Date of Award

2014

Document type

Thesis

Degree Name

PhD (Doctor of Philosophy)

First Supervisor

Professor David L Whitford

Second Supervisor

Dr Borislav D Dimitrov

Keywords

Breast Cancer, Bahrain, Quality of Life

Abstract

Breast cancer is the most prevalent cancer in women worldwide as well as in Bahrain. This thesis investigates the quality o f life o f Bahraini women with breast cancer using both a quantitative and a qualitative approach.

I also investigated the effect of psychological intervention in women with non metastatic breast cancer in a systematic review and meta-analysis. Twenty three trials were included and four meta-analyses were generated. The intervention proved to be effective in reducing anxiety, mood disturbance and depression (in group sessions). The improvement in survival is less promising and warrant more research before a solid conclusion can be made. The results should be interpreted cautiously considering the remarkable heterogeneity and shortcomings of included trials.

I have presented data from a randomly recruited sample of 239 Bahraini women with breast cancer in a cross-sectional study. Results showed that women had a comparable quality o f life to western women with a mean score for global health o f 63.9 (95% Cl 61.2-66.6). The presence o f metastases, having had a mastectomy as opposed to lumpectomy and the shorter time elapsed since diagnosis had a major effect across all the domains of quality of life o f breast cancer survivors.

I used a qualitative method to gain deeper understanding o f the quality o f life of Bahraini women with breast cancer. I undertook 12 semi-structured interviews to explore the beliefs, perceptions and attitudes of Bahraini women who have survived breast cancer towards their quality of life. Theme analysis revealed both similarities and differences between Bahraini Arab women and women in previous studies in their beliefs and perceptions towards breast cancer. This qualitative method has captured elements related to quality o f life of breast cancer survivors, particularly those with a more cultural and religious basis. This is important to healthcare professionals in ensuring an individualised approach to women with breast cancer.

This report explored another dimension o f quality of life of women with breast cancer in this region and set the platform for further comparative and longitudinal studies. Furthermore, the tentative effectiveness o f psychological interventions on psychological outcomes and survival in non-metastatic breast cancer warrants vigilant approaches and possibly targeting the population that need it the most. In this thesis I have managed to describe the quality o f life of breast cancer survivors in an Arab culture from both a quantitative and qualitative approach. The Cochrane review highlights the inadequacy o f knowledge concerning the most appropriate methods o f supporting breast cancer survivors. The results of this thesis raise issues for delivery of healthcare to this vulnerable population, for the role of women in this society and for future research into more effective support mechanisms.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.

File Size

13.2 MB

Comments

A thesis submitted for the degree of Doctor of Philosophy from the Royal College of Surgeons in Ireland in 2014.

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