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Psychological concerns of Indian women with breast cancer in different national contexts: a systematic review and mixed-methods synthesis
  1. Sunitha Daniel1,2,
  2. Joseph Clark2,3,
  3. Sam Gnanapragasam4,
  4. Chitra Venkateswaran5 and
  5. Miriam J Johnson2
  1. 1 Pain and Palliative Medicine, General hospital Ernakulam, Kochi, India
  2. 2 Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
  3. 3 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK, Hull, UK
  4. 4 Institute of Psychiatry, Psychology and Neuroscience, London, UK
  5. 5 Department of Psychiatry, Believers Church Medical College Hospital, Thiruvalla, India
  1. Correspondence to Dr Sunitha Daniel, Pain and Palliative Medicine, Kochi 682041, India; hysd11{at}


Background Breast cancer is becoming the most common cancer among women of Indian origin. However, little is known about the psychological impact of the disease and its treatment among this population.

Aim To improve understanding of psychological symptoms among Indian women with breast cancer.

Design This is a systematic literature review and critical interpretive synthesis. Medical Subject Headings(MeSH) terms and keywords for breast cancer, psychological symptoms and treatment were used to search databases from inception to 7 May 2019. The reference lists of the included articles were examined. Search results were screened against the inclusion criteria, data were extracted, and quality was appraised by two independent researchers with recourse to a third. Narrative (quantitative) and thematic qualitative syntheses were applied, followed by critical interpretive synthesis.

Data sources ProQuest, MEDLINE, Ovid EMBASE, EBSCO, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO.

Results 18 of 763 studies from India or Canada were included (13 quantitative, 5 qualitative). Critical interpretive synthesis found psychological concerns similar to ‘Western’ women, but were framed by the common culture of Indian women in either country. Family structure, religion and community appear to protect against and cause distress in relation to the expected core role of being a wife and a mother and the male dominance in decision making. Stigma was amplified by poor knowledge about the nature of cancer. Migrant Indian women had additional problems due to language barriers.

Conclusions Indian women with breast cancer living in India and Canada experience psychological morbidities which profoundly affect their role in their family and the wider community. Culturally congruent care, including accessible communication and information, may help prevent and alleviate distressing symptoms whether in India or in a migrant community.

  • breast
  • psychological care
  • cultural issues
  • spiritual care

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  • Correction notice This article has been updated since it was first published. The article type has been changed to Systematic review.

  • Contributors Concept: SD. Design: SD, CV, MJJ. Search: SD. Screening, data extraction and quality appraisal: SD, JC, SG. Data interpretation: all. First draft: SD. Revisions and final manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.