Exploratory Study of Factors Affecting Continuity of Cancer Care: Iranian Women's Perceptions

  • Fouladi, Nasrin (Department of Community Medicine, Ardabil University of Medical Sciences) ;
  • Ali-Mohammadi, Hossein (Department of Basic Science, Ardabil University of Medical Sciences) ;
  • Pourfarzi, Farhad (Department of Community Medicine, Ardabil University of Medical Sciences) ;
  • Homaunfar, Nasrin (Faculty of Nursing, Ardabil University of Medical Sciences)
  • Published : 2014.01.15


Background: Today, breast cancer is increasing in nearly all societies. Currently, cancers are the third leading cause of death in Iran after cardiovascular diseases and accidents. Of the cancers, breast cancer is spreading particularly rapidly among Iranian women. Negative effects of discontinuation of care on patient survival have been well documented. Inhibiting or facilitating factors affecting continuity of care at different stages of the patient care continuum should be identified. Materials and Methods: The current study implemented a qualitative method that provided tools to examine factors in detail. This study was conducted on 22 women, undergoing surgery and chemotherapy after being diagnosed with breast cancer. Content analysis was the technique adopted. Results: The effective factors in continuity of care from the patients' perception, based on the participant statements, were classified into three categories of evaluation of symptoms, psychological reactions, and care triggers with several subcategories. Conclusions: According to the outcomes of the current study, it can be noted that, the patient experiences can be brought into use by health-care professionals and assist them in providing patient sand their families with adequate consulting services. It can also provide an opportunity for making interventions tailored to the community culture, and closer adherence of patients to the prescribed treatments.


  1. Abdullah N, Yip CH (2004). Overview of breast cancer in Malaysian women: a problem with late diagnosis. Asian J Surg, 27, 130-3.
  2. Andersen BL, Cacioppo JT, Roberts DC (1995). Delay in seeking a cancer diagnosis: delay stages and psychophysiological comparison processes. Br J Soc Psycho, 34, 33-52.
  3. Anyanwu SN, Egwuonwu OA, Ihekwoaba EC. (2011). Acceptance and adherence to treatment among breast cancer patients in Eastern Nigeria. Breast, 20, 51-3.
  4. Ashing KT, Padilla G, Tejero J, Kagawa-Singer M(2003). Understanding the breast cancer experience of Asian American women. Psycho-Oncol, 12, 38-58.
  5. Ashing-Giwa KT, Padilla G, Tejero J, et al (2004). Understanding the breast cancer experience of women: a qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psycho-Oncol, 13, 408-28.
  6. Arman M, Rehnsfeldt A (2003). The hidden suffering among breast cancer patient: a qualitative metasynthesis. QHR, 13, 510-8.
  7. Avci IA, Okanli A, Karabulutlu E, Bilgili N(2009). Women's marital adjustment and hopelessness levels after mastectomy. Eur J Oncol Nurs, 13, 299-303.
  8. Azaiza F, Cohen M (2008). Between traditional and modern perceptions of breast and cervical cancer screenings: a qualitative study of Arab women in Israel. Psycho-Oncol, 17, 34-41.
  9. Bairati I, Fillion L, Meyer FA, Hery C, Larochlle M (2006). Women's perceptions of events impeding or facilitating the detection, investigation and treatment of breast cancer. Eur J Cancer Care, 15, 183-93.
  10. Bish A, Ramirez A, Burgess C, Hunter M, (2005) Understanding why women delay in seeking help for breast cancer symptoms. J Psychosom Res, 58, 321-6.
  11. Burgess C, Hunter S M, Ramirez J A(2001). A qualitative study of delay among women reporting symptoms of breast cancer. Br J Gen Pract, 51, 967-71.
  12. Brunicardi FC, Schwartz SI (2010). Schwartz's principles of surgery. 9th ed. New York; MC: Graw Hill, pp 424-69.
  13. Connell S, Patterson C, Newman B (2006). Issues and concerns of young Australian women with breast cancer. Support Care Cancer, 14, 419-26.
  14. Facione NC, Miaskowski C, Dodd MJ, Paul SM (2002). The Self-Reported Likelihood of Patient Delay in Breast Cancer:New Thoughts for Early Detection, Prev Med, 34, 397-407.
  15. Fazel A, Tirgari B, Mokhber N (2008). An investigation of effect of mastectomy on temperament and quality of life in breast cancer sufferers. J Shahid Sadoogi University Medicine Health-Care Service, 3, 26-8.
  16. Fouladi N, Amani F, sharghi A, Nayebyazdi N (2011). Five year survival of women with breast cancer in Ardabil, north-west of Iran. Asian Pac J Cancer Prev, 12, 1799-801.
  17. Fouladi N, Pourfarzi F, Ali-Mohammadi H, et al (2013). Process of coping with mastectomy: A qualitative study in Iran, Asian Pac J Cancer Prev, 14, 2079-84.
  18. Fouladi N, Pourfarzi F, Amani F, et al (2012). Breast cancer in Ardabil province in the North-West of Iran: An epidemiological study. Asian Pac J Cancer Prev, 13, 1543-5.
  19. Harirchi I, Kolahdoozan S, Karbakhsh M, et al (2011).Twenty years of breast cancer in Iran: downstaging without a formal screening program, Ann Oncol,22, 93-7.
  20. Harirchi I, Ghaemmaghami F, Karbakhsh M, Moghimi R, Mazaherie H (2005). Patient delay in women presenting with advanced breast cancer: an Iranian study, Public Health, 119, 885-91.
  21. Harun A, Harrison JD, Young JM (2013). Interventions to improve patient participation in the treatment process for culturally and linguistically diverse people with cancer: A systematic review. Asia-Pac J Clin Oncol, 9, 99-10.
  22. Klaeson K, Sandell K, Berteroc CM (2011). To feel like an outsider: focus group discussions regarding the influence on sexuality caused by breast cancer treatment, Eur J Cancer Care, 20, 728-37.
  23. Kreps GL, Sivaram R(2008). Strategic Health Communication Across the Continuum of Breast Cancer Care in Limited-Resource Countries. Cancer, 113, 2331-7.
  24. Landmark B T, Wahl A (2002) Living with newly diagnosed breast cancer: a qualitative study of 10 women with newly diagnosed breast cancer. J Adv Nurs, 40, 112-21.
  25. Lynn m, Glockler L A, Eisner M P (2006). Cancer of the female breast. NCI, 13, 101-10.
  26. Mousavi SM, Montazeri A, Mohagheghi MA, et al (2007). Breast cancer in Iran: an epidemiological review. Breast J, 13, 383-91.
  27. Naghavi M, Jafari N (2007). Mortality views in 29 Provinces of Iran in 2004-Ministry of Health, Deputy for Health Directory, Research and Development Office, Tehran, Iran (in Persian).
  28. Nausheen B, Kamal A(2007). Familial social support and depression in breast cancer:An exploratory study on a Pakistani sample. Psycho Oncol, 16, 859-62.
  29. Yau T, Choi C, Esther N, et al (2010). Delayed presentation of symptomatic breast cancers in Hong Kong: experience in a public cancer centre. Hong Kong Med J, 16, 373-7.

Cited by

  1. Systemic Analysis on Risk Factors for Breast Cancer Related Lymphedema vol.15, pp.16, 2014,
  2. Public Awareness of Warning Signs and Symptoms of Cancer in Oman: A Community-Based Survey of Adults vol.16, pp.7, 2015,
  3. Social Perceptions of Breast Cancer by Women Still Undergoing or Having Completed Therapy: a Qualitative Study vol.17, pp.2, 2016,