BREAST CANCER AND SPOUSAL RELATIONSHIP IN THE IBADAN METROPOLIS, NIGERIA

Abstract

Breast cancer (BC) is an abnormal growth from the breast tissue, and is a major cause of cancer-related death among women in Sub-Saharan Africa and Nigeria in particular. It affects women’s wellbeing, feminity, maternal-role and sexuality, and accounts for disaffection between couples. Previous studies have focused mainly on biomedical aspect, etiology, prevention and management of BC. However, little attention has been given to the social aspect of BC, as it affects spousal relationship in Ibadan. This study, therefore, examined spouses’ knowledge about BC, community members’ perceived knowledge, how BC diagnosis and treatment affects dynamics in spousal relationship, sick-roles of Women Living with Breast Cancer (WLBC), and coping mechanisms for BC in the Ibadan Metropolis, Nigeria.

Triangular Theory of Love guided the study, while descriptive cross-sectional survey design was adopted. Thirty in-depth interviews and four case-studies were conducted on life experiences of WLBC (15), Spouses (15) and affected couples (4) at the BC Unit, University College Hospital (UCH), Ibadan, which has a high referral population-based cancer registry. Purposive sampling was used to select five urban Local Government Areas (LGAs) in Ibadan. Twenty-four wards were randomly selected out of 59 wards in the selected LGAs. Kish’s (1965) formula was used to determine the sample size, and systematic sampling was used to proportionately administer semi-structured questionnaire on 660 community members comprising Ibadan North (167), Ibadan North-East (148), Ibadan North-West (75), Ibadan South-East (134) and Ibadan South-West (136). Qualitative data were content analysed. Quantitative data were analysed using descriptive and inferential statistics at p≤0.05.

WLBC and Spouses were knowledgeable about BC, but they trivialised its signs and symptoms. This informed late clinical presentation and affected success rate of treatment. Diagnostic report of disease resulted in instability in spousal relationship. Treatment affected the quality of time couples spent on leisure; sexual activities decreased; there were changes in child rearing and communication patterns. Some WLBC could not continue with the treatment regimen due to financial constraints. Fear of death of WLBC negatively affected spousal relationship. Sick-roles displayed by WLBC included inability to work, staying in bed for long, inability to attend to family and social responsibilities, and seeking for medical help (alternative or orthodox). The BC thought avoidance, genuine love, faith in God, adherence to medical advice were adopted as coping strategies. Respondents’ age was 35.53±11.24 years, and 65.6% had tertiary education. Community’s perceived knowledge about BC risk was: any woman (69.8%), women with BC family history (51.8%) and uneducated women (38.8%).They also perceived BC as non-communicable (20.8%), inherited (30.9%) and enemy at work (11.7%). It could be treated through traditional medicine (32%), radiotherapy (38.2%) and chemotherapy (48.5%). Ninety percent of the women were willing to be screened.

Trivialisation of signs and symptoms, and utilisation of alternative therapies contributed to late clinical presentation. This determined the extent and success of treatment. Regular breast examination, early clinical diagnosis by couples are recommended to avert late stage of disease and instability in spousal relationship. Sensitisation is needed for stakeholders on social supports for spouses affected with breast cancer.