Bioethics in India: Proceedings of the International Bioethics Workshop in Madras: Biomanagement of Biogeoresources, 16-19 Jan. 1997, University of Madras; Editors: Jayapaul Azariah, Hilda Azariah, & Darryl R.J. Macer, Copyright Eubios Ethics Institute 1997.
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24. Societal Reaction Towards a Woman Cancer Patient

Vanaja S. Kumar & R.P. Surendra Kumar*
Department of Sociology, BMS College for Women, Bangalore-4
* Cancer Biology Division, Department of Zoology, S.K.University, Anantapur-3


Abstract

Cancer is one of the oldest diseases of human beings. Diagnostic and therapeutic aspects have advanced significantly. The life span of a cancer patient of today is increased considerably, because of multifarious approach by scientists and medical personnel. However nothing much is done regarding the status of the patient in relation to the society and the mental, behavioral and physical aspects.

This paper, presents the societal reaction towards a cancer woman patient. Most prevalent cancers like those of breast and cervix have been taken up for studies. Age group, Religion, Occupation, Income, Education were recorded for about 200 patients suffering with breast and cervical cancer. Data was gathered by personal interviews and hospital records. Results revealed the information ranging from near normalcy to total non­normalcy. Emotional stress, helplessness, isolation, mounting expenses, distress, distrust, inferiority complex, insecurity are a few dominating reactions of the patients. Details of the assessment along with statistical data are presented.

1. Introduction

Malignant tumors have been described in pictures and writings from many ancient civilizations, including those of Asia and South America and Egypt. Writings from the Middle Ages made references to cancer houses, families and villages suggesting that cancer might be inherited or environmental disease. Medical sociology is concerned with the societal facts of health and Illness behavior of health personnel. In the Indian context medical sociology is a discipline dealing with an interface between the providers of health and medical care services. Illness behavior has been focused on symptoms, discomfort and other signs of organic malfunction. While medical sociology has made head way in West, it is comparatively a new concept in India. Information is available on the structural analysis and doctor-patient relationship. The social reaction towards the patient is not recorded. The present study is a preliminary one and attempts to report and analyze the psychological conditions of cancer woman patient. Since cervical and breast cancer have a high incidence in Indian women, patients with established ailments of these two categories are taken up for the present study.

2. Methodology

Data was collected from about 200 cancer women patients admitted or treated in a highly reputed cancer hospital in Bangalore. Interview schedules were prepared after the standard pattern covering the social, economical, educational and other aspects concerning the family background. Behavioural, attitudinal and psychological coordinates formed the second part of the schedule. Repeated courtesy calls and casual talks with the patients was the beginning to gain confidence of the patient. Except the sexual behavior, all the rest of the queries were answered without any hesitation. Further persuasion resulted in getting the answers concerned with sexual aspects, after initial hesitation. Of the total number of 2064 women patients registered during 1996, 125 cancer cervix and 75 breast cancer patients were interviewed. Subjects consisted of various grades of cancer ranging from grade I to terminal stage.

3. Results

413 cases of breast cancer and 1466 cervical cancer were registered during 1966, amounting to 10.3% and 36.65% of the total number of the cases. Of the women patients, 71% (1466) were cancer of the cervix , 20% (413) breast and 9% (185) were of other cases. 12% (248) were of the young age group of below 35 years, 58% (1197) were middle age group between 36 and 50 and 30% (619) were of the old age group of above 50 years. 55% (1135) belonged to the low income (below Rs.1500. p.m.), 32% (661) belonged to middle income (between Rs.1500 and 3000. p.m.) and 13% (268) belonged to high income (above Rs. 3000. p.m.).There was a varied size of family. 12% (248) were from small (0 to 4 persons) family groups, 54% were from medium size (5 to 7 persons) and 34 were from large (8 and above persons) family group. 70% (1445) of the subjects were married with husbands alive, 30% (702) belonged to either widow or divorcee or otherwise category. 85% (1754) women were illiterates, 10% (206) were literate who knew how to read and write, and 5% (104) were educated beyond high school. While 52% (1073) were employed 48% (991) were unemployed. Of the working women 88% (994) were employed either in manual or casual or domestic labour and 12% (129) were semi skilled, skilled or well employed.

4. Discussion

Results show that lack of awareness due to compelling socio-economic factors has manifested in increased incidence of the disease. Scientifically, though it has no relevance, it is very clear that awareness and identification of warning symptoms would have made the patient approach the doctors much earlier than they did. Curative chances would have been quite high compared to the present situation. Most of the illiterates had no knowledge of cancer. More than 50% were totally ignorant, those who suspected some change in their organs were shy to consult the clinician or other members of the family. The 'Doctor shy' mentality was prevalent even in some educated persons. While the illiterates readily agreed to go to the doctor when asked to, majority of the educated were to be persuaded and forced to consult the physician. Lack of time prevented most of the working women to reach the hospitals since the timings of the hospitals were the same as that of their work. While uneducated women did not hesitate to consult the doctor educated women had lot of hesitation and inhibition for the fear of pronouncement of the disease.

Analysis of the post-diagnostic behavior reveals thought provoking information. The very pronouncement of the cancer confirmation to the patient leaves more than 75% psychologically dead which forms a main basis of pessimism. About 50% felt totally sad and hopeless, 30% developed inferiority complex, 6% felt insecure and 14% kept normal, due to ignorance of the seriousness of the disease. However 25% believed in the destiny and left the matter to the Almighty. Fear complex was a major fact in inducing absolute no confidence in the therapeutic modalities. Frequent change of doctors and method of treatment lead to the loss of confidence in doctors. 80% (162) were desperate since they believed that no cure is possible, 20% (38) were optimistic and kept faith in the advanced modalities of treatment. They were highly hopeful of regaining the normal health and status. Mounting medical expenses were of great concern to majority of the patients. 48% were badly affected and their family economy was shattered. The rest were able to manage with great difficult. Selling the property or pawning was reported by 46% of the patients.

Significant information was given when questioned about their conjugal habits post confirmation of cancer. It is interesting to note that more than 60% patient's husbands in the uneducated group had no reservations or hesitation to participate in sex during the course of the ailment unless forbidden by the doctor. However the educated group almost totally abstained for having sex with their cancer woman on the pretext of medical advice. But the spouses were of the opinion that the husbands were more scared that the disease is contagious. This phenomenon is specially so in cancer cervix. Cosmetic consideration was a decisive part in the breast cancer patients.

Social reaction towards the cancer patient, in the present study, ranges from total nonnormalcy to almost normalcy. 75% of the families believed in 'God's Way', the others were showed no significant reaction. Children of the patient were more concerned, affectionate and sympathetic to their mother that the others. The husbands were either badly affected psychologically or kept up calm to face the situation. This was more so in educated ones. Relatives and neighbors showed considerable sympathy which demoralized the patients that they have no hope of survival. About 15% of the families encouraged the patients to gain strength and to face the disease which in turn has helped the patient to lead an almost normal life. The non-acceptance in the society, based on no firm grounds, is leading the patient to despair. However, avoidance of the patient in one pretext or the other is prevailing in significant number of cases.

Anger, irritation, sense of inferiority, insecure feeling, emotional stress and total lack of hope of survival were the main findings in the present study. Given a proper atmosphere of normalcy and affection, the quality of the life and survival time would be enhanced significantly. Philosophy has come as important source of solace to many affected families.


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