1. Introduction
Globally, breast cancer is women’s leading cause of death [
1]. The number of women diagnosed with breast cancer in South Korea has continually been on the rise, observing a 2.7% increase rate over the last two decades [
2]. In the United States, one out of every eight women is diagnosed with breast cancer [
3]. In addition, breast cancer is a major cause of mortality and morbidity in Middle Eastern countries [
4]. As such, breast cancer is not only a problem for individuals but also a serious public health concern [
5].
Early breast cancer patients who receive their diagnosis unexpectedly experience strong emotions, such as anxiety, anger, and resentment, due to the surprise of their sudden detection [
6]. In addition, they may experience despair because breast cancer requires a treatment period of five to ten years, unlike other curable cancers within five years after surgery [
7]. In particular, early breast cancer patients recognise the deformation of their breast as the biggest shock [
8]; they endure pain in the reconstruction process and a sense of loss of their breast.
In addition, the difficulties experienced by breast cancer patients are considerable. They experience deterioration of their physical strength while undergoing treatments, such as chemotherapy, radiation therapy, and taking hormonal drugs. They also experience loss of hair and nails due to complications and side effects associated with cancer treatments [
9,
10]. Furthermore, they may have problems doing household chores or working at their workplaces due to physical pain [
11]. Early breast cancer patients experience various stressors as their overall quality of life deteriorates [
12,
13].
Unfortunately, it is problematic that there is little psychological support available for patients who have survived cancer despite their worrisome fear of cancer recurrence [
14]. Therefore, as women overcome breast cancer, long-term emotional factors become more influential during and after treatment [
15]. Women with breast cancer also have lower sexual quality of life due to negative body image, physical inactivity, depression, sleep problems, chest symptoms, and chronic fatigue [
16]. Therefore, their quality of life should include consideration of their psychological, physical, and living characteristics [
11].
The longer the duration of breast cancer, the greater the stress [
17]. This impact means that reducing stress in the long term through appropriate responses is essential in the initial fight against the disease. Although they experience such difficulties, individuals may perceive the characteristics and degree of problems they feel differently; an individual’s culture or society affects their subjective perception. The diagnosis and treatment of breast cancer are affected by social, economic, and cultural factors. For example, conservative views on femininity and women’s roles dominate Korean culture [
18,
19]. As such, the characteristics of difficulties experienced by female patients with breast cancer may differ in Korea compared to a Western nation. Therefore, early breast cancer patients need individual psychological and emotional support according to their cultures.
Individualised treatment is vital for breast cancer patients [
20]. Thus, determining appropriate solutions requires identifying the individual’s subjective difficulties. Therefore, this study examined the subjective difficulties experienced by early breast cancer patients in South Korea to provide fundamental data that can help them overcome the disease.
4. Discussion
This study found three types of perceptions about the difficulties experienced by early breast cancer patients: Type 1, ‘fear of the future’, Type 2, ‘helplessness against what cannot be controlled’, and Type 3, ‘frustration due to difficulties in role performance’.
Type 1 patients feared the uncertain future in which breast cancer metastasis, recurrence, etc., might occur. According to studies [
32,
33], breast cancer patients’ fears of the future are a vital issue, supporting our study’s characteristics of Type 1. However, these patients do not fear changes in their appearance. Intolerance of uncertainty and worry is a psychological factor that causes fear of cancer recurrence (FCR) in early-stage breast cancer survivors in clinics [
34]. This characteristic corresponds to Type 1; therefore, addressing this aspect of FCR could support Type 1 patients.
Cognitive behavioural therapy related to positive psychology benefits breast cancer patients by providing appropriate coping measures for their fight against the disease [
35]. Moreover, breast cancer patients who received positive psychotherapy or cognitive behavioural stress management assistance experienced a decrease in psychological distress, which had a positive effect as breast cancer recurrence decreased [
36]. This finding indicates that Type 1 patients need psychological support to help them manage their difficulties.
Type 2 patients were embarrassed to have breast cancer despite managing their health carefully. However, they did not experience significant difficulties concerning loss, humiliation in relationships, or others’ prejudices. They appeared to be aware of the challenges since they could not control their lives. A study by Hernandez et al. [
37] found that cancer patients feel lethargic, similar to the difficulties experienced by Type 2 in our study. Thus, they need greater capacity for self-efficacy, which is a crucial element for breast cancer patients in fighting the disease [
38]. Self-efficacy is the self-judgement that one can solve problems by taking appropriate actions in one’s circumstances with belief in one’s abilities [
39]. Enhancing self-efficacy, a positive self-concept will enable early breast cancer patients to control their emotions and thoughts and take the best concrete and practical actions to recover their health in their fight against cancer.
Type 3 patients feel discouraged that their role performance at home or in the workplace has changed since they developed breast cancer. However, the results show that they did not think that their family members who wanted them to perform their role identically to what they did before they developed breast cancer were selfish. Spousal support did not affect breast cancer patients’ quality of life [
40]. Rather, they may need support and help from other breast cancer patients with the same experiences more than spousal support. Patients with similar experiences can help breast cancer patients overcome the difficulties associated with battling the disease.
Another study found that many women with breast cancer want to help other patients and feel helpful [
41]. In addition, according to Chin et al. [
42], mothers with breast cancer need support to improve intimacy in their mother–child relationships while preparing for an uncertain future. This finding means that, like Type 3, patients need support to continue their emotional role as mothers at home. Moreover, being supported by colleagues at work during cancer treatment stands out as a vital and lasting protective factor for continued work capacity [
43]. Therefore, communication with colleagues at work is an important aspect of their fight against the disease.
Statements commonly shown by all types included Q1 ‘I feel helpless because cancer is a disease beyond my control’ and Q19 ‘I am worried about not being able to fulfil my role and responsibilities at home during treatment.’ These results show that it is essential for patients to live independently and proactively. In addition, to improve breast cancer patients’ quality of life, education and family support that enable patients to develop knowledge about breast cancer are crucial [
44]. They commonly need to objectively accept situations they cannot control and understand that, instead of being caregivers, they are subjects that can receive care while they fight the disease.
The results of this study led to some suggestions as follows. First, breast cancer patients must communicate their difficulties in fighting the disease. In particular, early breast cancer patients should continuously communicate with their family members and the people in their lives to have an objective view on their situation. For instance, a study by Zhang et al. [
45] found that breast cancer patients do not communicate with their children about their breast cancer, even in family relationships. Furthermore, since they are uncertain about their future, they are also uncertain when and how to tell their children about their cancer. However, our study found that it is crucial for breast cancer patients to understand the necessity of communication and an appropriate method.
Second, not all early-stage breast cancer patients suffer from the same difficulties. For example,
Table 6 shows that Type 1 patients fear breast cancer recurrence but do not perceive significant challenges due to changes in their bodies or physical fatigue appearing during treatment. Although they experience difficulties fighting the disease, they do not experience all the difficulties breast cancer patients may experience. Therefore, it is necessary to identify each breast cancer patient’s challenges and provide support measures accordingly.
Third, although this study examined breast cancer patients’ perceptions of the difficulties they experience, the study’s results show that one should note the strengths they demonstrate in overcoming their perceived obstacles. It is also necessary to pay attention to the positive characteristics underpinning individual patients’ difficulties to overcome them.
Early breast cancer patients experience various physical, psychological, and social disabilities. Therefore, adaptability to change in multiple areas of life is essential, and they urgently need different countermeasures [
46,
47,
48]. Finally, this study provides the basis for policy support, such as programs, education, and training to improve the adaptability of early breast cancer patients.