Background Psychological symptoms are common in women with breast cancer and profoundly affect their role in the family and wider community, varying across cultural backgrounds. Breast cancer is becoming the most common cancer among women in India. We aimed to understand the cultural context within which Indian women with breast cancer living in India, experience psychological concerns.
Methods Five focus groups were conducted in South India (clinicians, lay-public ). A topic guide explored: understanding of breast cancer, experiences of patients with regards to diagnosis and treatment, and psychological impact. Groups were audio-recorded and verbatim transcribed. Lay groups were conducted in Malayalam with translation and back-translation. Transcripts were subjected to thematic analysis in English.
Results Forty five (oncologists , nurses , church members  and community volunteers working in a palliative care unit ) participated. Three major themes (Psychosocial impact of diagnosis, Psychosocial impact of cancer treatment and Coping with diagnosis and treatment )and nine subthemes emerged from the two groups. All described psychological impact on women with breast cancer including body image, change of family role and their need for support. Family and faith were recognised as the major framework providing key support but also significant stress - particularly where there was poor involvement in treatment decisions. Clinicians were also concerned about financial implications and issues around early cancer detection. Lay people and nurses also commented that poor communication and lack of empathy from doctors, aggravated distress.
Conclusion Clinical and lay communities were aware of widespread psychological impact affecting women with breast cancer. Family and faith provided both a strong support structure, but also could be a cause of distress as roles and expectations were challenged by the disease and its effects.
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