced by the other members so as not to arise during [4] the process
of data gathering since this may have a significant impact on the outcome of the study. Moreover,
negative case analysis was also done by actively searching for contradictions in the data called
‘outliers' and analyzing why these outliers exist, thus leading to a more comprehensive
identification of the strengths and limitations of the data, (Roller & Lavrakas, 2015).

The confirmability of the study was improved in the same manner accompanied by
documentation for each claim and interpretation of the data gathered from at least two sources so
that it is ensured that the results are accurate. Audit trailing was also done by keeping track of all
data and by compiling field notes and other records gathered by the researcher. These records do
not only contain raw data that the researchers gathered, but also his/her insights throughout the
progress of the study. These strategies were also accompanied by the competency of the
researchers, rest assured that the researchers are knowledgeable regarding the conduction of
descriptive qualitative research, (Krefting, 1991). As the researchers prepared to undertake this
study, they had gone through the necessary training needed as facilitated by their Research
Promoters, who were experienced in conducting, first-hand, qualitative-natured research.
[68]
EMBRACING THE JOURNEY: LIVING WITH CANCER 11

The dependability of the study was improved by describing the methodology of the study in
detail and ensuring that the data gathering procedure was reliable. The study was repeatable since
it was merely confined in Baguio City thus giving an opportunity for other prospect researchers to
conduct a similar study in a different setting and the population in the research study cannot be
generalized due to the uniqueness and individuality of each person. Nevertheless, the researchers
made sure
[49]
that the participants were vigilantly chosen by the researchers based on the inclusion
criteria.

Transferability is referred to the degree to which the results of the study can be generalized
to the population not involved in the study but has the same inclusion criteria for the participants.

FINDINGS AND DISCUSSION

[2]
Fig.1 Core Phenomenology of the Journey Living with Cancer

The figure above summarizes the study's findings through the themes explicated using
Benner's Hermeneutic Analysis wherein global themes have been identified, specifically,
Embarking on the Journey, Traversing through the Struggle, and Finding Meaning in the Journey.
[2]
Under these global themes, organizing themes have been identified which in turn show the basic
EMBRACING THE JOURNEY: LIVING WITH CANCER 12

themes of the experience, living with cancer. The staircase symbolizes the steps one goes through
living with cancer, ultimately arriving to the meaning of the journey.

I. Embarking on the Journey


The participants have illustrated mixed emotions upon knowing that they have been
diagnosed with cancer. Retrospectively, participants had reflected on the moments of being
diagnosed of having cancer, this being termed as: embarking on the journey. It encompasses their
moments of fear and grief, relating to the Five (5) Stages of Grief by Kubler-ross (1969).

A. Facets of Grieving

During the diagnosis phase, once a person hears from his physician that he has a cancer;
whatever type, stage and severity of cancer may it be, the initial feeling of that person is fear. It
may include many things like fear of death, fear of being blamed, and [38]
fear of leaving their love
ones on earth if ever they die. Fear is an unpleasant feeling or thought. It is the feeling [38]
you get
when you are afraid or anxious that something bad is going to happen (NLP staff, 2014). One of
the most common fear a cancer patient manifests is the fear of death and leaving their love ones
on earth if ever they die.

As stated by Siltuximab:

I was scared *open palms* because I thought I was going to die because invasive how
many months how many how many more years *hand gestures – emphasizing*

Siltuximab was also seen opening her palms while narrating, palms open at an angle means that
the person is being open and honest (Weinschenk, 2012).

Nolvadex also said:

“Nagstart na yung fear ko na cancer ganon, parang ang hirap pag ano eh, pag
hindi mo alam yung gagawin mo, parang napapanic ka na natatakot ka na nako
mamamatay na ako.” (My fear of cancer started like that, it was difficult if, if you
do not know what to do. You will start to panic; you feel fear because you think that
you are going to die).

Folfiri also shared:

“Kaya maliliit pa sila kaya siyempre hindi ko *short pause* hindi ko parang hindi
ko masyadong matanggap. Parang ayaw ko pa ganoon, eh alam mo noon pag ano
to, sinasabi ko pa, ang unang-una mo pag once na may asawa ka then may cancer
ka, unang-una mong iniisip, hala! Paano na kapag mag-asawa yung asawa ko?
*Laughs* yun! Hindi mo maiaalis yun syempre hindi mo maiaalis yun parang ano
kaya? Paano na yugn mga anak ko?” (They are still small that's why I can't, *short
pause* I can't, I can't accept. It is like I don't want, you know back then, I always
say, the first thing is when you have a husband and then you also have cancer,
EMBRACING THE JOURNEY: LIVING WITH CANCER 13

that's what you first think of. What if he remarries? *Laughs* I cannot take that
thought away. How about my children?)

During the interview Folfiri was seen laughing and has a short pause in between her
sentences. A short pause may refer to a rest, hesitation, or temporary stop (Lumen staff, 2018).
Many survivors believe that if they do not laugh about their experiences they will connect with
intense feelings of rage, despair, disappointment, or sadness (Ferentz, 2015).

Sonidegib adds:

“Yung sa totoo yung takot? summary ah.. ayaw ko pa mamatay. dun ako [21] takot.
palagi kong sinasabi "Diyos ko po, Diyos ko po, habaan niyo po buhay ko. (The
truth is, the summary, I don't want to die. Im fear that. I always say, “Lord, pls
lengthen my life”).

In accordance to the journal “Understanding ageing: fear of chronic diseases later in life”,
fear of death can form a basic fear underlying certain psychological conditions and is a exclusively
human dilemma that can consciously or unconsciously impact a person's everyday life functioning
(Awang, Mansor, Nai peng, & Osman, 2018). This is also in line with our study that people who
have cancer experiences fear initially mainly because they fear death. Upon hearing the diagnosis,
fear, especially fear of death, is the usual thing a person will feel because they see cancer as a
terminal case.

Most people diagnosed with cancer sees cancer as something terminal that's why they
develop fear, like fear of death. Therefore, these cancer patients must be well informed about the
course of their disease for them not to see cancer as a terminal case and prevent them from
developing fear. Fear was found to be a factor on a person's coping because fear leads to thoughts
of negative outcome, lack of self-confidence and troubles wherein if these thoughts continue, these
cancer patients' treatments may be affected because of these negative thoughts. (Puolamäki, 2013)

While some individuals fear cancer, some individuals also, upon hearing their diagnosis
chose to shade themselves from the fearful reality of cancer by denying it. Denial involves
blocking external happenings from consciousness. If some situation is just too much to grip, the
person just refuses to involve in it (McLeod, 2009).

Doxorubicin said:

“Sabi niya, *tsk* positive, breast cancer, yun lang yung narinig ko ang dami niyang
sinabi pero yun lang, tapos umiyak ako tapos 10 minutes ako sa ano niya na
nakaupo lang dun.” (She said, *tsk* positive, breast cancer, that was the only thing
I heard, she said so many things but I was just there sitting and crying for 10
minutes).
[9]
EMBRACING THE JOURNEY: LIVING WITH CANCER 14

Also, in this stage, individuals believe the diagnosis is somehow incorrect, and adhere to a
pretend, desirable reality as one of the participants (Axelrod, 2018).

Streptozocin said:

“With that na wala pa siyang evidence, parang oops, teka, hindi, hindi kwan. Ang
ang kwan ko is syempre nagulat ako kasi sabi niya may cancer ako na wala man
lang biopsy, diba kasi we, we will know. Tapos sabi kong ganun, “doc”, sabi kong
ganun ahm medyo nagkwan ako, so I questioned her, sabi kong ganun,
[31]
“doc, why are you telling that I have cancer and yet you don't have, you don't have,
I don't undergo ah this ah ano yung ah biopsy.” (With that, that the doctor doesn't
have evidence, like oops, wait, its not, its not, my, my reaction was of course I was
shocked because the doctor said I have cancer without any biopsy, because we, we
will know, and then I said, “doc”, I said, ahm I doubted so I questioned the doctor,
I told the doctor, “doc why are you telling that I have cancer and yet you don't
have, you don't have, I don't undergo this ah this ah this biopsy.)

This coping may help the person overcome the emotional turmoil from knowing that they
have cancer, and it may also be a problem when you do not overcome denial and go to the next
[10]
step which is anger. As the journal “Coping in patients with heart failure” states that a significant
number of these patients (45.3%) employ denial and have a negative outcome because they
postpone starting the treatment and have a low compliance (Farcas & Nastasa, 2011). In addition,
[5]
the journal “Defense Mechanism used by university students to cope with stress” also states that
similarly, alcohol addicts or drug addicts deny their problems and claim that they do not have any
problems. The functioning of denial mechanism increasingly faces growing difficulty when the
ego matures and understands[69]
the reality better, and the individual spends more energy and time
for denial (Gokdag, 2015). On the other hand, Mayo Clinic states that[69] refusing to face the reality
might seem unhealthy, though, a short period of denial can be helpful. Being in denial gives your
mind the chance to unconsciously absorb shocking or stressful information
[69]
at a speed that will not
send you into a psychological problem (Mayo staff clinic, 2017). To summarize, denial can be
helpful and it can be a problem and according to [0]
the journal “This Too Shall Pass: A Grounded
Theory Study of Filipino Cancer Survivorship” stated that one can be observed to be shocked,
denial, and feel negativity in the initial stages of finding out about their condition (De Guzman, et
al., 2013).

Health care providers and significant others should guide cancer patients when they are
experiencing [9]
this stage since this is a crucial stage which will really affect how they face cancer
and survive it.

However, when the individual recognizes[9]


that denial cannot continue, they become
frustrated, especially at proximate individuals. Certain psychological
[9]
responses of a person
[9]
undergoing this[9]phase would be: "Why me? It's not fair!"; "How can this happen to me?"; "Who
is to blame?"; "Why would this happen?" (Axelrod, 2018)
EMBRACING THE JOURNEY: LIVING WITH CANCER 15

Folfiri verbalizes:

“Mahirap talaga hindi lang yung ah syempre alam niyo noon everyday yan may time pa
na yung sisigaw kayo inaano mo na bakit nangyare to *cries*” (It was difficult, not only
the, of course you know back then, every day, there was a time that you will shout, you will
ask why did this happen *cries*.)

Folfiri was seen crying while she was telling her story and according to Mandy Oklander,
that crying is more than a symptom of sadness. It is triggered by a range of feelings; from empathy
and surprise to anger and grief (Oaklander, 2016).

When a person slowly realizes that he has a cancer he will feel anger, this stage is when
they try to question why cancer had stricken them despite of the things they did good.

Siltuximab discloses,

“I was very angry *forehead wrinkles* (in response stress), because I was the most
disciplined of all of us, and I was the one who was diagnosed with that.”

Siltuximab was seen creasing her forehead causing her eyebrows to meet. When the middle
of the eyebrows are pulled down so they slope inwards, this often shows that the person is angry
or frustrated. It can also indicate intense concentration (Changing mind staff, 2018). .Some
questions God,

As Doxorubicin had said:

“Sabi ko Lord bakit ako Lord? Ganon nung una bakit ako bakit ang dami naming
sira ulo dyan sa labas bakit hindi nalang sila, bakit hindi nalang yung mga walang
silbi sa buhay.”- Doxorubicin (I said, Lord, why me? That is the first, there are
many crazy people out there, why not them. Why not those people who do not have
purpose in life?)

[11]
The journal “Relationship with God,[11]Loneliness, Anger and Symptom Distress in Patients
with Cancer who are Near the End [11]
of Life” identified that cancer patients near the finale of life
agrees that anger can be an issue. While anger scores have generally been low in studies of patients
with cancer, one study of advanced cancer patients found [11]
that 53% of interactions between patients
and clinicians contained patient expressions of anger. Anger toward God has been reported in
response to negative events (Scott, Law, Brodeur, & Salerno, 2014). Anger must be controlled
because uncontrolled anger does not[52]just affect the psychological aspect of a person; it also affects
the physiological aspect of a person. Uncontrolled
[52]
anger can lead to arguments, physical fights,
physical abuse, assault and self-harm. On the other hand, well-managed anger can be a useful
emotion that motivates you to make positive changes while physical effects of uncontrolled anger
include increased anxiety, high blood pressure and headache (Better health channel staff, 2018).
EMBRACING THE JOURNEY: LIVING WITH CANCER 16

Moreover, when you feel like hope is gone, you will find yourself in the next stage where
you bargain, usually, with God. This is the stage wherein cancer patients ask God to heal them in
return of something.

Nolvadex states:

“Nung una, na ano, nag-ano ako is, hindi naman doubt pero ang ano ko is, “Lord,
ano pa ba ang hindi ko ginawa? Ano pa ang hindi naming binibigay sayo?” (At
first, I, not doubt but my concern is Lord, what else did I not do? What else did I
not give to you?).

Folfiri discloses:

“Para bang hindi ko kinuquestion si Lord pero ang palagi kong sinasabi noon sana
bigyan ako ng lakas ano pa ba ang misyon ko yung ganoon.” (Like, I was not
questioning Lord but what I always say is to give me strength, what's my mission,
like that).

Sonidegib added:

“Ahh Lord pahabain niyo pa yung buhay ako para makapaglingkod ako sainyo
habang ako'y nabubuhay yun lang ang nasa isip ko.” (Ahh Lord, lengthen my life
so that I can still serve you, that's what is on my mind)
[9]
This involves the optimism that the person can evade a cause [9]
of grief. Usually, the
negotiation for an extended life is made in exchange for somehting. People facing less serious
suffering can bargain or seek negotiation (McLeod, 2009). According to the journal “This Too
[0]
Shall Pass: A Grounded Theory Study of Filipino Cancer Survivorship”. After they have asked
Him (God) why such thing happened to them, and when all their efforts seemed to have gone to
waste, they resorted to bargaining, as reflected by one of the responses: I bargained and said, “Lord,
I want to believe that my mission is already done, but I'm still young; I can still do a lot of things.
Give me another chance to serve You.” (De Guzman, et al., 2013).

The journal “The varying phases of emotions in a terminally ill patient and Social Work
Interventions” also stated that this stage is more seen in a person diagnosed with a terminal illness
like cancer than with a person who has experienced a death of love one (Jiji & Rakesh, 2014).
However, according to Kübler-Ross and her followers, it is still part of the grieving process and
typically follows a stage
[57]
of anger. Bargaining almost always includes a discussion with a higher
power (Axelrod, 2018).

Bargaining can affect the way a person copes with a certain situation. Health care providers
must guide these cancer patients in going through this stage because bargaining may lead to
feelings of remorse and guilt that might interfere with the healing process, but it also has a good
effect because these thoughts may help these cancer patients begin to accept the loss or change by
revealing the impact of the situation. (Aiger, 2017)
EMBRACING THE JOURNEY: LIVING WITH CANCER 17

After some time of denial and bargaining, when cancer already took some toll on them,
they felt sadness and some eventually led to depression.

Adriamycin enunciated:

“Naging impact niya sakin, sobrang naging depressed talaga ako noon, nung
malaman ko na ganoon, na parang actually ayaw ko ng may visit, vinivisit ako nun
eh. Sabi ko sakanila wag niyo akong bisitahin kasi mas lalo akong nadedepress.”
(The impact to me was I became depressed that time, when I knew about that, that
actually, I do not want people to visit me, they were visiting me that time. I told
them “do not visit me because I become more depressed).

Nolvadex added:

“That was my birthday so tinawag ako ni dra, December 10 yun na yung start na
diniagnose niya ako ng non-Hodgkin's lymphoma stage, yun, so December 10 na
yun and then ahh inexplain niya kung paano ang treatment, paano ang, how will it
go, yung treatment ko tapos uhh syempre I was depressed, emotionally depressed
ako, uhm mentally disturbed ako, kasi syempre mga kids ko they are still small mga
elementary pa sila noon eh. My oldest son is in grade 5, so grade 5 and then (name
of the child) is grade 3 siguro.” (That was my birthday the doctor called me, that
was December 10, that was the start when the doctor diagnosed me with non-
Hodgkin's lymphoma stage, so December 10 that time and then ah the doctor
explained how will the treatment be, how will it go, my treatment, of course I was
depressed, I was emotionally depressed , uhm, I was mentally disturbed, because
of course my kids were still small that time, they were still in elementary. My oldest
son is in grade 5 and then (name of the child) was I think, grade 3.)

Depression causes feelings of sadness and/or a loss of attention in activities they once
enjoyed. It can lead to a diversity of emotional and physical problems and can decrease a person's
ability to function (Parekh, 2017).

The journal “This Too Shall Pass: A Grounded Theory Study of Filipino Cancer
[0]
Survivorship” stated in accordance with our study; In this study, several accounts from the
participants' shared stories were thought significant as they revealed stressful moments that lead
[36]
them to define their lives to be “falling into pieces.” As defined by the National Comprehensive
Cancer Network (2008) of the United States, distress is a multifactorial unpleasant emotional
experience of a psychological,
[7]
social, and spiritual nature that may affect the ability to cope
efficiently with cancer. As their condition progresses, they then move to the next stage wherein
they experience the consequences of cancer dampening their spirits, which runs parallel with
Zabora, BrintzenhofeSzoc, Curbow, Hooker, and Piantadosi's (2001) findings that about 29% to
43% of cancer survivors have manifestations of clinical depression (De Guzman, et al., 2013).
EMBRACING THE JOURNEY: LIVING WITH CANCER 18

Sadness and depression is inevitable in this case. Because cancer is an illness that these
cancer
[40]
patients view as something terminal and fear that they may die. According[40]to the journal
“The experience of counseling the terminally ill and the best counseling practices” stated that one
quarter of all patients with terminal cancer will develop symptoms of depression and sixty percent
of them[40]
will experience some type of psychological distress, such as anxiety or adjustment
disorder. People may fear the dying process more than they fear actual death, as dying can cause
people to worry about pain, being a burden, losing control, weakness, separation from family
members, and losing one's sense of purpose (Bleicher, 2011). Health care providers must guide
every cancer patient because this stage is a crucial stage in developing ways to cope with a certain
situation. Patients treated for depressive disorders in stressful situations, have more difficulties in
positive reinterpretation of stressful events. Mood disorders, like depression may be an important
factor that may contribute to a person's coping. People with depression often have a greater
tendency to perceive stressful events as overwhelming (Orzechowska, et. Al, 2013).

After the cancer patients have gone through fear, denial, anger, bargaining and depression,
they now proceed to acceptance. Some developed acceptance upon diagnosis while others went
through the initial phases of grieving. During this phase, the cancer survivors were now able to see
cancer as part of their lives, and believed that someday it will come to pass. They were able to see
the good things from it and were able to generate their own sources of strength. Acceptance, for
them, is the beginning of hope.

In another interview, Doxorubicin said:

“Never na nagkaroon ako ng hinanakit. I never asked the Lord na “Bakit mo


binigay sa akin?” ..,bata pa ako, marami pa akong dreams, but I really accepted
it. Inaccept ko na siya right there and then na sinabi ni doc na, you have cancer
and it's positive.umiyak ako, siyempre umiyak ako but I really accepted it, I never
questioned.” ( I never had a grudge. I never asked the Lord “Why did you gave it
to me?” I'm still young, I still have a lot of dreams, but I really accepted it. I
accepted it already right there and then when the doctor said to me that you have
a cancer and it's positive. I cried, of course I cried but I really accepted it, I never
questioned)

Said by Siltuximab:
[13]
“I was fearful and then … until I accepted it after I don't know how long…, a
month was too long kasi, I accepted it. It was after acceptance *palms at sides*
when …, when I tried to look and read and saw na there are many many possibilities
and I always, I was very hopeful because[82]
there was hope na pwede naman.” (“I
was fearful and then I accepted it after. I don't know for how long. A month was
too long. It was after acceptance *palms at sides* when I tried to read and saw that
there are many many possibilities and I always, I was very hopeful because there
was hope that it can be”).
EMBRACING THE JOURNEY: LIVING WITH CANCER 19

Siltuximab's palms were observed to be positioned at the sides while saying this statement.
Palms open at an angle means that the person is being open and honest (Weinschenk, 2012).
Acceptance can come in the form of increasing knowledge about the disease as what Siltuximab
did.

This has opened her eyes to the possibilities of survival and has given her strength to fight
cancer.

Neomycin has said:

“pero ano eh, I had to be strong, so I had to accept, kung ano yung nangyayari
sakin, and then you have to learn to make a way, to make myself presentable.”
(“but, I had to be strong, so I had to accept what will happen to me, and learn to
make a way, to make myself presentable.”)

Folfiri added:

“Iaccept mo mas mabilis ang paggaling mo doon, kaysa yung “bakit ako may
cancer, bakit? Bakit?...dapat i-embrace mo nalang kung anong meron ka. Hindi ka
dapat nagmumukmok, hindi mo iniisip na may sakit kang cancer kasi the more na
iniisip mo na may cancer ka wala.(“You must accept it, you will be cured faster
rather than thinking “why do I have cancer? Why? Why?”. You will become
stressed and all. You should embrace what you have. You must not remain in
distress, you must not think that you have a cancer because the more you think of
it, then nothing”.).

Life experiences have also been a factor that contributed to their acceptance of their disease
as Streptozocin said:

“Siguro with all the experience I experienced in my life. All the situations, all the
trial is parang nagkaroon kasi ako ng perspective na makakaya ko to.. It will come
to pass. Yung ganoon. Mapagdadaanan ko to.. yung ganoon.. it will not remain in
my life, but mapagdadaanan ko to kasi sabi ko nga so that I have a story to tell.
Yun yung, parang yun yung nag kwan sakin yung nagbibigay ng lakas sa akin.”
(“Maybe with all the experience I experienced in my life. All the situations, all the
trial, maybe I was able to develop a perspective that I can surpass it. It will come to
pass. Like that. I will go through this, like that. It will not remain in my life but I
will go through this and just like what I've said, so that I have a story to tell. It, it's
like, it was the one that's giving me strength.”)
[68]
Some of the cancer survivors interviewed have come to a point of acceptance upon diagnosis.

In the study entitled ”Feelings Experienced by Women When Receiving the Diagnosis of
Breast Cancer”, they found out that some women did not experience sadness, despair, fear and
remained to be positive upon diagnosis of breast cancer (Sousa Barros, Conde, Lemos, Kunz, &
EMBRACING THE JOURNEY: LIVING WITH CANCER 20

de Lourdes da Silva Marques Ferreira, 2018). Cancer survivors embraced their disease and
developed strategies that can help them cope up with it. They held on to their spirituality and see
the goodness from it and from there they were now able to realize their life's purpose. Acceptance
is the stage wherein you recognize that the new reality is the permanent reality. We can never
replace what has been lost or done. Instead of ignoring one's feelings, one must listen to his/her
needs, move, change, grow and transform (Kessler, n.d). They didn't allow the news to take over
them, instead, they develop a positive perspective that helped them move on from the sad truth
cancer has given them. Seeing an event as a proof that life is unfair will increase the risk of
developing depression (Horgan, n.d). For them depression will make your health go weaker. They
also see that acceptance will buffer up your healing process.

B. Having Optimism and Strength

After the grieving process, some were now able to look positively towards living with the
disease. The optimism they had, made them develop strength while going through it. Some of the
survivors have pictured themselves as an individual who has a positive outlook in life. Optimism
is a generalised belief that good things will happen (Scheier & Carver 1985). This has made them
accept their disease easier. They were now able to see the importance of having a positive attitude
in dealing with cancer. They set aside all the negative thoughts for they believe it will do no good
to them.

Doxorubicin said:

“hindi kasi ako very negative, very positive talaga yung outlook ko and then I
counsel especially yung ayaw mag-chemo.” (“I'm not very negative. I have a very
positive outlook and then I counsel especially those people who don't want to
undergo chemotherapy.”)

Optimism made her help those who have cancer. People who developed a positive
perspective have the tendency to share their strategies on how they fight an overwhelming disease
(de Guzman et. al., 2012).

Methotrexate states:

“Yun lang yung mind set mo na mamamatay ka. That's it mamamatay ka talaga.
Kasi wala ka nang gagawin eh, malulungkot ka lang. defeatist ba yung magiging
attitude mo. Yun talo ka talaga dun. Tapos maging positive kasi negativity talagang
nag-aatract siya ng ano eh. Ako tingin ko nag-aattract talaga siya ng sakit yung
yung mindset mo dapat very happy ka lang”.(If your mind set is that you will die.
That's it! You will really die. Because you will not do anything already, you will
only feel sad. Defeated is the attitude that you will gain. Be positive because
negativity really attracts, for me, I think it really attracts a disease. Your mind set
should be, you must only be very happy.)
EMBRACING THE JOURNEY: LIVING WITH CANCER 21

Optimism helped cancer patients create a good attitude towards cancer and protect their
selves from being stressed by it. Optimism safeguards one from experiencing distress in stressful
situations and may act as a stress mediator (Carver, Smith, Petronis & Antoni, 2006). For them,
optimism is something that you must have for you to defeat cancer.
[4]
If you will let cancer win over
you and negative thoughts reign in you, then you'll be defeated. Optimism has been found to be
a predictor of good adjustment to a variety of somatic illnesses, including cancer. (Friedman et al.,
2006; Carver, Lehman & Michael, 2003).

Positive behavior has made the cancer survivors to develop strength while going through
an overwhelming disease. They realized that they need to strength to survive. Strengths are built-
in capacities for certain thoughts feelings and behaviors. Using strength is usually the most
effective way to accomplish a goal (Siegel, n.d). When they accepted that they have cancer, they
see their selves as strong individuals and thought that being strong is an essential characteristic
one must have in dealing with cancer. Some said that cancer has turned them to become a fighter
while others perceived that they are already one before having the disease.

Methotrexate said:

”Siguro doon sa idea na I know what I'm going through, I know na kailangan
strong ako, yung hindi ako madepress. Yung character ko kasi, fighter. Hindi ako,
hindi ako madramang tao. Kahit pag handle ng death palagi kong sinasabi death, [31]
uhm wala tayong magagawa diyan eh. Walang wala. Ayaw ko ng drama.”… “And
ano it was handled with full, ano ba to, uhm what do you call that, tapang. I was
talagang very strong na pa- tatalunin ko to,cancer lang to parang ganun.
Personality ko yun eh. Hindi ako basta basta nagpapatalo so nakatulong din yun [41]
sa battle ko sa cancer.” (Maybe in the idea that I know what I'm going through. I
know that I need to be strong. I should not be depressed. I'm a fighter, I'm not a
dramatic person.
[31]
Even in handling death. I always say that we can't do anything
about that. I don't like drama… and what, it was handled with full, what is this,
uhm what do you call that, courage. I was really very strong, I will defeat this, this
is only cancer it was like that. It's my personality. I don't get defeated so easily so
it has also helped in my battle with cancer.)

Another participant, Folfiri, said:

“ Naging strong ka! Kasi noon weak ako. Konting ano lang, konting ano to,
sumusuko na ako.pero once na nagkasakit ka ng ganun dapat fighter ka na, fighter
ka na.”(You become strong because before, I'm weak. I get swayed easily by small
thing. But once you had an illness like cancer, you must become a fighter. You must
be a fighter.)

Streptozocin discloses:

“I believe na hindi dun mag eend ang buhay ko. Kasi kung nag end ang buhay ko
edi wala ako ngayon. Kung nag end, kaya I believe na with that kung bakit ko sinabi
EMBRACING THE JOURNEY: LIVING WITH CANCER 22

yun kasi nakikita ko sarili ko na I'm still here. So yun, tsaka yun nga tapos sabi mo
na fighter, yes. Because pinanghahawakan ko yung fight the good, fight the faith sa
bible.” (I believe that my life wouldn't end there. Because if my life has ended there,
I'm not here today. If it has ended, that is why I believe that with that, the reason
why I said that because I can see myself that I'm still here. And there, and you said,
fighter, yes. Because I hold on to the fight the good fight the faith in the bible.)

Cancer has changed them. It has helped them also to become stronger than they were before
they had the disease. Having a strong personality was an advantage to them while they were
adjusting to cancer (Hodges & Wistanley, 2012). For them, it is a disease that challenges you and
that you should not let it defeat you. Working through emotions can help lower stress thus will
lead to improved physical and mental health. Feeling strong and positive may help one during
healing process (Livestrong, 2015) Some had strength from their sense of spirituality and they
become more appreciative of life (de Guzman et al. 2015). Having a strong personality, as
verbalized by one of the participants, may help one in dealing with cancer.

I. Traversing through the Struggle

This stage of the journey: living with cancer, follows after garnering the ability to see
cancer as part of their lives. They had accepted their diagnosis and had equipped themselves with
the strength to face the next phase, dubbed: traversing through the struggle. At this point in time,
they had confronted themselves with living with their “new” selves in an encounter against cancer.

This involved overcoming, in several of ways, with the struggle. Struggle, in which they
had triumphed over, with their own coping and help from those who surrounding them; while
facing, emotional turmoil, feelings of hopelessness and for some, feelings of expecting more from
their support system.

A. Regaining Control

When undertaking their cancer journey, the participants faced physical, mental, social,
emotional and spiritual challenges. These challenges led them to employ coping strategies that
somewhat lessened their burdens while going through their journey.

One coping strategy identified by the participants is by writing their journals that includes
all their experiences, feelings and insights during their journey. Journals or diaries can be a means
of reflection for a person that allows them to identify their worldview and personal philosophy
around death and dying (Germain et. al., 2016). The participants claimed that having their own
journals allowed them to somewhat look back on their journey and reflect on all the experiences
they had gone through. According to Mehrabian (2017), an illustrator category of implicit
behaviors is one that acts the words to provide emphasis on the statements that the person is saying.
During the interview, Siltuximab moved her hand in circular motion to emphasize the word “life”
in her statement. Moreover, enacting a statement also gives emphasis on it as seen in Siltuximab's
statement wherein she enacts having a journal by imitating a writing gesture.
EMBRACING THE JOURNEY: LIVING WITH CANCER 23

In accordance to this, Siltuximab stated:

“…I felt, I felt na *hand moves in circular motion*(emphasizing) life had more
meaning, it added more meaning to why I am, why I survived, …, in fact, there was
there's one person who's insisting, including my husband, there are two already,
insisting that I write, I write my story through a book, …, I have my journal
*imitates writing gesture* for that whole time…” (“…I felt, I felt that *hand moves
in circular motion*(emphasizing) life had more meaning, it added more meaning
to why I am, why I survived, …, in facet, there's one person who's insisting,
including my husband, there are two already, insisting that I write my story through
a book, …, I have my journal *imitates writing gesture* for that whole time…”)

In addition, Streptozocin stated:

"...And through that, ang nakatulong din sa akin, is writing my journal. Yung
pagsusulat ko kung ano ang journey ko at that time, parang mostly ano,
pasasalamat kay Lord. Yun yung sinusulat ko sa journal ko, or yung mga
experiences ko..." ("…And through that, one thing that helped me was writing my
journal. What I wrote on my journal was mostly thankfulness to The Lord. That's
what I wrote on my journal, my experiences…")

These statements show that the participants wrote their stories through a journal that
includes all their experiences and reflections on those experiences. Having their own diaries or
journals can help patients keep track of their personal
[12]
accounts with the experience and enables
them to look back and reflect on their journey. By writing their own encounters with cancer
somewhat gave the participants a sense of relief thus enabling them to cope with the situation. As
evidenced by this, health care providers may encourage patients to have their own diaries or
journals as a coping method. The health care team may allot ample amount of time for patients to
write down their experiences, feelings and insights and allow them to take a moment to read a
reflect on their experiences.

Another subtopic of coping methods utilized by the participants is through different


activities such as listening to music, strolling and driving. They mentioned that doing these
activities helped them cope with their situation and also relieve their stress thus allowing them to
deal with the physical changes they experienced especially during the course of their treatment.
These diversional activities such as exercise, music therapy, art therapy, guided imagery, and
relaxation, as well as animal-assisted therapy, spiritual support, therapeutic touch, visitation
facilitation, and meditation help patients cope with the effects of illness and are particularly useful
in the oncology population, (Lee, 2003)

Siltuximab stated that:

"...Ang coping mechanism mo talaga is like ayan, you- you be the one to be on top
of things *closed fist, puts on table*(connote firmness), that music can help as
standing, standing, going out for a walk, uh five minutes or so, mga ganon, small
EMBRACING THE JOURNEY: LIVING WITH CANCER 24

things that you can do to help yourself..." ("…Your coping mechanism is that you-
you be on thop of things *closed fist, puts on table*(connote firmness), that music
can help as standing, standing, going out for a walk, uh, five minutes or so, small
things that you can do to help yourself…")

As seen in
[35]
Siltuximab's statement music therapy and strolling somewhat helped her cope with the
situation.

This is supported by a statement from Rituximab saying:

"… Parang makapagpahangin lang, tinitignan yung view. Yun, pampatanggal ng


stress. Magpahangin. Kung minsan pahinto-hinto ako sa may lugar na malakas
yung hangin, andun lang ako kaya kung minsan natatagalan din ako, kahit umuulan
yan makapunta lang…" ("…To get some air, look at the view. That removes stress.
Get some air. Sometimes I stop by places with a strong wind; I stay there that is
why sometimes I stay for too long, even if it's raining, just to go to those places…")

In Rituximab's statement, he goes to places that alleviate his stress as a way of coping.
These statements imply that diversional activities may prevent the patients from focusing too much
on the disease that may cause more stress, anxiety and strain unto themselves. Although patients
have different preferences, diversional activities enable them to relieve their stress and lessen the
load of the problems they have encountered during their cancer experience. Facilitating this coping
method can be done by identifying the patient's own preferences, adjusting it to the patient's
situation and giving them the opportunities and to do the activity that helps them relax. Through
this, too much stressing on the illness may be lessened hence, decreasing the weight of burden on
the patient's shoulders.

The participants also found a[12]way to cope during the course of having cancer by sharing
their experiences with other people. They mentioned that it gave them a sense of healing thus
allowing them to cope with the situation. In a journal that studied patients with arthritis, the
participants mentioned that they felt strengthened confidence when sharing their experiences. It
made them discover that it was beneficial to be more open than they were before. It felt good to
let others know how a life with arthritis could be like, and they could be honest about their
limitations, (Grønning, Midttun & Steinsbekk, 2016). This is somewhat similar to the participants
of this study where,

Doxorubicin stated:

"... When you share- it's your healing actually kasi shinishare mo siya eh para-
para sa akin when I share my story, it's my healing..." ("…When you share, it's your
healing actually, because you are sharing. For me, when I share my story, it's my
healing…")
EMBRACING THE JOURNEY: LIVING WITH CANCER 25

As seen in Doxorubicin's statement, she mentioned that sharing is her healing. This implies
that releasing the thoughts, feelings and loads that they have been carrying since the start of their
journey by sharing it to other people, helps them to deal with it just by knowing that they were
able to let loose of their difficulties while facing cancer. This can be facilitated in the clinical
setting by allowing patients to share their stories, not only does it give information on the patient's
medical history, but it also helps the patient by ventilating their hardships knowing that someone
is listening to them. Therefore, health care providers should learn the skill of listening intently to
the patient knowing that they are utilizing it as a coping strategy to alleviate their burdens.

The need to do lifestyle changes was also mentioned by the participants since they
experienced physical limitations hence, making it a need [14]
for them to modify their usual lifestyle
when it comes to diet, exercise and other related activities. Cancer patients who are aware of their
diagnosis are more likely to adhere to[80]
lifestyle changes than those who were not given enough
information by medical professionals. This indicates that most patients with cancer reported
making changes in lifestyle to improve their health and well being after a diagnosis of cancer,
(Kostopoulou & Katsouyanni, 2006). During the interview

Doxorubicin stated:

"...Ano na ako, medyo mapili na. Oo, di na ako ano sa karne kasi nga daw ano
yun, sa taba, pero sabi naman ng onco ko, pwede naman basta in moderation lahat,
sabi niya sa akin, para mas safe minsan di ko nalang din kinakain, lalo na daw
yung mga matataba, yun naman ang advice sakin, more on fruits at tsaka
vegetables..." ("…I am picky. Yes, I don't eat much meat because of the fat, but my
oncologist said that it's okay as long as I take it in moderation. She said,
[21]
to be safe
it would be better not to eat it, most
[12]
especially the meat, she advised. I should eat
more fruits and vegetables…")

In Doxorubicin's statement, she made lifestyle changes by modifying her diet in


accordance to the specifications of the physician. She followed a new diet plan that is different
from her preferences before having the disease.

Siltuximab, also stated:

"…It's hard when it comes to lifestyle, a lot of discipline, yes, imagine that during
your treatment you cannot go to crowded places. I cannot get into family reunions
and all that, the family gatherings, it's hard
[109]
*open hands and laughs*(being honest
and as she laughs while telling the story. According to Lickerman (2011), by being
able to laugh at traumatic events in our own lives doesn't cause us to ignore them,
[31]
but instead seems to prepare us to endure them.), but then again you have to do
it…"

She mentioned that one modification she had[2]to do while going through cancer was to avoid
crowded places and socialization to a lot of people. This may be due to the risks involved while
having the disease. She also mentioned that discipline is an essential factor to be able to adhere to
EMBRACING THE JOURNEY: LIVING WITH CANCER 26

the needed modifications. The health care provider's aid is also an essential factor to the
compliance of the patient to the needed lifestyle changes, therefore they should endow the patients
with relevant and appropriate health teachings to increase the knowledge on the patient and inform
them of the result of pursuing these lifestyle modifications.

Additionally, in dealing with the illness and effects of its treatment, another means of
coping is to broaden their knowledge. After knowing about their condition participants now seek
for information, they often have their research on what was their diagnosis all about. During this
phase, the cancer survivors are now able to make different strategies on how they can cope with
the situation. After knowing the effects of chemotherapy and radiation
[4]
therapy, some participants
felt afraid and undecided, but most of them felt the other way. In accordance with the journal
“Patients' Experiences of Preparation for Radiation Therapy: A Qualitative Study”. Having
information on the following topic areas were identified as important in feeling prepared: radiation
therapy-related side effects, the practicalities of treatment (e.g., what radiation therapy does, or
what is involved); what does the treatment machine look like and how does it works; and what do
patient feel during treatment, (Forshaw, et.al, 2017). During the interview the process participant
frown, which means that she is thinking deeply. According to Vidya Hattangadi (2014), frowning
is a facial expression, which depicts that a person is concentrating deeply on something.

Nolvadex stated that:

“Nagresearch research na din ako, andami kong nababasa, nababasa mo tungkol


lahat sa …sa kasamaan ng chemotherapy at saka radiation*frowning*, edi parang
nagdadalawang isip ka na, nagdadalawang isip ako na itutuloy ko pa ba o hindi
na” (I did my research, I read a lot of things, I read about everything, the bad side
of chemotherapy and radiation *frowning* and [111]
then I started to have doubts,
doubts if I should continue the treatment or not.)

In addition to that it is also stated by Methotrexate:

“tapos, I read noh talagang nagbabasa ako, ano tong sakit ko, para hindi ako
natatakot.” (Then I read, I really read about my disease, for me not to be scared.)

Gaining knowledge about their condition helped them to be aware of the procedure and
what was their condition all about. It affects their feelings on what does the chemotherapy
[22]
and
radiation therapy do, that can lead them in having low or high level of anxiety. This can be
implemented in clinical setting by giving thorough health teachings to patients, to enforce the
relevant information to the patient's case.

In relation to that, It is normal for a person who's undergoing such disease to look for
another way of treatment. Some patients are not satisfied or would like to view for other options
they seem important or relevant in the treatment of their condition, some are looking for additional
information regarding their needs facilitate fast healing. While participants are in the process of
EMBRACING THE JOURNEY: LIVING WITH CANCER 27

treatment, some of them seek for other ways or alternative just to fasten the treatment of their
cancer.

During the interview, Rituximab stated:

“Pero yung iba, yung lasa pinipilit ko lang, wala namang mawawala kako,
makasurvive man, makasurvive lang ganon. Pagmararanasan niyo din yung
naranasan ko, ganon din ang gagawin niyo, kahit anong anek anek na gamot na
diyan, makasurvive lang, iinumin niyo talaga. Oo, kahit mapanghi yung amoy,
ganyan” (But those with strange taste, I just force myself to take it, I won't lose
anything if I try, just to survive. If you experience what I experienced, you'll
probably do the same, any drug or medicine around, just to survive, you will drink
it. Yes, even if it smells like urine.)

In addition to that Nolvadex also said that:

“Oo, these are times to relax, oo to pamper myself, ano din nag, nag -alternative
din ako , eh siyempre i-try mo lahat ng bagay na, na alam mong para sa katawan,
to heal yourself.”(Yes, there are times to relax, yes, to pamper myself, uh, I did
alternative too, you will try everything for your body, to heal yourself.)

Complementary and Alternative Medicine (CAM) was used more frequently and in tandem
with mainstream medicine. The usual reasons for the utilization of CAM interventions are the
promotion of wellness, disease prevention, and symptom management, (Garland, et. al, 2012).
With the use of alternative medicines, it allows participants to facilitate the treatment of their own.
Despite that they're not sure if the alternative medicine they were taking will efficiently treat them,
they at least try it just to heal themselves. However, when taking alternative medicine, the guidance
and approval of health care practitioners are essential, this is to ensure the effectiveness of the
alternative medication that the patient is taking, appropriate health teaching must be given to secure
compliance to be advice about medical regimen.

Consequently, during course of treatment there are a lot of changes happening in


one individual, it can be physical, emotional, social and others. Participant Isolate their self
to protect their ego. As a consequence of the participant who's in the course of treatment,
one undergoes a state of isolation from society, mostly because of the social stigma that
comes with cancer, (De Guzman, et. al, 2015).

Bortezomib stated that:

“Magpupunta kaya ako ng barber o ano, pero parang inisip ko, ano kayang
sasabihin nila baka madami nanamang mga question yung parang maaawa sila
sayo yung mga ganyan so dinecide ko na ako nalang mag ano, magshave, so
shinave ko talaga siya in front of the mirror, shinave ko siya..”. (I thought about
going to the barber, but I was thinking, what would they say, what if they would ask
EMBRACING THE JOURNEY: LIVING WITH CANCER 28

me a lot of questions, what if they would pity me, so I decided that I would be the
one to shave my hair, I really shaved it in front of the mirror.)

In addition to that Rituximab stated that:

“Parang kuwan, parang,parang ngay naaawa din sila saakin. Ay wag kayong
makwan sakin parang nakwakwan ako nadodown din kaya nga di ako lumalabas,
yung mga kabatch ko nagreuinion sila “ay si __ (name of participant) nagkacancer
yan sabi nila, meron pang umiiyak na kabatch ko noon nung nagreunion kami. Wag
ka na umiyak, buhay na buhay nga ako nakikita mo nga na nakikita mo ako sa
harap harapan mo pero di tulad ng dati yung katawan mo sabi niya” (It was like,
like, they pity me. Don't be like that, because I feel down, that is why I avoid going
out, during batch reunions, they would talk about me “(name)...he had cancer”
There were also people who were crying during the reunion. [I would say] “Don't
cry, I am alive, you are seeing me right now, right now with your own eyes” [He
said] “Your body is not the same anymore”)

Rituximab also stated that:

“....ayokong may naaawa. Emotions talaga. Ayoko yung maemotions pag may
umiiyak parang naaapektaran. Ayokong naaapektuhan, gusto ko masaya. Ayoko
noon, ayoko ng malungkot. Pag umiiyak si mother lalayuan [82]
ka niya tapos iiyak siya
sa kanyang[13]
bahay, e ang gusto ko happy happy lang” (... I don't want any person
pitying me. I do not want to be affected; I want it to be happy. I do not like sadness.
When my mother cries, she will go away, [33]and she would cry in her house because
I want [the environment] to be happy only.)

The participant limits their social interaction during the course of treatment because they
don't want to be pitied by other people, so they instead stay from their home. These finding tells
us that as nurses we should not show that we pity them when it comes to this kind of situation
because it can make them feel bad. And it is also important that people around them should treat
them the way they treat them before, for them not to feel being pitied.

Furthermore, the participants said that their innate faith in higher being during the course
of their treatment had played a big part in coping with cancer. Through their hope that God will
heal them and their belief itself that they will eventually get cured and survive. According to
Movafagh et al. (2017), the results of this brief review paper suggest that it may be helpful for
clinical oncologists to be aware of the prevalence of the use of spirituality in their practice and
according also to Puchalski (2001) Spiritual beliefs can help patients [47] cope with the disease.
Spiritual commitment tends to enhance recovery from illness and surgery. For example, a study of
heart transplant patients showed that those who participated in religious activities and said their
beliefs were important complied better with follow-up treatment, had improved physical
functioning at the 12-month follow-up visit, had higher levels of self-esteem, and had less anxiety
and fewer health worries. Related to spirituality is the power of hope and positive thinking. Jakafi
experienced this stating while smiling, According to Harker and Keltner (2001) smiles are not
EMBRACING THE JOURNEY: LIVING WITH CANCER 29

transient sparks of emotion but rather clear windows into a person's core disposition and it
expresses positive emotions

Jakafi said:

“…inaccept ko na lahat, every possible thing to happen, like kung mamatay man ako bukas,
or hindi ako ma-heal or whatever, sinuko ko lahat kay Lord *looks to the ceiling*, let Your
will be done if You say You'll heal You heal me *smiles* (I accepted everything, every
possible thing to happen, like if I were to die tomorrow or if my illness can't be healed or
whatever, I gave everything up to the Lord *looks to the ceiling*, let your will be done, If
you say you will heal, you heal me *smiles*

Another participant named Doxurubicin stated that:

” …lord has given me the strength, babalik ako sa ano ng panginoon na walang
ibang nagbigay ng kalakasan ko kundi and panginoon…” (Lord has given me the
strength; I am going back to the Lord, who gave only strength, the Lord alone.)

This finding tells us how the religious beliefs of a patient can have a good effect on the
feelings of the patient. As members of the Health Care team, we should accept and acknowledge
their beliefs, and not pass on judgments even if it contradicts what we believe in. We should be
there when they are in need, give them time and privacy to pray and do religious activities.

B. Struggles Encountered

Severe ailments such as cancer, are known to produce enormous amounts of deviation in
the lifestyle of those affected and can restrict a person's freedom of movement and self-sufficiency.
Cancer and other chronic illnesses may make it unfeasible to engage in the activities
[98]
that one likes
and can weaken self-confidence and the feeling of hope in the time to come.

It is not alarming, then, that people with[41]cancer often undergo a certain amount of
emotional turmoil and feelings of hopelessness.

This is evidenced by the statements and verbalizations of the participants as they find some
[98]
conditions that they have, as unfavorable, overwhelming and miserable. In some cases, the
physical effects of the illness itself or side effects of medication may also lead to emotional turmoil.

Cancer affects not only the physical health but also the mental health of an affected person;
their feelings may become more intense and exaggerated. The constant pain which patients
experience during treatment leads to a wide range of emotions such as frustration, irritation,
depression, or anger. Participants expressed how the agony of suffering from cancer alters their
mood, and lowered their temperament with the people around them; it made them avoid social
contact.

Rituximab shared that:


EMBRACING THE JOURNEY: LIVING WITH CANCER 30

“Tumataas agad boses konting kwan lang, konting kamali lang…pati mga pusa
nun pinagtritripan ko, gusto ko ng patayin” (My voice gets high everytime, even
small things, even the cats, I take it out on them, I want to kill them.)

Rituximab further added:

“Yung mga emotions ko...parang nasa kwarto parang gusto mo silang palabasin
lahat..may mga iniisip lang ako, parang pag kinakausap nila ako parang nawawala
ako sa isip” (My emotions..when in the room, I felt like I wanted everyone to go out
and leave me..I am thinking of things….When they are talking to me, it is as if I am
out of my mind.)

Life-threatening ailments such as cancer represent unique ordeals—compared with


singular, time-limited traumatic events—given their multidimensional, undefined, and continuing
nature (Leal, et al., 2014). Also, some participants experienced pitying themselves because of the
agony they are experiencing, it stops them from doing what normal people do and it makes them
pity themselves.

Streptozicin shared:

“Though sometimes, may mga situation ako na, “Lord, buti pa sila diyan lang sila
sa labas” especially kapag may naririning kang nagkwukwuntuhan dyan s alabas,
nasa bed ka tapos ikaw “buti pa sila nagkwekwentuhan, ako?” sometimes I feel
that I already pity myself” (Though sometimes, there are situations I say “Lord, it
is good that other people get to go outside” especially when you hear people talking
outside and you are just there on your bed thinking, “Good for them they are able
to socialize, how about me?)

Depression remains an under-recognized comorbidity in cancer patients, with major


implications
[7]
on patient suffering, mortality and healthcare expenditure (Smith, 2015).

Those who are diagnosed with cancer may sometimes feel that they are responsible for
protecting their family from emotional stress. They didn't want to let others see that they are weak
and that they can overcome the challenge that came into their lives. They are afraid that it might
affect them.

Adriamycin said:

“Actually, ayokong magpakita ng weakness because I was fearing na pag


nagpakita
[77]
ako ng weakness, it will affect din especially yung mga anak ko”
(“Actually, I don't want to show weakness because I am afraid that if I showed
weakness, it might affect my children.”)

Doxorubicin added:
EMBRACING THE JOURNEY: LIVING WITH CANCER 31

“I never cried in front of him kasi gusto ko na Makita niya na ummm, Makita nila
na they will not be burdened na they are doing their part to support me sa lahat ng
aspeto and yet ako hindi ko ginagawa yung part ko. So I never cried in front of my
family. I cried sa inyo, wth my kasama ko na cancer patients na nadiagnosed, I
cried even my friends I cried but sa family ko never nilang nakita akong umiyak
and going through my journey kasi ayaw kong mapanghinaan ba sila ng loob.” (I
never cried in front of him because I wanted him to see, them to see that they will
not feel burdened, that they are doing their part to support me in all aspects and
yet here I am not doing my part so I never in front of my family. I cried in front of
my co-cancer patients, in front of my friends but my family never saw me crying.
[44]
Going through my journey, I don't want them to lose their hope.)

From our interview, we have seen that cancer patients don't want to become a burden to
their family, a reason for them to hide their emotions from them.
[78]
They also think about the welfare
of their children so they didn't want to discuss it with them. In contrary to that, it is important to
talk openly with your family most especially your children about your diagnosis and treatment.
Even young children can sense that there is a problem. Avoiding the discussion may make them
believe that the situation is worse than it actually is. This might create feelings of confusion and
fear. Honest communication will help your family cope with your disease (American Society of
Clinical Oncology, 2016). Most cancer survivors from our interview fought cancer hiding their
real emotions. For them showing strength towards your family will protect them from emotional
[
stress and
1
will9help them
]
keep on hoping that they will survive.

Patients who have


[19]
cancer may find the physical, emotional, and social effects of the disease
to be stressful. When patients feel that they are unable
[19]
to manage, or control changes caused by
cancer or normal life activities, they are in distress. Distress has[51]
become progressively recognized
as a factor that can reduce the quality of life of cancer patients. Several studies have shown the
stress related with cancer treatment might have a role in progression of cancer and cancer-related
death (Karunanithi, Sagar, Joy, & Vedasoundaram, 2018), also stated in this study, psychosocial
stress associated with cancer and its treatment is often disregarded by the treating physicians. It
can impact the QOL and[80]social functioning of the patient and needs to be addressed along with the
cancer-directed therapy. As there is a significant association between psychosocial distress and
QOL experienced, interventions such as holistic palliative care and social support aiming to reduce
the patients' distress could result in improved QOL and better social functioning (Karunanithi,
Sagar, Joy, & Vedasoundaram, 2018).

Resulting from the changes, the losing of hair, the weakness, their bodies slowly
deteriorating during the treatment, some participants
[42]
somewhat lose their hope. They lost all their
hope, thought of the worst, which is dying. Hopelessness[18]
has been associated with diminished
physical, psychological, mental, and spiritual health. Hopelessness is also characterized by
insistent negative feelings and expectations about the future as well as loss of drive (Pehlivan,
Ovayolu, Ovayolu, Sevinc, & Camci, 2012).

Adriamycin, had feelings of negativity by stating that:


EMBRACING THE JOURNEY: LIVING WITH CANCER 32

“yun na yung moment na parang biglang…bigla ka ng ano…parang feeling mo


end of the world na…parang ganoon kasi parang impression…Oo, yung feeling
pala kapag ikaw na yung merong ganon, parang wala ng chance”. (That was the
moment, it was like…suddenly… I felt like it was the end of the world that…it was
like, because of the impression…Yeah, that feeling when you, yourself is already
experiencing it, it felt like there was no more chance.)

According to (Somasunduram & Devamani, 2016), hopelessness surges the feelings of


stress which in turn also increases negative feelings about the future.

Adriamycin also had negative feelings about what the future will hold, verbalizing:

“Ala, sabi ko, Doc, mabubuhay pa ba ako? (I said, “Doctor, am I still going to
live?)

The participants also reached a point wherein as if they already have given up, they
wanted to end all the suffering.

Nolvadex stated:

“Pero there are times na after my chemo therapy, may time na gusto ko ng
mamatay, yung gusto kong,, Lord, pwede bang I will just close my eyes and then
paggising ko anjan na ako sa tabi mo” (But there are times after my chemotherapy,
there were times that I wanted to die, I want that.. “Lord, [8]
can I just close my eyes
and then when I wake up, I am there by your side already.)

With medical bills piling up and extensive absences from working because of surgery and
management, every aspect of the lives of people and families are affected. It not only [18]
devastates
the physical health of those who are afflicted, it turns their entire lives upside down. Social support
of cancer patients
[18]
from family is the most influential factor in overcoming feelings of hopelessness
and loneliness. For this reason, it is important that nurses do not disregard the social support
systems of patients when evaluating their hopelessness and loneliness status (Pehlivan, Ovayolu,
Ovayolu, Sevinc, & Camci, 2012). To aid long-term adjustment of cancer patients, the health care
system will need to implement interventions at multiple levels (patient, family/friend, provider,
organization) that help identify and applicably address the evolving support needs of cancer
patients throughout their cancer experience in a way that also minimizes the care giving burden on
members of the patient's social network (Arora, Ruten, Gustafson, Moser, & Hawkins, 2006).

Moreover, cancer and its treatment can affect physical appearance and how people feel
about themselves. It is normal for different people to be focused on different aspects of change in
response to their cancer treatment. Some cancer survivors can be very focused on the physical
aspects, feeling as if their bodies have been damaged.

Nolvadex described it as:


EMBRACING THE JOURNEY: LIVING WITH CANCER 33

“Para na akong mamamatay eh, yung effect ng chemo, talagang nararamdaman


ko, talagang patay na lahat ng good cells ng katawan ko” (I felt like I was dying,
the effects of chemo, I really felt that my good cells were also dead.)

The participants experienced so many changes during chemotherapy especially when it


comes to their physical attributes like losing hair, which was mostly their main concern, their
bodies having lowered
[61]
pain tolerance made it difficult to perform daily activities and it also made
them exhausted. It can be difficult to plan for the emotional and self-image
[61]
challenges that the
treatment itself may present. Cancer patients manifest physical changes. Patients with cancers that
can cause more readily obvious physical changes — and create a visual sign of their illness — may
become more self-conscious and have a poorer self-image (Lewis, 2016). Female cancer patients
who undergo chemotherapy treatment often experience hair loss. Most of the participants talked
about how they value their hair and their feelings when they started losing hair, how they accepted
and got over it.

Siltuximab, stated that:

“I started to feel na nalalagas na ung hair *holds hair*(gives emphasize on her


hairpart) and then I just pull and then as time went, the hairfall and then it just goes
and then buholbuhol na at 1st I was scared and then I just parang its acceptance
*hand gesture in a circular motion*(emphasizing) immediate acceptance so that u
will not ano u will not prolong your agony so this is part of it parang ganon so
nalalagas until its until it was gone *hand gesture like wearing a
scarf*(emphasizing)”. (I started to feel my hair falling *holds hair*(gives
emphasize on her hair part) and then I just pull and then as time went, the hairfall,
then it just goes and then it gets tangled, at 1st I was scared and then I just accepted
it *hand gesture in a circular motion*(emphasizing) immediately so that you will
na prolong your agony so this is part of it, just like that until its until it was gone
*hand gesture like wearing a scarf*(emphasizing))

Another participant, Folfiri also said:

“Hindi mo dapat ikakahiya yun once na may yung kinalbo ka, yung ganun, kasi
mawawala lahat pati pubic air lahat lahat makinis nga sabi ko nga sana di na
tumubo para di na nagpapaano nagpapawax (laughs)” (You shouldn't be ashamed
of it once you're bald, that, [13]
because all of it will be gone, pubic hair, all of it. I said
to myself it was so smooth; I wish it wouldn't grow back so I don't have to go for
waxing *laughs*)

The participants then shared how, this event, the loss of hair made them feel depressed and
devastated.

Jakafi shared:
EMBRACING THE JOURNEY: LIVING WITH CANCER 34

“So before ako magkaroon ng, before ako madiagnose, talagang love na love ko
yung hair ko, diba na, dapat ayos lagi, ayoko yung nagflafly away, ayoko yung
ganoon, so nong nalaglag yung hair ko, doon tlaaga [31]
yung saddest moment and
lowest talaga, doon ako mas nadepress ako doon” (Before I got diagnosed, I really
love my hair, it should always be neat, I don't like it flying away, I don't like that.
So when my hair started to fall, that was my saddest moment and lowest, that was
when I was more depressed)

This was also experienced by Bortezomib wherein she said:

“Nung maglalagas na talaga yung hair as in uhh, ayun pa pala second downfall ko,
you face people every day looking at you na alam mo yun yung kalbo ganun. (When
my hair started to fall out as in uhh, that was my second downfall, you face people
every day looking at you, you know, you're bald)

The hair loss associated with chemotherapy really affected how the participants, some
readily accepted it right away but some were not able to. This can really affect how patients viewed
themselves, it may have lowered their self-esteem in facing people every day. As nurses, we can
help patients overcome hair loss by encouraging them to seek out and take advantage of available
resources like head wear, the use of wigs, bandanas, fashionable hats, beanies, hair wraps that are
available in the market.

Another identified concern of patients during course of treatment is fatigue. Cancer-related


fatigue has been defined as sustainable subjective feeling of tiredness, related to the oncologic
disease or its treatment, which restricts normal functioning (Strebkova, Petkova, & Minev, 2017).
[51]
Fatigue is the most widespread cancer-related symptom and is associated with significant
morbidity, functional deficiencies and reduced quality of life (Wagner & Cella, 2004).

Rituximab stated that:

“Oo, strong pero physically matamlay parang nanghihina ako dun parati ikaw ba
naman na ilang buwan na di kumain, tubig at prutas lang grabe pero nakayanan
kahit masakit dito nun pinilit ko parin kumain mahirap, masakit *laughs*(
Participant laughs while telling the story. According to Lickerman (2011), by being
able to laugh at traumatic events in our own lives doesn't cause us to ignore them,
but instead seems to prepare us to endure them.)” (Yes, strong but physically
drained, it felt like I was really weak, always, I only drank water and fruits, who
wouldn't feel tired? I forced myself to eat even if it is painful *laughs* (Participant
laughs while telling the story. According to Lickerman (2011), by being able to
laugh at traumatic events in our own lives doesn't cause us to ignore them, but
instead seems to prepare us to endure them.).

They felt how their bodies deteriorated during the course of treatment and how these
brought about[106]
limitations in their physical functioning especially in doing their jobs and activities
of daily living. In fact, the very same treatments that would have supposedly increased their chance
[106]
EMBRACING THE JOURNEY: LIVING WITH CANCER 35

[106]
of survival can also cause several physical and psychological sequelae. Some of these may persist
for an extended period after cancer treatment is completed, they may become long term. Not all
symptoms appear at once, others can appear during treatment and some appear months or years
later (Stein, Syrjala, & Andrykowski, 2008). Most of the participants emphasized on how they felt
weaker and weaker each day after going for chemotherapy wherein it already affected their lives,
they cannot perform their usual ADLs like how they use to be.

Rituximab described it as:

“Nakahiga lang dun nga ako nakwakwan ayaw sumonod ng katawan ko nun sa
isip parang gusto kong parang gusto kong gawin yun ganito eh ayaw na ngang
sumunod ng katawan kaya ayun dun nalang kahit gusto mong maglakad ayaw kaya
nanghihina talaga parang nahihilo pa, meron pa yung time na magccr ka bigla
kang matutumba, hirap. Mahirap mag-adjust. Yung dating ginagawa mo. Kumbaga
gawin mo, wala, ang hirap, ang hirap na. Talagang magpagpapawisan ka na
talaga tapos yung kuwan mo katawan mo madali mapagod hindi katulad ng dati
kahit ilang bese akong tumakbo diyan hindi ako madali mapagod ngayon wala na,
mga dalawa o tatlo pagod na ako hinihingal na ako pag akyat ko palang jan sa
hagdanan wala na eh.” (I just lay in bed, my body won't do it, in my mind I want
to do something but my body just[10]
can't, even if I want to walk, I can't, I was really
weak, I was feeling nauseous. There was also a time when I have to go to the
bathroom, I just fall, it was hard. It was hard to adjust. The things you do before.
Now, none…it is so hard. I get really sweaty and my body just becomes tired easily,
unlike before, even if I run I don't get tired easily, now, it is gone, two or three, I
get tired easily, I am already catching my breath, climbing the stairs, it's all gone).

Also, work has been difficult for them because of the physical limitations imposed by the
after effects of cancer.

Bortezomib said that:

“dati kaya ko yan kahit halos, kung dire-diretso na 48 hours na magwork, na idlip
idlip lang in between, ngayon hindi na pwede, parang talagang magbabug down
na yung katawan ko, so yun, one is uhh talagang uhh longer na sleep dapat”
(Before I can work up to 48 hours straight, just naps in between, it is not like that
anymore, my body just can't handle it, one is uhh longer sleep is really needed)

It is not surprising that many people with cancer remaining at work throughout treatment
or
[37]
returning to work, experience troubles in managing their work, (Pryce, Munir, & Haslam, 2007).
Since one of their main concerns is their desire to go back to work, understanding the effects of
cancer and treatment on work performance is serious for the millions of cancer survivors actively
engaged in the workforce. Based on this information, more effective return to work policies and
measures can be developed by teams of occupational health professionals, oncologists, and cancer
survivors to address the adjustable environmental barriers, and improve the return to work process
for cancer survivors, (Nachreiner, Shanley, & Ghebre, 2013).
EMBRACING THE JOURNEY: LIVING WITH CANCER 36

They also experienced not having been recognized by the people they knew before because
of the change in physical appearance.

Folfiri shared:

“Ay ang hirap kasi alam mo pag nasa daan ka siempre kahit na ganun ka ng ganun
*waving gesture*(grabbing attention) sa kakilala mo, hindi ka makikilala kaya
parang ang sakit din ang sakit din kaya yung mga iba na nagmumokmok sila sa
loob” (It is so hard, you know when I am on the streets, even if I am waving at
people I know, they could not recognize me, it was so hurtful, I was so hurt, that's
why others prefer to stay inside their homes)

Experience of depression varies from one person to another rooting from different causes
with unique manifestations, (Smith, 2015). As nurses this tells us that cancer patients really need
acknowledgement, we can help them by being there for them during treatment, initiating small
talks to somehow help them to bring out emotions, or provide diversional activity so they won't
be preoccupied with negative feelings.

All changes not only those that are visible but also those that aren't as visible, such
[57]
as
feeling tired or exhausted, can make someone feel differently about themselves. These may
produce[57]some psychological distress, depending on the patient, their age, personality, gender and
culture. Some cancer patients may be more troubled by changes in appearance, while others may
be more troubled by changes in body function. This can cause changes in self-esteem, defining
factors that promise physical and psychological well-being, which can positively or negatively
affect how the patient deal with the disease and its treatment, (Da Mata, Faria, Chavez , Antunes,
De Silva, & Oliveira, 2016). As health care practitioners we should do more than just identify and
treat a specific disease. We should look into the various aspects be more holistic in creating a plan
of care to help patients reach their optimum level of wellness.

C. Help Seeking Behavior

Family, friends, co-workers, neighbors, health care providers and sometimes even
strangers: just a sample of the people who were part of a majority of the participants' lives. They
had provided support in different types and forms namely financial support, physical support, and
emotional support just to name few.

The presence of an adequate support system for cancer patients had been shown to be
effectual in decreasing the negative bearing of diagnosis and treatment and elevating psychological
well-being (Ell, Nishimoto, Mediansky, Mantell & Hamovitch, 1992). As noted with some of the
participant's statements and testimonies. While, some who were deprived thereof had experienced
feelings of distress, negative feelings to treatment and outlook. This implies a major role of those
composed in the support system along with the types of support they offer during the journey. This
is discussed more in depth in the following:
EMBRACING THE JOURNEY: LIVING WITH CANCER 37

Each and every cancer diagnosis inaugurates a distinctive experience,[32]


and the conduit
through treatment is a remarkable journey; at times a lonesome one. This remarkability, for the
participants had also required remarkable amounts of support from many remarkable people,
family, friends, support groups, cancer survivors and health care providers to name a few. The
participants themselves accentuated the key role of support systems in one's handling with cancer.
It is average for Filipinos to be communal and social, and this is particularly apparent in times of
must or emergencies (Licuanan, 1988).

`An integral component to the cancer journey is the presence of an adequate family support
system. The family has the potential to provide support that spans from emotional to financial
aspects and
[21]
can shoulder a magnitude of the struggle in effort to relieve burden from their affected
member. This kind of adequate family support in return has a positive impact on quality of life for
both the patients and their families (Su et al., 2017).

As articulated by Doxorubicin:

“Sa family- my family supported me. Lahat, oo. Emotionally, financially, grabe ang
support ng family” (The family- my family supported me. Everything yes;
emotionally, financially... Great is the support of my family).

Additionally, disclosed by Folfiri:

“Very important yung support ng family kung may sakin kang ganito…very, very
important”. (Very important, family support is; especially with an illness like
this…very, very important).

An adequate family support system motives and inspires action in response to trials,
treatments and burden. The manifestation or lack of family support strongly affects the cancer
patient's outlook of their disease and their will to fight on (Ng, Ong, Jegadeesan, Dean & Yap,
2017).

As verbalized by Rituximab:

“Linabanan ko para syempre yung effort nila hindi masayang; nilabanan ko ganun.
Parang give and take lang yan, at yung reward yun,[31]
survival, yun yung reward” (I
fought so that my family's effort won't go in vain; it's like that, give and take; and
the reward: survival).

Furthermore, support wasn't just limited to the immediate family but from those relatives,
clan and kin members. “Family” in this regard is defined as whomever the patient designates as
“family” and may include close friends or significant others. (Fineberg & Bauer, 2011).

As articulated by Siltuximab:
EMBRACING THE JOURNEY: LIVING WITH CANCER 38

“Where we come from, we call it bayanihan? Something like bayanihan but it's not likely
bayanihan, but the spirit is there. Within the clan na like, we agreed that when somebody
is sick we contribute *hand gestures in a circular motion* this much, mga ganyan. And I
saw it; you would be so touched *looks at the table* when you see, it was a list given to
me, the first list given to me by my mother…48 people na I don't know but they were part
of my clan. (Where we come from, we call it bayanihan? Something like bayanihan but it's
not likely bayanihan, but the spirit is there. Within the clan we agreed that when somebody
is sick we contribute *hand gestures in a circular motion* this much, mga ganyan. And I
saw it; you would be so touched *looks at the table* when you see. It was a list given to
me, the first list given to me by my mother…48 people that I don't know but they were part
of my clan).

Hand gestures are used to purposefully explain important points. In addition, Looking at
the table may indicate that someone is studying, thinking, or focusing about something.

“Bayanihan” is a Filipino word (from the word “bayan”, referring to a nation, town or
community, denotation a community spirit of union and teamwork that makes outwardly incredible
tasks conceivable through the resolute effort of numerous people working hand-in-hand on a
[8]
common goal (Stewart, 2014). Cancer's effects are not isolated to an individual. Instead, it has an
impact on the entire “family” and deserves a spot in every step of the journey. This implies greater
efforts towards collaboration of those health care providers with the families of those affected there
with.

The participants also expressed their feelings of having friends as part of their support
system and considered them as great help during their course of treatment. They were lightened in
a way that their friends gave them directions on how the participants should be dealing with cancer
and also, lightened because they were helped by their friends regarding on their workloads.

As Siltuximab said:

“She (friend) gave me the picture on how she experienced it, so I braced myself for
the worst, especially for the ano…the falling of the hair, the vomiting. So, binigyan
niya din ako ng How should you deal, what should be your diet *hand gestures in
a circular motion*, your disposition. She was a good reference. Source-person. I
needed it badly kasi iba yung binabasa mo, iba ‘yung naaano mo sa tao diba?”
(She gave me the picture on how she experienced it, so I braced myself for the worst,
especially for the falling of the hair, the vomiting. She also guided me on how
should you deal, what should be your diet *hand gestures in a circular motion*,
your disposition. She was a good reference, a source-person. I needed it badly
because the information that you get from what you read is different from what you
get from other people).

Hand gestures are used to purposefully explain important points.

In line with this, Jakafi also said:


EMBRACING THE JOURNEY: LIVING WITH CANCER 39

“Hindi ako nagleave… Continuous ‘yung work ko as clinical instructor… Very


thankful ako kasi ‘yung mga co-instructors ko din mga colleagues ko, pagka may
mga work, “(name) kami na gagawa sa'yo”, kapag ka-skills lab, “(name) kami na
ang gagawa para sa'yo”. Very supportive sila.” (I continued working as a clinical
instructor, I did not leave. I was very thankful to my co-instructors and to my
colleagues because they helped me on my workloads. They were very supportive).
[2]
Having friends made the participants be more prepared on how to face cancer. Their help
also gave a way for the participants to feel more at ease. In equating these findings to healthcare,
nurses could provide information regarding on the significance of having friends beside the cancer
patients by educating their significant others to invite the known friends of the patients. Informing
their friends directly as well by encouraging them to visit the cancer patients, to be with them, to
talk to them, and be sensitive with their needs.

The significance of having family and friends who could ‘just be there' all the way through
diagnosis, treatment and recovery were conveyed by the cancer patients, most especially because
they are benefited by understanding and empathy. They also expressed their desire to talk with
others willingly regarding on their emotional state and experiences, and wanted to gain
encouragement as well. Cancer patients also wanted a ‘practical support' from others,
predominantly with organizing appointments, domestic or home duties and in transport
(Richardson, Morton, & Broadbent, 2015).

Social support has been known as being an important aspect for health and, in particular,
for decreasing and even preventing cancer-related distress. This would include prevention of
anxiety,[14]
depression, and other psychological problems, which are commonly observed in cancer
patients. The presence of total social support from family, friends and[5]significant others had been
found to have a positive connection (Banovcinova & Baskova ,2016).

When it comes to the support groups the participants [5]


they belong with, comfort is what
they've found and this contributed to their social well-being.

This is in line with Streptozocin's statement:

“Kasi we believe na this is a support group that it will help one another sa bawat isa sa
amin. I feel comfort kasi lahat kami nagshe-share.” (We believe that this is a support group
that will help each one of us. I feel comfortable because all of us shares).

Doxorubicin also said:

“Syempre ang napagsasabihan ko lang ‘yung may cancer din na going through
kasi nagkaka-intindihan kami eh.” (Of course, I share to people who have the same
illness as mine, which is cancer, because we understand each other).
EMBRACING THE JOURNEY: LIVING WITH CANCER 40

Being part of a support group can be considered as a place where cancer patients can
find comfort which provides an exclusive opportunity for them to interact and share their own
knowledge and experiences with other people who have the similar situatio n.

One of the interventions that had been considered to improve cancer patients' psychosocial
well-being is their involvement in a cancer support group. In a comfortable social environment,
this had been identified to provide an exchange of not just emotional and social support but as well
as educational information for cancer patients. This also benefits the patients in a way that they
could cope with cancer by fine-tuning their knowledge, expectation, and attitudes about the disease
(Chou, Lee-Lin, & Kuang, 2015).

Sharing feelings
[4]
and experiences and as well exchanging information would be a benefit
from support groups. They can also be considered as a contributor in the quality of life of cancer
patients since they can be a potential source of emotional support (Nordner, & Ahlberg, 2006)
When it comes to healthcare providers, the participants considered them as helpful during
their course of treatment in a way that they provided motivation for them and support them during
their course of treatment.

As Nolvadex said:

“Buti na lang mabait ‘yung doctor… (Doctor)-“Bakit ‘yung ibang patients kong
60 years old kaya nila, kaya mo ‘yan”. Parang binibigyan niya ako ng motivation.”
(The doctor was good at me. He gave me a motivation in a way that he emphasized
that I can go through my illness since he had a 60 year-old patient who was able
to make it).

Jakafi also said:

“Nakita ko kila Dr. (name of the doctor) at Dra. (name of the doctor)… during my
treatment hindi ako iniwan, nandiyan sila very supportive din, their smiles, their
support, everytime na mag-aano ako.” (What I saw from my doctors is that they
did not leave me during my treatment, they were there, very supportive. They smile
and support me).

It would be beneficial if healthcare providers are knowledgeable regarding on the whole


course of the illness in order to provide adequate information on what are the impacts of the
treatment, what should be aware of and guide patients on how they would deal with the illness as
a whole.

Cancer patients wanted a psychological support in a form of having a face-to-face meeting


with a psychologist, what to expect from the disease were provided and as well as the strategies
that make it easier to cope (Richardson, Morton, & Broadbent, 2015).
EMBRACING THE JOURNEY: LIVING WITH CANCER 41

Support from significant others come in different forms. They could be Physical, emotional
or spiritual. According to (Goldberg & Rickler, 2011). Family caregivers function as advocates
and provide physical, emotional and financial support, frequently without any training, often
without recognition or support, and rarely with financial reimbursement. Many people living with
chronic illness could not live independently without family caregivers.

Due to the expensive treatments for cancer and inability to continue doing their jobs, it
made it hard for them to pay their bills. With the cost of treatment and different needs of cancer
patients, money becomes a necessity. This was observed when participants shared how their
families, friends, workmates, and acquaintances recognize this needs by providing financial aid to
them during the course of their treatment. During the interview, Jakafi was seen maintaining eye
contact, according to (Nelson, 2010) maintaining eye contact helps an individual to understand the
patients level of stress and eyes are highly expressive of emotions and Methotrexate was seen
smiling, according to (Harker and Keltner, 2001) smiles are not transient sparks of emotion but
rather clear windows into a person's core disposition and it expresses positive emotions.

Jakafi experienced this by stating:

"…Ang finances, from people whom we do not expect, *Participant maintains eye
contact* mga friends namin sa US, mga friends naming sa ano parang, (name),
magpapadala ako ng ganito, magpapadala, mga ganon, tsaka talagang hindi kami
namooblrema, hindi kami namomblema ng pera, every 21 days..." (…the finances,
from people whom we do not expect *maintains eye contact*, from our friends in
US, from our Friends it's like, “(name), I will send you this, They will send that,
and we didn't have a problem, we didn't have a problem regarding the money,
every 21 days…)

Methotrexate also stated this while smiling:

“…ang tumulong sakin friends ko from UP Baguio, nagcontribute sila…*smiles*


(…those who helped me are my friends from UP Baguio, they contributed…
*smiles*)

Finances are vital in having a disease like[41] cancer, having known the cost of the
chemotherapy and other methods of treatment. As implied in the statements of the participants,
getting financial support from the people who are significant like your family, friends, and even
from the people whom you did not expect to give an amount for your treatment can give such
impact in dealing with the course of cancer. Being surrounded with people who are willing to help
you in times you need it, is also a form of supportive care. It implies that not everyone who is
being diagnosed with cancer has the means to aid their treatment financially. Some can, but due to
the expenses and the interval of time during the cycle of the chemotherapy, it may not be enough.
This is where financial support from significant others and friends come very handy.
With these findings, the government can be a big help to the cancer patients regarding on
the financial burden that they are experiencing, they should allot funds and increase the financial
health care budget with allocations for cancer patients here in the Philippines in order for them to
EMBRACING THE JOURNEY: LIVING WITH CANCER 42

lessen their burdens especially those patients having a costly chemotherapy and other treatments.
They can create benefit packages to help address patients' needs that require longer hospital
confinement
[67]
and special treatment procedures.

Support also comes in the form of prayers. Upon knowing about the participants' diagnosis,
their family, workmates, and neighbors started to pray for them. According to the participants,
through the prayers of and with other people the perception of healing is achieved. Participant
paused during story telling. During the interview, Jakafi was pausing when telling the story.
[86]
According to (Siegman, 1978) It is usually assumed that anxiety arousal has a disruptive effect on
speech and that it is associated with an increase in the frequency and the duration of silent pauses
and Streptozocin was seen looking the interviewer. According to (Jors, Büssing, Hvidt, &
Baumann, 2015) through the prayers of other people it improves their physical health or state of
mind, disease management, decision-making, and can contribute positive experience of the disease
and also through prayers they think that it provides them protection, strength and hope.

As stated by Jakafi:

“…yung first chemo ko *pause* sinabi na ni Dra. “Oh (name), stage 2” my


husband is a pastor so parang yung encouragement niya, yung support niya,
nandoon, and he is always there praying for me…na sabi ko din “Lord kahit ano
pang stage ang ilagay ng doctor sa papel ko *pause*, sa diagnosis ko, I will still
believe in you…you are much…stronger, or you are higher than this cancer…”
(…in my first chemo *pause* my Doctor said “Oh (name), stage 2” my husband is
a pastor so it's like his encouragement and support was there, and he is always
praying for me, I said also that “Lord whatever stage that the doctor put on my
paper *pause*, in my diagnosis, I still believe in You… You are much stronger, or
You are higher than this cancer…)

Another participant, Streptozocin also added:

“…from God, of course, the people around me who really supported me. The
people around me who kept on praying me. The people around me who give an
assurance na… gagaling ka. *looks to the interviewers* And I take note with
that.. gagaling talaga ako… dami daming nagpost sa facebook ko mga assurance
mga nagsasabing I pray for you…” (…From God, of course, the people around
me who really supported me. The people around me who kept praying for me. The
people around me who give an assurance that I will be healed. *looks to the
interviewers* And I take note with that, I will really be healed…there are a lot
who posted on my facebook like assurances, and they told me "I pray for you"…)

This finding then implies that as nurses, we should accept acknowledge and respect the
patient's religious beliefs. Since most of the participants are Christians, we should also participate
in praying for the client together with the family and the relatives because it was seen that it really
helped them to have a sense of healing and it provides motivation. And also, it can enlighten every
individual to appreciate even the simplest concern that other people can give.
EMBRACING THE JOURNEY: LIVING WITH CANCER 43

During the course of their treatment, their family members, friends and relatives were
always there for them and took care of them. Through their efforts in providing care, it helped the
participants boost their self-worth and self-esteem in dealing with cancer.

During the course of the participants' treatments, their Family members invested the effort
to uplift them in dealing with cancer. During the interview, Rituximab was seen smiling, according
to (Harker and Keltner, 2001) smiles are not transient sparks of emotion but rather clear windows
into a person's core disposition and it expresses positive emotions. Nolvadex was seen nodding
her head during the interview. According to (Tarakanov, 2012) Head gestures reveal the way we
see things and how we feel about them. By simply doing head-nods show agreement and
understanding.

As Rituximab stated:

"… Wala. Doon nga ako nag kwan, nagbilib sa pamilya ko ta walang iwanan.
Talagang para akong bunso, baby ulet. Parang ganon ang feeling *smiles* Hindi
tulad nung iba na pinapabayaan lang, ako talagang asikaso ng pamilya. Walang
problema naman saakin na, kahit anong gawin ko okay lang sa kanila kasi ahhh
tawag na nun, parang baby talaga ah na.. anong sabi ko, ano nang tawag dun.
Parang baby na talagang asikaso talaga sila…" (...None. That's when I. It felt like
I'm the youngest, like a baby again. That's what I felt *smiles*. Not like the others
that they don't care anymore, my family takes care of me all the time. There's no
problem with me, anything that I will [31]
do is okay with them because ahhhh what do
you call that, it felt like I was a baby.. what am I saying, what do you call that. It
felt like I'm a baby that they take care of them all the time...)

And according also to Nolvadex:

“…nanjan sila lagi sa akin na pag sa hospital.*nods head*…sila ang nag aalaga
saakin… oo, sila yung naghahatid sa akin, hanggang sa radiation, sila ang
nagdradrive sa akin. Tapos yung nakakapagdrive din ako, pero hindi sila
pumapayag, so sinasamahan nila ako…” (…they are always there for me, when
I'm in the hospital, *nods head* they take care of me... they take me, until my
radiation, they drive me, when I can drive already they does not want to, so they
accompanied me…)

Participants have seen the support from their colleagues and friends during the course of
their treatment that boosts their self-worth and lessen their burden in dealing with cancer. Folfiri
was seen nodding her head and maintaining eye contact to the interviewer. According to
(Tarakanov, 2012) Head gestures reveal the way we see things and how we feel about them. By
simply doing head-nods show agreement and understanding and according to (Nelson, 2010)
maintaining eye contact are highly expressive of emotions.

Folfiri experienced this by stating:


EMBRACING THE JOURNEY: LIVING WITH CANCER 44

“…and then dinadalaw kasi ako ng friends ko. Yung mga talagang barkada na ano
dinadalhan ako ng kung ano ano. Oo *nods head*, andami kayang, alam mo nung
kwan, nung nagchechemo ako, ang daming nagdadala sa akin ng ano to, nung
leaves ng Guyabano, yung mga ganon. Talagang fruits. Dinadalhan ako kahit after
work nila kaya kung minsan may dumadalaw dun ng 7 PM para lang ibigay yun
*maintains eye contact* (…and then my friends visited me. The real friends who
bring me anything. Yes, *nods* there were so many, you know, when I was having
chemotherapy, many people were giving me those leaves of Guyabano, those ones.
Real fruits. They give it to me after their work that is why sometimes, they would
come late like at 7pm to give it… *maintains eye contact to the interviewer*)

And Jakafi also experienced this by stating:

“…hindi ako nag leave…continuous yung work ko as a clinical instructor…Very


thankful ako kasi yung mga co-instructors ko din mga colleagues ko, pagka may
mga work, “(name) kami na gagawa para sayo” kapag ka skills lab “(name) kami
na ang gagawa para sayo” very supportive sila…” (...I did not leave, my work as
a clinical instructor is continuous…I'm very thankful that my co -instructors and
my colleagues, if there's a work “(name) we will do it for you” if it is skills lab
“(name) we will do it for you” they are very supportive...)

Participants acknowledge the presence of Healthcare providers in taking care of them that
helps uplift and boost their self-worth and self-esteem in dealing with their cancer. According to
(Furler, et al., 2008) Social circumstances and emotional responses infuse the perceptions people
have of their condition, and this was linked to the way they care for and manage it, particularly
concerning diet and physical activity. This implies that the role of health care professionals can
play a big part in supporting patients' care. Jakafi was seen laughing while telling the story.
According to (Lickerman, 2011) by being able to laugh at traumatic events in our own lives doesn't
cause us to ignore them, but instead seems to prepare us to endure them.

Jakafi experienced this by stating:

“…kasi naexperienced ko kay dra (name of doctor) na during the course of my


treatment talagang andoon siya… Ang ginagawa din ni dra is binigyan ako ng
valium pampatulog bago nila ilagay yung ano ung treatment ko so binabantayan
talaga ako ni dra. Hanggang makatulog ako…” *laughs* (...what I've experienced
to my doctor, during the course of my treatment she is still there... what my doctor
did was, she gave me Valium to sleep before they put my treatment, so my doctor
stayed with me until I fall asleep…*laughs*)

And Rituximab also stated that:

“Ay dun ako bilib! Asikaso naman. Walang problema… Pati nurses. Talagang
kung may sakit kang cancer talaga, kailangan mo talagang pagtuonan siya ng
EMBRACING THE JOURNEY: LIVING WITH CANCER 45

atensiyon…” (...that what I admired! When they provide care. There's no problem...
also to nurses. When you have cancer, you are needed to have close attention to...)

With this finding, it tells us how family support is so imperative in uplifting the patient's
spirit. According to (Given, Given, & Kozachik, 2001) Support from health care professionals,
family, and friends can help family caregivers expand their capacities to respond to care demands
for patients. The goals of support should be to enable family caregivers to maintain the patient's
[91]
comfort and enhance the patient's quality of life. As nurses, we should encourage the families and
relatives to participate in the care of the patient, even the simplest things like accompanying them
to the hospital was seen to have a significant impact on the client's feelings. As members of the
Health Care Team, this tells us that we should not overlook the other aspects of caring for patients.
A holistic and humanistic approach should be given, being concerned and appreciative of their
feelings, talking to them, and just being there during the treatment showed a good impact in
uplifting their spirit.

In the time when the participant is feeling down, their family, friends, and relatives emphasized
and gave them words of encouragement during their course of treatment, through this, it helps
them to continue fighting for cancer. According to (Furler, et al., 2008) Emotional states and their
link to health are an essential focus of research into healthcare from a sociological perspective as
well as increasingly seen in clinical research. They explored how the understanding regarding the
emotional needs of a patient can be an essential element in ensuring that health professionals
provide appropriate support to patients despite the evolving progression of living with an illness.
What their study offers is to have the act of strengthening emotional states potentially from the
critical context and element of any patients approach in managing their illness as well as a tentative
interpretation showing how cultural context may be relevant within that. Adriamycin was seen
laughing while telling the story. According to (Lickerman, 2011) by being able to laugh at
traumatic events in our own lives doesn't cause us to ignore them, but instead seems to prepare us
to endure them and Nolvadex was seen smiling while telling the story. According to (Harker and
Keltner, 2001) smiles are not transient sparks of emotion but rather clear windows into a person's
core disposition and it expresses positive emotions.

This was experienced by Adriamycin, stating:

"…sa 3rd na chemo nanaman di ko kaya. sa mga anak ko parang ganon parang
sila din nagmomotivate saakin na "ma kaya mo yan oh tapos na yung dalawa tatlo
nalang parang ganon" kaya mo yan so parang naisip ko naman nalalabanan ko
din minsan kahit super nanghihina na ako... *laughs*" (During my third
chemotherapy, I couldn't do it. My children are the ones motivating me like, “Mom,
you can do it, you did 2 already, 3 more and you are done” *laughs*)

Additionally, Jakafi stated that:

"…pero dahil sa napaka supportive, parang nagpopoisitive ako, "parang kaya mo


yan, kaya mo yan, isipin mo lang yung mga anak mo maliliit pa sila, and you are
still young, God knows whats best for you…" (But because, they were very
EMBRACING THE JOURNEY: LIVING WITH CANCER 46

supportive, I was positive myself, it was like “I can do this, I can do it, just think
about your children, they are still young, God knows what is best for you”)

And Nolvadex added that:

“Full support naman sila *smiles*, alam ko naman na nandoon din yung fear
nila…theres no so much love there's still so much love kaya parang be strong
andiyan kami suportado kapatid ko andiyan din…” (...they have the full support
*smiles*, I know that their fear is there...there's no so much love there's still so
much love to be strong we are here, supporting you, my sibling is there also...)

Through other people's words of encouragement, it can boost every person's self-esteem
who gives them the reason to be strong because a person will not know who cares for them until
they experience to face the inevitable and survive it. Through words of encouragements from
others, it lets them not to give up and to continue fighting for cancer. With this finding, we can see
that words of encouragement, though verbal only, can change how a patient feels about themselves
and about the situation they are into. As members of the Health Care Team, we should be
therapeutic as much as possible and we could use also the Carative Factors of Jean Watsons when
interacting with cancer patients here are some ways that we could use as health care providers,
first is that, we should be authentically present and have a sustaining deep belief system and
subjective life world of self and one-being care for. Second is that, we should develop and sustain
a helping-trust and authentic caring relationship. Lastly, we should be present and supportive to
them especially our expressions of positive and negative feelings (Watsons, 2008).

D. My Frustrations

Social support systems are seen as a vital element in the undertaking of their journey and
act as reinforcement to the partaking in health practices. Contrariwise, those
[101]
who experience the
lack or absence of support may experience distress, and negative feelings. A lack of social support,
coping methods, and aspects of care such as poor communication with physicians, function as
factors to poorer ratings of quality of life or an individual's assessment of his or her own general
well-being (Mandelblatt et al., 2003; Ganz et al., 2003b, Avis et al., 2005).

As enunciated by Methotrexate:

“Kasi inexpect ko nga, inexpect ko na tatawagan nila [the family] ako, tutulungan
nila ako financially, kakamustahin nila ako emotionally and then wala yun. (I had
expected my family to call me, to help me financial to check on me emotionally but
no, none of that appeared).

In addition to that Bortezomib articulated:

“Pag yung trust mo asa tao… It will fail you, madedepress ka lang. Kung hindi
nangyari yung gusto mo or yung inaasahan mo sa support…madedepress ka lang”
(If your trust is with people… It will fail you, you'll only get depressed. If what you
EMBRACING THE JOURNEY: LIVING WITH CANCER 47

want doesn't
[1]
happen or when the support you want is not delivered, you'll only get
depressed).

Henceforward, for those providing health care to the patient, it is imperative to recognize
family relations during the course of the illness and to deliver information about how or in what
way can they improve and preserve adequate family support and functionality.

Another integral part of the cancer


[32]
journey is the health care providers (HCP) and their
involvement in their treatment. These health care providers (HCP) utilize systematically developed
evidence-based clinical practice
[101]
guidelines, assessment tools, and screening instruments (Hewitt,
Greenfield, & Stovall, 2006). However, a majority of the participants felt the care delivered were
lacking and non-holistic.

As enunciated by Bortezomib:

“I think it's really important na iassess muna nila yung, parang hollistic ba? Na
sitwasyon nung tao bago mo irecommend for whatever recommendation kasi ang
isang tao na may problematic ang pamilya, hiwahiwalay, wala ka namang
makikitang talagang magaalaga sakanya irerecommend mo parin siya ng
treatment? Or financially talaga hindi naman kaya, irerecommend mo parin siya
ng treatment, you're just adding burden” (I think it's really important to assess
first- the holistic aspect? To assess the person before you recommend for whatever
recommendation, because a person that has problems with family, who are
separated; you can't really see anyone who can take care of them and you'd
recommend treatment? Or financially, they cannot handle it, you'd still recommend
treatment? You're just adding burden.)

It can be said that, as every patient is diverse, cancer care has to be custom-made to each
patient based on a holistic needs assessment (Ng, Ong, Jegadeesan, Dean & Yap, 2017). If not,
could result to health care system distrust and ultimately lower adherence to care and treatment
(Yang, Mathews & Hillemeir, 2011). This implies further reevaluations of screening instruments,
assessments tools and overall approaches to health care or treatment deliver.

II. Finding Meaning in the Journey: Living with Cancer

The meaning of the entire experience is the amalgamation of all the feelings, lessons
learned, regrets,
[32]
and conclusions of the participant going through the journey of cancer. It is the
culmination; the consummation of the total experience going through cancer as they endure a
legacy of physical, psychological, social, vocational, spiritual, and economic consequences.

A. Living a purpose driven life

Subsequent to the participants' expression of frustrations, they have found the purpose of
living their lives. A strong perception of meaning in life leads to significantly higher mental well-
being and physical health, (Tsipursky, 2016). In this stage, it was shown how the participants were
EMBRACING THE JOURNEY: LIVING WITH CANCER 48

able to find a new purpose, how they recognized the value of life, the need to spread awareness
about cancer, and how they lived their life as an instrument in helping others.

The participants have been observed to raise the value of life. Knowing that to have cancer
is a very critical event in anyone's life, the[16]
participants were observed to have recognized the value
not only of their lives but also of others'. Value of life differs both within a single life (in different
periods or possible situations) and between
[16]
lives (lives that vary in length, health or even physical
maturity are not all equally fulfilled). As with any other form of human expansion,[16]the value of
life-and-health must be distinguished from the moral importance of human beings: less fulfilled
means not less important morally, but more in need of being fulfilled, (Watt, 2015). Most types of
cancers are life-threatening, (Ramsey & Schickedanz, 2010), which prompts us to value our life
more. In the case of the cancer survivors, they have seen the purpose of life which enhanced its
meaning to them.

According to our participants who realized the value of life, (Doxorubicin):


“But when you are diagnosed, kung mayroon kang pinagdaanan, you will never see
life [the same] again. The lives of others are also important, uhh para saakin just one
life ibigay ng Panginoon every day and make a difference sa buhay ng iba… uhh yung
natutunan ko ng how many years sa buhay ko at yung natutunan ko nitong 9 years na
nadiagnose ako mas marami pa. Mas sobra sobra yung natutunan ko, and to really
*close eyes* live life na yun nga sinasabi nila to the fullest, but to the fullest with a
purpose… but when I got cancer it taught me na hindi pala ganon ang buhay yung
ganon lang, hindi lang ako, the life of other people are important too as I'm as
important as my life.” (But when you are diagnosed, if you have gone through
something, you will never see life [the same] again. The lives of others [5]
are also
important, for me there is just one life that our Lord gave us, [with that] you should
make a difference in the lives of other people every day…uhh I have learned for how
many years in my life, and what I have learned for this 9 years that I have been
diagnosed were increased. There were more I learned, and to really *close eyes* live
life that as they say to the fullest, but to the fullest with a purpose… but when I got
cancer it taught me that life is not just like that, the life of other people are important
too as I'm important as my life.)

As noticed in the interview, with our participant (Doxorubicin), there was the part where the
participant's eyes closed. In relation with the article entitled: “Eyes body language” by Changing
minds.org (n.d.), Visual thinkers may also close their eyes, sometimes when talking, for them to
have a better vision of the internal images without external distractions.

In accordance to an article entitled: “Meaning in life and pain among breast cancer patients”
by Anand (2014), it revealed that when the breast cancer patients have purpose and values in life,
sense of efficacy, harmony, peace, faith in God, and spirituality, and feel them as good and worthy
persons, they would protect themselves against meaninglessness which also helps them to manage
their other psychological problems. The statements of the participant convey that having gone
through the course of cancer became a way of realizing the value of life in the context of theirs
and the life of others.
EMBRACING THE JOURNEY: LIVING WITH CANCER 49

Awareness and early detection of cancer generally increases the chances for informed
discovery and successful treatment by focusing on detecting symptomatic patients as early as
possible. Awareness and early detection can inhibit the accumulative load of the ailment and is the
initial step in the fight counter to cancer, (Dey, et al., 2016). Knowing that information, the
participants are inclined to share lessons from their own experiences, struggles and learning.

As enunciated by Doxorubicin:

“So ang ano ko sa kanila is really magkaroon ng awareness sa atin especially here
in the Philippines kasi nga ayaw nga pag-usapan ang cancer, parang, “Ay hindi
pwedeng pag-usapan yan kasi parang nakakatakot na pag-usapan”, pero hindi,
kailangan siyang pagusapan” (So my part to others is really to create awareness
especially here in the Philippines, no one wants to talk about cancer, for example
“Ay, talking about that isn't right because it's scary to talk about it”, But no, we
need to talk about this).

According to Grande et al. (2015), persons with a prior diagnosis of cancer are eager to
share their health information due to the reason that they consider the purpose of future reuse of
that information as the most important determinant of their willingness to share. This implies that
even more people would be encouraged to share what they know and correct preconceptions,
additional it may also imply a need for more outlets to share awareness throughout the Philippines.

After the realization of the need to spread awareness, the participants knew what cancer
meant for them. This was discerned when the participants became a tool to help others who are
experiencing the same situation that they have faced before. Being able to help other people who
are undergoing the same situation as you did before can ease them and make them feel better about
what they are going through. Engaging in altruistic acts may allow us to find gratification because
it helps us improves our relationships with others, (Hopper, 2016). Doing the right thing for others
means helping those who are in need. Being with them equally in solidarity is important too rather
than behaving in a predominant position, (Plante, 2009).

According to Jakafi:

“Nagkaroon na ako so naging way na itong *pause* itong pagkakaroon ko ng cancer


saakin to reach out sa mga cancer patients *smile* so everytime na nandoon ako sa
hospital when I see cancer patients or when I, when we have cancer patients na
ipapahandle ko sa mga students ko yung rub ko palang sakanila *taps shoulder of the
interviewer* (giving attention to the interviewer) or [by saying] ‘you want me to pray
for you?' or ‘you know kaya mo yan kasi napagdaanan ko yan' so naiintindihan
naming yung mga ano mo yung mga emotions mo yung mga ano mo, so parang mas
nakaka, nakaka minister ako or mas nakaka help ako sa patient kasi nararamdaman,
naranasan ko na eh. So pag sinabi nilang ‘yes pwede mo ba akong ipagpray', so
pinagppray ko sila parang na aano sila so very meaningful siya sa career ko sa ano
sano ko as a nurse kasi mas oo, mas nakakareach-out ako sa mga patients parang
EMBRACING THE JOURNEY: LIVING WITH CANCER 50

ganon *laughs*,” (“I already had [cancer] so that became a way *pause*, this
experience of mine having cancer, to reach out to other cancer patients *smile* so
every time that I'm there at the hospital when I see cancer patients or when I, when we
have cancer patients that I'm going to let my students handle, my rub to them *taps
shoulder of the interviewer*
[3]
(giving attention to the interviewer) or [by saying] ‘you
want me to pray for you?' or ‘you know you can do it because I have also gone through
that' so we can understand the, your emotions, so it's like, I can, I can minister or I
can help the patient better because I can feel, I already have gone through it. So if they
say, ‘yes can you pray for me', so I pray for them, it's like they [feel inspired], so it's
very meaningful for my career as a nurse, because yes, I can reach out to patients
more, like that. *laughs*)

Doxorubicin also added:

“*Looks at ceiling* And then sabi ko, ‘Lord, uh if you have put me in this situation,
uh, for me to really uh, relate with these people na may ano ding same, same ano
disease as me, help me to start a support group, *moves hand in circular motion*
nagstart siya as counseling lang siya… I thank that experience because I believe na
nagagamit siya
[7]
to really give hope naman sa ibang tao, uhmm yun yung aking cancer
experience.” (*Looks at ceiling* And then I said, ‘Lord, uh if you have out me in this
situation, uh, for me to really uh, relate with these people that has the same disease as
mine, help me to start a support, *moves hand in circular motion* it started with
counseling… I thank that experience because I believe that it can be used to really give
hope to other people, uhmm that was my cancer experience.)

In addition, Streptozocin said:


[11]
“Thank you Lord! Because you allow this to happen to me and I believe na ito rin
yung makakatulong sa akin to help others also.” (Thank you Lord! Because you allow
this to happen to me and I believe that this can also help me to help others also.)
[35]
As observed in the interview of our participant (Jakafi), the participant smiled. According to
the article entitled “What does your smile say about you?” by Barker (2012), the smile of a person
is the simplest, straight forward, and most importantly, most sincere gesture he/she can make. With
our participant (Doxorubicin), the look at the ceiling and moving hands in circular motion were
noted. According to the article entitled: “Head body language” by Changing Minds.org (n.d.),
looking at the ceiling or raising the head may also indicate a visual thinker who is looking at
internal images. Also, in accordance with the article entitled: “Your hand Gestures Are Speaking
For You” by Weinschenk (2012), hand gestures that are larger than the outlines of the body means
it communicates a large idea or concept.
[6]
In accordance with the article entitled: “Breast Cancer Survivors' Contribution to
Psychosocial Adjustment of Newly Diagnosed
[6]
Breast Cancer Patients in a Computer-Mediated
Social Support Group” by Moon et. al, (2017), results revealed that, compared with newly
diagnosed patients, breast cancer survivors were able to provide more emotional and informational
EMBRACING THE JOURNEY: LIVING WITH CANCER 51

[6]
support. Receiving emotional support from survivors contributed to an improvement in the quality
of life and the depression of patients. The statements of the participants implies that having and
going through the course of cancer can be a way to understand more and to help the cancer patients.
Being of service to other cancer patients/survivors may also serve as an inspiration for them to
thrive. It gives help to others without anything in return.
[ 3 ]
B. Interpersonal Transcendence

At this stage, the participants were able to develop a new perspective in relating with others,
find their inner strengths, and develop new ways to be healthier. Meaning mindset portrays a
pivotal perspective change from a success orientation to a meaning orientation that advances the
discovery of meaning, (Wong, 2016).
[3]

Subsequent with being a medium to help others, the participants were able to enhance a
new outlook in connecting with other people. Self-transcendence is the ability to expand one's
relationship with other people and the environment. It has been found to provide hope and meaning
which helps a person to cope and adapt with illness, (Haugan, Moksnes, & Lohre, 2016).

According to Doxorubicin:

“Andami talaga tinuro ng aking journey saakin, right now I have become more
patient sa mga tao, hindi *shakes head* ko sinasabi, hindi ako nagagalit, kasi
plastic naman, hypocrite naman ako *raises eyebrows*. Nagagalit ako, pero hindi
na ganun, pag nagagalit ako, tinitignan ko siya…ganon sya and kaya nga sabi ko
ang tingin ko kung may nagsusungit sakin may pinagdadaanan siya.” (There are a
lot of lessons taught to me by my journey, right now I have become more patient
with other people, I'm not *shakes head* saying that I'm not getting mad because
it's being “plastic” [fake] or being a hypocrite *raises eyebrows*. I get mad but
not the same as before, if I get mad, I just look [at the person]…it's like that, that's
why I said if someone is grumpy at me, there must be something she is going
through.)

As observed in the interview, Doxorubicin shook her head and raised her eyebrows.
According to the article entitled, “Head body language” by Changing minds.org (n.d.),
turning the head from side to side usually implies disagreement or disapproval and it can
also mean an encouragement for the other person to agree. Raising eyebrows may convey
asking for attention from others and can signal general emphasis; it can also mean a
submissive move or imply openness of a person when communicating.

This was also experienced by Bortezomib:

“It's really an eye opener for me na nakita ko yung mga ganyan, na experience ko
so the more parang mas maiintindihan ko na nga yung mga may sakit… when I
went through cancer parang naintindihan ko na it's hard parin, it's, it's, hard, and
kung ikaw yung magtetake care you should take into consideration yung talagang
EMBRACING THE JOURNEY: LIVING WITH CANCER 52

emotional strength nung tao.” (It's really an eye opener for me when I thought of
my experiences so the more that I had the understanding for the people who are
sick… when I went through cancer, I understood that it's still hard, it's, it's hard,
and if you will be the one who will take care, you should take into consideration
the emotional strength of the person.)

As observed in the interview, Doxorubicin shook her head and raised her eyebrows.
According to the article entitled, “Head body language” by Changing minds.org (n.d.), turning the
head from side to side usually implies disagreement or disapproval and it can also mean an
encouragement for the other person to agree. Raising eyebrows may convey asking for attention
from others and can signal general emphasis; it can also mean a submissive move or imply
openness of a person when communicating.

In conformity with the article entitled: “Intrapersonal Self-Transcendence, Meaning-in-


Life and Nurse-Patient Interaction: Powerful Assets for Quality of Life in Cognitively Intact
Nursing-Home Patients” by Haugan, Moksnes, & Lohre (2016), both interpersonal and
intrapersonal self-transcendence have an effect not only emotional, social and spiritual well-being,
but functional and physical well-being. Interpersonal aspects, such as relationships with friends,
family and the nurse–patient interaction, also affect self-acceptance. The statement of the
participant implies that the way how other people communicates with other people, i.e., the cancer
surivors, has something to do with what they are going through. They were able to have more
understanding on why other people act the way they do.

Behind the experiences of developing a new perspective in relating with others, the
participants were able to find the strength within them in battling cancer. Inner strength has been
defined as a quality that has an outcome on one's ability to solve problems or surmount obstacles.
It involves a method of examination of self, a relationship with others, which can serve as a
resource that can be used, (Dingley, Roux & Bush, 2000). It is also essential in battling a disease
like cancer.

As experienced by our participant, Methotrexate:

“Saakin na yun either talunin ka or talunin mo. Palagi ko ring, kasi yun nag -
iinspire sakin na pwede pala, pwede mo pala siyang talunin” (“For me, [cancer]
can either defeat you or you choose to defeat it. I always, because that's what
inspired me- that it [cancer] can be defeated.)

Adding to that (Rituximab) stated:

“*Lowers voice* natutunan yung kwan stay strong fight ganun labanan. Labanan
ang problema ganun.” (*Lowers voice* I learned to stay strong, and fight. Fight
the problems.”)

During the interview of Rituximab, the lowering of voice was noted. According to
the article entitled, “The Body Language of Voice: Use Your Voice to Your Advantage”
EMBRACING THE JOURNEY: LIVING WITH CANCER 53

by Flachman (2013), emotional state of people affects the pitch of voice; a soft, soothing
and subtle tone of voice implies delight or pleasure.
[4]
In accordance with the
[4]
article entitled: “Intrapersonal self-transcendence, meaning-in-life
and nurse-patient
[92]
interaction: powerful assets for quality of life in cognitively intact nursing-home
patients” by Haugan, Moksnes, & Lohre (2016), a vital aspect of hope among older individuals
inner strength has been associated with connectedness, firmness, flexibility, creativity, a sense of
competence in oneself yet having faith in others, accepting both the light and the dark side of life,
and being the same person yet growing into a new garment. The statement of the participants
implies that they have perceived cancer as a battle that you have to be prepared for. They also
convey the importance of having strength if one wants to achieve the goal of winning over cancer.
[7]
There were realizations that emerged after the whole course of cancer. One of it is the
lifestyle change. This realization paved a way to improve well being of the cancer survivors. Such
reports include engaging to relaxation[12]activities, giving enough rest to self, eating nutritious food,
and mainly caring and loving for self.

This is in line with what Methotrexate said:

“You learn to relax, to enjoy life ganun. Para may rest period ka, ganun. Wag
masyadong tinitipid ang sarili, mga ganun. ‘yun basically that's it. Kasi we work
to spend money, spend for your medications, relaxation, magpa-spa ka, magpa-
massage ka. Lalo na ako kasi malaki ako physically. I'm being, hindi ako active...
Pero ‘pag weekly ka nagpapamassage at least ‘ung circulation ng blood tapos
narerelax ka pa, naapreciate mo ‘yung life, nag-iiba ‘yung mind set mo. Feeling
mo naalagaan mo ‘yung sarili mo ganun.” (You learn to relax, to enjoy life so that
you will have a rest period. Do not limit your budget to yourself, because we work
to spend money, spend for your medications, relaxation, have a spa, have a
massage. Most especially because I am physically big, I'm not active… But when
you go to a massage every week, it would be good for your body circulation, and
you'll be relaxed as well. You'll be able to appreciate your life, your mindset
changes. You'll feel that you're able to take care of yourself.)

Neomycin also said:

“You learn to love your body. Parang you respect ‘yung katawan mo by, in the
past naging abuso din ako sa katawan ko kasi *pause* (allotting time time think of
what to say), kaya parang ngayon, um, ‘yung kinakain ko na lang ‘yung mga wala
ng junk food, wala ng softdrinks, wala ng *pause* (allotting time time think of what
to say), wala ng alak, wala na ring sigarilyo, ayun, pero ‘yung abuso din sa
trabaho, ‘yung katawan sobrang pagod. Workaholic kasi ako.” (You learn to love
your body. You respect your body by, in the past I also abuse my body *pause*
(allotting time time think of what to say), so it seems like today, I'm no longer eating
junk food, no more softdrinks, no *pause* (allotting time time think of what to say),
EMBRACING THE JOURNEY: LIVING WITH CANCER 54

no alcohol, no cigarettes, but also when you abuse yourself due to work, your body
will get tired as well. It's because I'm workaholic.)

The health care providers should then give them health teachings regarding healthy
lifestyle. In line with this, the government, specifically the Department of Health (DOH), can also
promote programs that could educate greater number of people regarding the importance of diet,
physical activities and relaxations to prevent illnesses.

Cancer survivors tend to give more importance to their body and learned how to appreciate
life after surpassing cancer. These realizations led them to adapt consistently to a healthy lifestyle.
They changed their usual food contents, abstained from tobacco, and managed emotional problems
that were caused by the disease,(Shiow-Luan, Wang, & Kuan, 2017).

Their change of perception helped them develop their well-being and it made them more
efficient in doing so. Reports from cancer survivors mainly focused on improving physical,
spiritual, and emotional well-being. There were also reports in the context of improving diet or
physical activity and reduction in alcohol use or stress due to the desire to prevent reoccurrence of
the illness and the belief that cancer will have more severe consequences, (Costanzo, Lutgendorf,
& Roeder, 2011).

C. Gratitude to Higher Being

Filipinos have achieved strength from a widespread assortment of religious practices and
outlooks to assist them in handling day-to-day trials and adversities, (Gonzalez, 2009). Their
spiritual faith incorporates a plethora of formal and informal opportunities for pursuing God's aid,
supervision, and miracles. Actions comprises of everything from private petitions and prayers to
community processions, (Mulder, 1997). For numerous Filipino Christians, a prayer or request
granted by the Lord, would invoke gratitude and thanksgiving.

Doxorubicin discloses,

“Hindi ko maiput into words yung goodness ng Diyos saakin, kasi yung mga
nakasabay ko maraming namatay. Actually when I was diagnosed dahil very
aggressive yung cancer cells… two years, I was only given two years, but actually
yung two years na yun, sabi ko- I even thank the Lord because two years is very
long” (I cannot put into words the goodness of the Lord to me, because the other
cancer patients who were with me had died. Actually I was diagnosed because my
cancer cells were very aggressive… two years, I was only given two years, but those
two years, I said- I even thank the Lord because two years is very long).

The heightened feelings of faith and spirituality create room for gratitude and appreciation
as they connect their struggle to a higher being. It can be seen as comprising elements of meaning,
purpose, and connection to a higher power or something greater than the self (Targ & Levine,
2002).
EMBRACING THE JOURNEY: LIVING WITH CANCER 55

As verbalized by Bortezomib:

“A reflection talaga, whether naniniwala ka sa Diyos, hindi ka naniniwala sa


Diyos, tignan mo yung situation mo. And kung wala ang Diyos, parang so for what
yung magiging yung life mo kung wala talagang Diyos” (A reflection, whether you
believe in God or don't, look into your situation, if there isn't a God, then what will
become your life if there isn't a God.)

Cisplatin also mentioned:

“Sa panginoon nalang ako, total nakita ko naman ang buhay talaga, si Panginnon
talaga ang number 1 nagbibigay ng buhay natin”(I'd rather be with God since I
saw that in life, God is the number 1 who gives us life.)

Subsequently, leaning on faith is something that most people do in times of difficulties


especially Filipinos, for it somewhat makes them feel better. As evident to a study in which they
concluded that faith and life purpose were both found to foresee well-being significantly. This
suggests that belief and life purpose contribute to the progress of welfare and may be essential
characteristics to promote to enhance one's sense of well-being, (Byron & Miller-Perrin, 2009).

The participant Bortezomib notably stated:

‘' Uhh well actually I don't think you really get over yung sickness taalga na cancer
but umm you just go through, you just go through it uhh well thankfully sa akin
umm na di ko naman masasabi that I'm cancer-free. Uhh but uhh even going
through yung medication and yung yun nga yung effects ng medications, uhh that
uhh I could still continue with yung life parang normal parin, yun yung ano ko, well
I have other people na hindi ganun ang sitwasyon so it's still ano parang sa akin I
see na I've been blessed.'' (Well I do not think that you really get over cancer but
you just go through, you just go through it, well thankfully in my part I cannot say
that I'm cancer free but uhh even going through the medication and the effects of
the medications, that I could still continue with yung life that it still seems normal,
well I have other people that is not in the same situation as I do so it's still, for me
I see that I've been blessed.)

Bortezomib further added:

"Yung moments na maganda yung pakiramdam mo yun yung ano na uhhm most of
it I spent talaga in prayer and in talagang tinitignan ko yung life ko in the past and
comparing sa kung ano yung talagang uhh is it a line yung sa will ni God yun yung
ano kaya sabi ko well, ito- kasi before that I had been very busy nga and even yung
spiritual life ko was neglected, so isang nakita ko talaga yun na wow it's uhh you
know wakeup call na you have to stop muna parang ganun parang inistop ako ni
God and then para makita ko Siya lahat ng gusto Niya.'' (Most of the moments
EMBRACING THE JOURNEY: LIVING WITH CANCER 56

when I feel good I spent it on prayer and if I really look on the life that I had in the
past and compare it in line with the will of God, because before I had been very
busy and even my spiritual life was neglected, so one thing that I saw is it is you
know wakeup call that you have to stop for a bit, it seems like God stopped me in
order for me to see Him and everything that He want.)

For some cancer patients, faith helped them in their journey to cope. In one study entitled
“Spirituality Self-care Effects on Quality of Life for Patients Diagnosed with Chronic Illness”, it
concluded that spirituality is integrated through all aspects of a life of a chronically ill patient,
including health practices that influence their health beliefs and health outcomes that can then
affect their self-care practices, (White, 2013). It is in the part of health care providers especially
nurses to give holistic care, and one component of holistic care is spirituality, and it is their duty
to promote spiritual care as long as it does not harm the patient the nurse help the clients meet their
spiritual needs.

D. Fear of Recurrence

Cancer patients who already survived cancer still have fear in mind, which is fear of
recurrence.

According to Methotrexate:

“May konting fear, kasi alam ko rin na posibleng magmetastasize.” (I have some
fear, because I know that there is a possibility to metastasize.)

Rituximab also shared:

“Ay nako sana di na maulit grabe di na sana bumalik kasi grabe yun may tendency
na bumalik kaya[35]
ayaw ko na bumalik kung tutuusin ayaw ko nang balikan yung
mga nangyari.” (I hope it will not happen again, I hope it will not recur because
there may be a tendency that it will recur, I don't want it to recur, I don't want to
go back to what happened.)

In accordance to the journal “This too shall pass: A Grounded Theory Study of Filipino
Cancer Survivorship”, the participants also shared the process that they have experienced after
knowing about their full recovery from cancer. Though they were sure that they were fully healed,
the thought of possible recurrence was always in their minds, to the point that they feel they still[2]
suffer the condition. This is termed as the trembling stage of cancer survivorship, (Guzman et al.,
2013)

Some survivors have the fear of recurrence, but with the thought of them being able to
survive cancer, they were more confident that they will be able to survive cancer the second time
around if ever it might recur, and they will be more knowledgeable about what to do.

As Siltuximab said:
EMBRACING THE JOURNEY: LIVING WITH CANCER 57

“What happens if it recurs *eyebrows meet*, what will I do? Uh yes, I fear that it
will comeback, uh but then not too fearful because uh like I think I know what to
do.”

The journal “This too shall pass: A Grounded Theory Study of Filipino Cancer
Survivorship” says that however, it is also important to comprehend that because a person has
already gone through the whole experience of having cancer, he will more probable be at ease
toward facing the disease the second or even third time around. As one respondent exemplified,
“When I had my recurrence, of course I was scared, but not as scared as before. I was surprised,
but I was more equipped with knowledge the second time around. Plus, I have my family, my
friends, and my support group with me, so it was definitely easier for me to accept and survive
once again.” (Guzman et al., 2013)

Cancer survivors, not because they already survived cancer, should still be given proper
attention and support because they still fear recurrence. They must be well knowledgeable about
what things are needed to do for cancer not to recur and what to do when it recurs.
[ 8 5 ]
E. Effects of Treatment

There are many types of cancer treatment. The types of treatment that cancer patients have
to undergo, will depend on the type of cancer that patients have and how advanced it is. Hence,
the effects of treatment will also depend on this fact. Nausea, vomiting, difficulty sleeping,
memory and concentration problems, feelings of not coping generally with treatment and feelings
of dejection just to name a few of the effects has the potential to affect mental and physical aspects
of the patient undergoing treatment, (Coates et al., 1983) contributing to and and influencing the
participants' outlook on the treatment and journey itself.

In the process of facing cancer there are different outcomes that cancer can bring about.
One of the most difficult stages in which the participant had gone across is an unfavorable
experience regarding limited resources. The participants admitted that they had challenges
obtaining finances. Financial strain often contributes to families' load during a time when many
already are experiencing severe stress, (Klimmek, Snow, & Wenzel, 2010).

As mentioned by Rituximab,

"Parang gusto kong tama na parang wala na atang wala na ata tayong budget [13]
kako pano in the future kako pag nagchechemo ako wala din lang namang silbi" (It
feels like I don't want to continue anymore, it seems like we don't have the budget
I said, what about the future if continue chemo, it's not worth it.)

In addition, while Methotrexate's eyebrows raised, signaling a general emphasis on to what


she is saying and her arms wide open while it moves indicating that nothing is concealed,
also stated,
EMBRACING THE JOURNEY: LIVING WITH CANCER 58

“Naiinis kasi hindi naman kasi dapat ganito na advance payment because the
policy is you have to comply pero hindi ako happy doon sa ganon na advance
payment.” (I was frustrated since it was not supposed to be like this there's an
advance payment because the[67]policy is you have to comply but I was not happy with
that advance payment policy.)

It was observed that financial status had a great impact on the participants regarding
their view on surviving cancer.

As reflected by Rituximab's response,

"Kung wala kang pera wala na talaga hindi ka makakasurvive." (If you do not have
money you won't survive.)

Financial status also affects the compliance of cancer patients to the treatment regimen.
As evident to Siltuximab's verbatim,

“Kahit na may savings ka, you always fear for the worst, the financial implications
of the medicine (eyebrows meet). (Even if you have savings, you always fear for the
worst, the financial implications of medicine.)

As seen while the participant is verbalizing her eyebrows met which indicates
concentration Lickerman (2011),

Further stated by Rituximab,

"Nagskip ako ng chemo kasi wala na eh kailangan magtrabaho ulit para may
pangchemo kaya ganon mahirap din mahal kung kwekwentahin lahat aabot sa 300
mga ganun 300K." (I skipped chemo since I do not have the money I need to go
back to work in order for me to save money for my chemo, it is hard, it's costly,
about 300 thousand.)

Therefore, leading to a realization that having cancer needs financial resources.

As evident to the verbatim of Rituximab,

“Kasi syempre kailangan din ng pera eh kaya yun, mahirap din pag may kuwan maysakit
na ganon, sakit talaga ng mayaman, kung walang pera talaga wala na kasi mahal eh every[8]
session umaabot sa 11,00o iba pa yung pagkain din mga kwan trans. *Shakes his head*”
(Money is also needed, it is hard when you get sick of cancer, a sickness for rich people, if
you do not have the money it would be difficult since every session is about 11,000 pesos,
food and transportation are not even included there.)

Participant was noted to be shaking his head as an indication of negativity of the experience.
EMBRACING THE JOURNEY: LIVING WITH CANCER 59

Strains in resources can bring about challenges in facing cancer like stress, anger,
compliance on treatment and even their view on surviving cancer. Financial resources are one
thing that is necessary when going on treatment as evident to a study done by Lindholm (2001),
as she stated that the present study indicates that chronic illness causes adverse social and
economic consequences in which financial difficulty is one of them and so health care providers
should research about the different programs of the government such as health insurances that can
help reduce the financial constraints and present them to cancer patients.

Despite the problem on limited resources that they faced during the experience of treatment
one of the respondent still believed that the treatment had a good effect to her well-being.

Streptozocin verbalized:

"Yung bang sabi ko nga eh, ang pasalamat ko bago na yung, kasi nga nagcleanse
na ako, dahil sa chemo, I believe na cleansing yun sa akin. Kasi ang daming kuwan
eh. Ok nay unh kuwan ko, so yun I believe na cleanse ako *nods head* (What I am
thankful about is that it is new, because I was cleansed because of chemo, I believe
that it was a cleansing because there were a lot of, so that's it I believe that I was
cleansed.)

As she nods her head it signifies, agreement to her sentence and at the same time positivity
of what she is saying.

Only a few of the respondents believe the treatment had a good effect as evident as well to
a study done by Saratsiotou, et al. (2010), there were only 16.7% of the patients supposing that
their treatment is effective.

Awareness on treatment and knowing what[68] the treatment is for might help the cancer
patients appreciate the cancer treatment more. It is on the part of Health Care Providers to educate
their client regarding the treatment they are going through in order for them to have a better grasp
on what is going to happen or what is happening during the course of treatment. A study done by
Nissen, Tsai, Blaes, Swenson, & Koering (2017), had treatment summary which includes detailed
information about tumor characteristics and cancer care received, and a follow-up care plan
including recommendations for cancer screening and potential late effects of treatment. They
found out that treatment summaries could improve cancer survivors' knowledge of details about
their diagnosis and treatment in which cancer survivors showed significant improvement in
[
accuracy
5
on stage
]
of disease.

In addition to that, there are a several changes that happened, emotionally, physically, and
spiritually. Some of them positively gain something after those changes, and some do not.
Accepting the physical changes was difficult especially when something in your body was
removed and lost its function. In here participants
[0]
accept the changes happened to them, they do
not care about what other people will say. Individuals
[0]
were imparted with a ray of hope and finally
started to blossom their way out [0]of that abyss. Amidst their fears and hardships, they got back on
their feet and chose to live anew. They eventually shared their resentment instead of facing their
EMBRACING THE JOURNEY: LIVING WITH CANCER 60

[0]
challenges alone. They learned to accept reality and did not bear it in silence, (Guzman, et al.,
2015).

Siltuximab stated that:

“ I used to wear the ano, yung uh, silicon? Silicon bra *places both hands on
breasts* myung ginaganon mo yun, sabi ko “ what, why am I doing this?” , sabi
ko, bababa ako ng manila, nahuhulog ngay kasi diba mainit, oo nahuhulog siya, ay
inalis ko na and then it was okay na, ano lang kasi, pagka-pagka conscious ka
makikita mo, but is that what people look at you ? Hindi naman diba? Kaya sabi
ko, ako lang naman ang conscious na ano *palpates chest* so its okay.” (I used to
wear the…silicone? Silicone bra *places both hands on breasts* the one you…I
said, “what am I doing this?” I said, I will go down Manila, it would fall out
because it was hot, yes, it fell, I removed it already and then it was okay, it is just
that, if you are conscious you would see it, but is that why people look at you? No,
that is why I told myself, I am the only one who is conscious *palpates chest*), so
it is okay.)

An illustrator is very much part of speech and serves the function of emphasis. It acts the
words to provide emphasis on the statements that the person is saying, (Mehrabian, 2017), wherein
siltuximab was seen touching her breast and palpating her chest part to emphasize that she used
silicon bra.

In addition to that Bortezomib also stated that:

“ Yung options na ano… one is parang ano bayun yung parang… what do you call
that, parang aesthetic, parang maglalagay sila na parang ano sabi ko.. It's no use,
form lang yan itsura lang yan, pwede mo namang ano, na hindi mapansin diba, na
hinid mo nilagyan. ” (The option that... The one that, what was that, it's like... what
do you call that, it seems aesthetic, it's like they will just put it, I said it's no use,
it's just a form it's just the way you look like, you can just ignore it, no one will
notice that you haven't put it.)

These finding tell us that accepting the physical changes that cancer made them makes
them firmer and confident to face every challenge that they were about to experience. Showing
strength and courage to face that kind of situation is very admiring, mainly that they were able to
see the good effect from them and live normally. It is essential that people around them should
make them feel that their physical changes are reasonable and do not make them think that they
are incomplete because of the changes in their physical aspect. They should think that their
physical changes are a sign that they survived cancer and symbolizes their journey.

F. Cancer a new Perspective


EMBRACING THE JOURNEY: LIVING WITH CANCER 61

After the experience of having cancer, the participants had developed a different
meaning to cancer in which the participants described it in different ways. Some of the
participants describe it as a battle that they have to win.

As evident to the statement of Methotrexate in which she constantly nods her head
signifying the agreement in her previous statement that the meaning hasn't changed,

“Yun parin yun parin it-it-really it's a battle that you have to win. Kailangan
talaga uhh ano positive ka na mananalo ka.” (It's really a battle that you have to
win. All you need is a positivity that you will win.)

As well as Streptozocin, stating,

“Cancer is not a death sentence, but the start of fighting.”

Others would describe cancer as something ordinary, conferring to Bortezomib's statement


while her hands draw forward and eyebrows raise imitating a road thus giving more
emphasis,

“It's just parang yung sa road yung ano ba yung bump that you just have to get
over it. Yun. You just go through you just go through it.” (It's like a road bump that
you just have to get over it. That's it you just go through it.)

Streptozocin also stated,


[5]
“Actually sa akin, uhm.. ang cancer is just part of life. Na if you uhm. If you handle
it right… uhm.. maging okay ka. Pero if you will not handle it right, of course,
cancer will take your life.” (Actually for me cancer is just part of life. That if you
handle it right, you will be fine but if you will not handle it right, of course, cancer
will take your life.)

Siltuximab would also describe it as a lifestyle disease in her statement

“They say that uhm cancer is a is genetic *looks at interviewers* they say uhm
cancer is uhm ah a lifestyle thing uhm for me it was a it was more of a life's its its
more of a lifestyle disease. *raised eyebrows*

As the participant looks at the interviewer it shows connection in interacting and as she
raised her eyebrows as she gives emphasis on her statement.

By the end of the experience they realized that cancer is treatable as manifested by
following the statement by Methotrexate,
EMBRACING THE JOURNEY: LIVING WITH CANCER 62

“It's parang ano tinignan ko siya as an ordinary sickness. Hindi something na


terminal extra- nakakatakot or ano. It's something that is treatable.” (In which her
head was raised in which head raising is usually displayed after a victory.)

Further added by Adriamycin:

“Ang impression ko noon parang terminal na sakit parang ganon na hindi


nakayang gamotin yun pala uhmmm magagamot pala sa ngayon.” (I just look at it
as an ordinary sickness. Not as something terminal, frightened or what. It is
something that is treatable.)

Different participants would describe it in different ways but it is notably that most of the
participants shared a positive impression to cancer, that helped them in going through cancer as
evident in a study done by Briley, Rudd & Aaker (2016), positivity has been shown to be a
foundation of successful recovery in the aspect of a health challenge. Health care professionals
would then now be helpful in boasting the positivity of cancer patients.

G. Cancer, a new Perspective

After the experience of having cancer, the participants had developed a different
meaning to cancer in which the participants described it in different ways. Some of the
participants describe it as a battle that they have to win.

As evident to the statement of Methotrexate in which she constantly nods her head
signifying the agreement in her previous statement that the meaning hasn't changed,

“Yun parin yun parin it-it-really it's a battle that you have to win. Kailangan
talaga uhh ano positive ka na mananalo ka.” (It's really a battle that you have to
win. All you need is a positivity that you will win.)

As well as Streptozocin, stating,

“Cancer is not a death sentence, but the start of fighting.”

Others would describe cancer as something ordinary, conferring to Bortezomib's statement


while her hands draw forward and eyebrows raise imitating a road thus giving more
emphasis,

“It's just parang yung sa road yung ano ba yung bump that you just have to get
over it. Yun. You just go through you just go through it.” (It's like a road bump that
you just have to get over it. That's it you just go through it.)

Streptozocin also stated,


EMBRACING THE JOURNEY: LIVING WITH CANCER 63

“Actually sa akin, uhm.. ang cancer is just part of life. Na if you uhm. If you handle
it right… uhm.. maging okay ka. Pero if you will not handle it right, of course,
cancer will take your life.” (Actually for me cancer is just part of life. That if you
handle it right, you will be fine but if you will not handle it right, of course, cancer
will take your life.)

Siltuximab would also describe it as a lifestyle disease in her statement,

“They say that uhm cancer is a is genetic *looks at interviewers* (showing


connection in interacting) they say uhm cancer is uhm ah a lifestyle thing uhm for
me it was a it was more of a life's its its more of a lifestyle disease. *raised
eyebrows* (gives emphasize on statement)”

By the end of the experience they realized that cancer is treatable as manifested by
following the statement by Methotrexate,

“It's parang ano tinignan ko siya as an ordinary sickness. Hindi something na


terminal extra- nakakatakot or ano. It's something that is treatable.” (In which her
head was raised in which head raising is usually displayed after a victory.)

Further added by Adriamycin:

“Ang impression ko noon parang terminal na sakit parang ganon na hindi


nakayang gamotin yun pala uhmmm magagamot pala sa ngayon.” (I just look at it
as an ordinary sickness. Not as something terminal, frightened or what. It is
something that is treatable.)

Different participants would describe it in different ways but it is notably that most of the
participants shared a positive impression to cancer, that helped them in going through cancer as
evident in a study done by Briley, Rudd & Aaker (2016), positivity has been shown to be a
foundation of successful recovery in the aspect of a health challenge. Health care professionals
would then now be helpful in boasting the positivity of cancer patients.

I. Embarking on the Journey


A. Facets of Grieving
B. Having Optimism and Strength

II. Traversing through the Struggle


A. Regaining Control
B. Struggles Encountered
C. Help seeking
D. My Frustrations

III. Finding Meaning in the Journey: Living with Cancer


EMBRACING THE JOURNEY: LIVING WITH CANCER 64

A. Living a Purpose Driven Life


B. Interpersonal Transcendence
C. Gratitude
D. Fear of Recurrence
E. Effects[1]of Treatment
F. Cancer: A new Perspective

IMPLICATIONS

Going through
[22]
cancer, health care providers play an important role in the journey of these
patients. Therefore, nurses and other health care providers must be equipped with substantial
knowledge regarding the experiences and insights of their patients, they can benefit from this study
by having a broader view of cancer and how cancer patients went through the journey of
survivorship. This will inspire nurses to give a holistic approach, and not just in the physical aspect
of these cancer patients, when caring for patients with cancer [3] with the knowledge that support
system can create a big impact on the patients' survivorship.

These cancer patients have faced many problems, but they were able to overcome these
through different coping methods that they developed over time and with the help of support
systems in various forms coming from other people. Thus, cancer patients usually tend to look for
these sources of support that enables them to continue the struggle to overcome the disease. In
addition, health education to patients with cancer is essential in their survivorship, cancer patients
who are more educated
[37]
or informed with their disease tend to be more compliant and involved in
their treatment. One of the problems faced by these cancer survivors is the financial aspect, this
would implicate that the government must increase the budget on health care to reduce the financial
burden of cancer patients and their families.

In addition,[5]another aspect that health care providers can look into is the emotional impact
of having cancer. They may be able to address this through different techniques such as the use of
therapeutic communication, which could possible alleviate or lessen the stresses that the patients
are experiencing.
[5]

LIMITATIONS

There are some limitations of this study that needs to be acknowledged. Firstly, though we
utilized Maximum Variation Sampling, the researchers had a difficulty in finding participants at
the age bracket of 18-29 years old within Baguio City. The researchers were not able to cover all
types of cancer. Also, some interviews were conducted in places where environmental noises were
beyond the control of the researchers which may have affected the interview process.

CONCLUSIONS

This study broadens and enhances our knowledge and reveals a bigger picture about the [7]
impact of living with cancer and the threat to the overall well-being of facing possible death. Based
on the results, it can be concluded that cancer troubles a person and creates a variety of feelings:
EMBRACING THE JOURNEY: LIVING WITH CANCER 65

[8]
emotional distress, physical crisis, meaning, and purpose. Despite the fact that there are different
types of cancer with varying levels of severity and that people are uniquely different from one
another, cancer survivors embarked on the journey, traversed through the struggle, and realized
the meaning of the experience. Lastly, faith and belief in a higher being presents as a source of
hope for survivors.

Partaking through the experience developed a way of realizing the value of life, cancer is a
way for them to relate and help other cancer patients. Consequently, the need to interact with other
cancer patients will give them further understanding of what other people are experiencing. Going
through the experience of having cancer, they have found new meaning in their lives realizing the
blessing of being given another chance through their survival hence valuing life.

RECOMMENDATIONS

This research reveals that living with cancer troubles a person and creates a variety of
feelings, emotional distress, physical crisis, meaning and purpose. From the findings, we
recommend the following:

1. For the health care providers, this can be a basis on the creation of new policies in the
involvement for the care of the patients since support from family was seen very helpful.
[ 4 1 ]
2. The findings can be a basis for the government to pursue the pending bill for the National
Integrated Cancer Control.

3. As for the nursing practice and education, this study strengthens the need to deal with
patients with cancer holistically.

4. The creation of support groups or group therapies in the hospital may provide emotional
support during the treatment since interacting with other patients was seen to significantly
allay their negative feelings.

5. To heighten the integration of health education on coping methods and diversional


activities for cancer patients during the celebration of the National Cancer Consciousness
Week every month of January.