"I believe I will still beat it again." These are the words of a Nigerian woman, Didi, who feared a recurrence of her cancer - but saw herself as a survivor.
Her attitude is becoming more common everywhere as more people are living after a cancer diagnosis. Though populations are growing and ageing, and cancer incidence is therefore rising, it's also true that the likelihood of surviving is greater than before.
And identifying as a survivor, rather than a "victim", matters. Studies show that it's associated with better health outcomes.
Didi's optimism is inspiring when you consider the challenges women like her face: a weak health system, high out-of-pocket medical costs, cancer stigma, and a highly patriarchal society that increases women's vulnerability.
In 2020, Nigeria reported an estimated 124,815 new cancer cases and 78,899 cancer deaths, mostly from breast, cervical and prostate cancers. The country is projected to experience an increase in cancer incidence by 2040.
The growing population of people who have had cancer makes it important to understand their experiences. What is it like to be a cancer survivor in Nigeria? Does identifying as a survivor rather than as a victim make a difference? Can the survivors' quality of life be improved?
These were the questions my colleagues and I - gerontology and public health researchers - had in mind when we conducted the study that Didi took part in.
Breast cancer survivors
For our study of what it means to be a female cancer survivor in Nigeria, we took a qualitative descriptive research approach. We interviewed 30 women in Abuja who had had cancer (29 had been diagnosed with breast cancer and one with skin cancer). They were aged between 29 and 55; 16 were married; 19 had children; 29 had tertiary education.
The women in the study were recruited through a partnership with an organisation that offers psycho-social support to cancer survivors. This meant they felt comfortable enough to share their experiences.
We analysed what they told us to identify themes.
Three key findings emerged:
- cancer can be stigmatising
- women made sense of their experience in diverse ways
- identifying as a cancer survivor can be empowering.
The Nigerian women reported that they had encountered negative attitudes from others. One said: "I have been mocked ... laughed at ... embarrassed." Another said she had not been given her job back after her cancer treatment was complete. She also said her husband treated her unkindly after her mastectomy. Stigma can result in social isolation, loss of livelihood and fear of seeking help.
All the study participants identified as survivors, but for different reasons. They mentioned strength, hope, self-esteem, having a positive outlook on life, and maintaining a sense of control. For some, their religious faith gave them this identity. One said that seeing herself as a survivor enabled her to stick to her medical treatment. Care and support contributed to this identity for some:
Since when I joined (a support group), I see myself as a cancer survivor. I'm going to make it no matter what, I know that I'm going to make it.
The women shared their thoughts about the future and looking beyond their cancer diagnosis. Many showed great resilience as their responses reflected hope for a better future, beyond cancer.
Overall, although some of the women in the study spoke of their negative experiences, they reported that identifying as cancer survivors gave them a positive outlook. This was in line with other studies that found that identifying as a cancer survivor can be empowering.
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These qualities are particularly significant in Nigeria, where some people diagnosed with cancer may see it as a death sentence or refuse chemotherapy and surgery because they think those treatments can kill.
Cancer is extremely disruptive: it involves treatment and changes to relationships, careers and lifestyles. It can have a huge impact on future goals. The way people choose to make sense of all this is the difference between being a "survivor" and being a "victim".
Choosing to identify as a cancer survivor in Nigeria is choosing to have a voice or an active role. It may empower a person and make them more resilient.
Still, there is a need for support and for Nigeria to reduce the burden of cancer through its national plan.
Candi Nwakasi, Professor of Human Development and Family Sciences, University of Connecticut
