Conflicting demands, coping, and adjustment: A grounded theory to understand rehabilitation processes in long-term breast cancer survivors

Abstract

Objective: This study explores rehabilitation processes in long-term cancer survivors (CSs) and explains the causes, contexts, and consequences under which decisions related to rehabilitation are made. Methods: Within the mixed-methods Breast Cancer Patients' Return to Work (B-CARE) project, conducted from 2018–2020, data were collected through a written survey and semi-structured interviews with CSs 5–6 years after their diagnosis. In total, 184 female CSs participated in the survey, and 26 were interviewed. A qualitative grounded theory approach was applied. Results: The 26 interviewees were 57 years old on average, 70% were married, and 65% had children. The participants experienced incompatibilities caused by the cancer disease in their areas of life and the demands that arose from it. To reconcile demands from the areas family, work, leisure time, household, and disease, the interviewed CSs used different coping mechanisms and adjusted their lives by prioritizing certain areas as a consequence. This prioritizing was often to the detriment of work and rehabilitation. Furthermore, it worked as a barrier for participation in rehabilitation programs and explains why CSs experienced job changes after their return to work. Conclusions: Physical and mental long-term effects were observed in the interviewees' lives 5–6 years into survival. The study results stress the importance of individualized and needs-oriented survivorship care.