Case Study: The Career Life Process after Treatment of Breast

Cancer Survivors

Zulfah Purwina

and Dian Ratna Sawitri

Department of Psychology, Universitas Diponegoro, Semarang, Indonesia

Head, Center for Career and Capacity Development Studies, Department of Psychology,

Universitas Diponegoro, Semarang, Indonesia

Keywords: Case Study, Career Resilience, Cancer Survivor.

Abstract: This study is a qualitative research with case study data analysis which aims to see the pattern of career life

processes of breast cancer survivors after treatment. Subjects in this study are two people who are middle-

aged women, working women, and have been declared cured of breast cancer taken by purposive sampling

technique. Data collection is taken by interview and observation method. The results of the interview show

that the two subjects have different patterns of life processes in interpreting career resilience that proved by

the appearing of four concepts from the results of case study analysis namely social support, self-

management, self-acceptance and optimism. The conclusion is that every cancer survivor has a different

career resilience experience because of the different patterns of life processes. Recommendations for scientific

development referring to research results are expected to be able to make psychosocial intervention steps for

breast cancer survivors who want to continue their careers.

1 INTRODUCTION

Cancer is one of the main causes of death in the world.

According to data from the International Agency for

Research on Cancer (IARC), it is found that in 2018

there were 9,555,027 cancer deaths in the world. In

Indonesia, the prevalence of cancer is also quite high.

According to data from Basic Health Research

(2018), the prevalence of cancer increases from 1.4%

to 1.8%. During 2010 - 2015, breast cancer, cervical

cancer and lung cancer were the three highest

diseases with the number of cancer new rising cases.

Starting the various types of cancer that are the

most cases at Dharmais Cancer Hospital Jakarta, breast

cancer is in the first position in the last 10 years until

2016 (Basic Health Research, 2016). Based on these

data, the researchers see that breast cancer is a type of

cancer with the highest cases but not a deadly one.

The discussion about breast cancer becomes very

important because the breast itself has an important

meaning for a woman. Breast is one of the secondary

sex characteristics which is not only an identity but

has its own value both in terms of biology,

psychology, psychosexual and psychosocial (Bagheri

& Mazaheri, 2015). All aspects of a breast cancer

survivor's life are significantly affected by the

traumatic experience of breast loss which is an

attribute of femininity (Shetter et al, in Sadeghi et al,

2018). Most breast cancer survivors are influenced by

pessimistic mind, hopelessness, loneliness, and fear

of death because of thoughts about the disease that

haunt them (Yalom & Vinograd in Sadeghi et al,

2018). However, a qualitative study conducted by

Lam, et al (2018) revealed that most women with

breast cancer do not all look bad, some of them

survive. Survive toward the pressure is an attitude in

dealing with illness by continuing to live the life well,

optimistically and wisely.

A cancer survivor is person who has ever been

diagnosed with cancer, either who has completed

treatment or currently had treatment (American

Cancer Society, 2016). The journey of a cancer

survivor is marked by 3 (three) general phases, active

treatment and recovery, life after recovery including

survivors who are disease-free or who have stable

disease, and the most serious stage of cancer and end-

of-life cancer (Rock, 2012). The American Cancer

Society (2014), defines cancer survivors as people

who have been diagnosed with cancer and have

successes to get through a balance in life. According

to the American Society of Clinical Oncology (2011),

every cancer survivor has its own concerns and

Purwina, Z. and Sawitri, D.

Case Study: The Career Life Process after Treatment of Breast Cancer Survivors.

DOI: 10.5220/0010808100003347

In Proceedings of the 2nd International Conference on Psychological Studies (ICPsyche 2021), pages 5-13

ISBN: 978-989-758-580-7

challenges in their social life. They are relationships,

when someone has completed cancer treatment, some

survivors need different types of support like never

before. In addition, the colleague also has an effect.

Back to work is a sign of getting back into a normal

routine and lifestyle, and most survivors need their

jobs to get salaries and pay health insurance. Some of

the survivors feel that they are treated differently or

unfairly. Others think that they are less capable of

doing the job. The impact is they feel uncomfortable

when dealing with colleagues or embarrassed in

changing physical appearances.

Researcher conducted a preliminary study of two

people, the first subject is on March 7, 2018 with the

initials S (45 years old) at 10.00 WIB at Siloam

Semanggi Hospital with the aim of seeing a simple

case related to psychological condition of a breast

cancer survivor. Subject S is an employee of a

company in Jakarta who has radiation treatment at the

hospital every day. The researcher had several short

interview with subject S and found three main majors

that give impact to breast cancer survivors. They are

emotional regulation, social support, and optimism.

In addition, the researcher also conducted a

preliminary study with a survivor R (41 years old)

who is a teacher and member of the Komunitas YKPI

(Yayasan Kanker Payudara Indonesia). She

explained that activities in the community have had

an impact on survivors in more positive way, such as

assisting in breast cancer seminars, conducting early

detection of breast cancer, making handicrafts whose

products will be donated to the YKPI program, and

activities to share experiences with the fellow.

From the results of the preliminary study

interview, the researcher finds that someone suffering

from breast cancer has different backgrounds and

they are women who have quite a lot of activities even

though they are sick. This is supported by the results

of research by Taylor, et al (in Cucarella & Perez,

2015), which states that 70% of people who have

been diagnosed with breast cancer had changes in life,

and 60% are changes in a more positive. Kelly (2018)

stated that although in life people often do not have

power over the situation that happen to them, such as

a women diagnosed with cancer, but each woman can

choose how to rise and adapt to deal with these

condition. People ability to choose to rise and adapt

to this condition is called resilience. The results of

research conducted by Fradelos et al (2017) stated

that cancer symptoms survivor have a lower level of

resilience compared to one without cancer symptoms.

In this case, people can step out of their passive

position and begin to face challenges and to manage

their lives (Connor et al in Sadeghi et al, 2018).

Cancer has been shown to have a major impact on

survivors experiences and feelings about work. Some

survivors struggle with anxiety and depression, while

others rely on good adaptation (Stepanikova, 2016).

Women who survive breast cancer generally have a

desire to return to their previous roles (Tiedtke et al.,

2010), but this is not always supportive. Stepanikova

et al., (2016) found that many long-term cancer

survivors experience a 'career derailment'. They are

unable to resume their careers, and have no choice but

to retire or find an entirely new way of earning a

living. Stewart et al., (in Woodhouse & Yates, 2020 )

found that 18% of breast cancer survivors were

motivated to make a career change, and 5% reported

that they were afraid to make a career change if they

got sick again.

According to research by Edward et al., (in Jin &

Lee, 2020) after return to work, cancer survivor

experience physical functional limitations and

decreased cognitive function due to treatment.

Financial and temporal burdens in managing work

schedules and treatment that cause fatigue so that

work stress increases. Fatigue is a factor that causes

individuals to have the desire to resign from work,

therefore, this side effect of fatigue must be managed

immediately (Lee et al, 2017).

Career issues are being particular concern for

breast cancer survivors because it can be an indicator

of life quality to represent themselves returning to a

normal life after recovery, representing hope for the

future, providing access to social support, health

insurance, and financial resources (Fantoni et al.

2010). Employment and career issues may be

important components of post-treatment quality of

life for young survivors, who may have 25 years or

more of service remaining. Young survivors have the

worse prognosis than the older one, including a higher

risk for cancer recurrence and death, more reduction

in cognitive function, reproductive health, more

financial problems, and more social relationships

interference (Matthews et al, in Raque-Bogdan,

2015).

Tiedtke's research (2010) explains that some

women re-evaluate the role of a job in their life after

they had breast cancer, so the job adjustments can

help them to maintain their jobs during illness and

recovery. Liebenberg & Ungar (in Maree & Venter,

2018) said that the emergence of resilience in career

studies replace the focus of stress and danger to

designing interventions that aim to increase strength

and build individual capacities. Career resilience

refers to a sense of overcoming obstacles and

difficulties that affect someone confidence, need for

achievement and independence (Paul & Garg, 2014).

ICPsyche 2021 - International Conference on Psychological Studies

Career resilience is an important psychosocial career

resource that facilitates a personal suitability to the

environment, development and growth at every age

(Bezuidenhout, in Coetzee, 2015). Van Vuuren &

Fourie (in Coetzee, 2015) viewed career resilience as

a product of an individual ability to adapt in changing

circumstances, accept the job with organizational

changes, return to work with new-different people,

show the confidence and willingness to take risks.

This research becomes very interesting because

the concept of career resilience is very rarely studied.

According to this background, the researcher sees that

the patterns of individual life processes are different

from each other because they have different life

experiences. Researcher make a discussion about

career resistance by comparing 2 (two) subjects’ life

who became breast cancer survivors. This study aims

to look at the career life patterns of post-treatment

breast cancer survivors.

2 METHOD

This study uses a qualitative approach with interview

and observation techniques. Characteristics of the

subjects in this study are women who have been

diagnosed of breast cancer or called cancer survivors.

They have undergoing medical treatment process

with an age range of 40-55 years. Subjects are from

different family backgrounds, ethnicities, and cancer

stages. Researcher uses 2 (two) subjects in

accordance with the characteristics of the study (with

2 informants each). The researcher uses research

triangulation to check on the consistency of the

interviews results with the subjects. Researcher use

triangulation of data sources to explore the truth of

certain information by using various data sources

such as documents, archives, interviews,

observations. In addition, the researcher also

interviewed more than one subject who were

considered to have different points of view. The

observation technique used is by making direct

observations of the object of research such as: living

conditions and facial expressions.

3 DATA ANALYSIS

The data analysis technique that will be carried out in

this study uses Creswell. Stake (in Creswell, 2015),

says there are four forms of data analysis and their

interpretation in case study research, namely: (1)

Category collection, the researcher looks for a

collection of data examples and hopes to get meaning

that is relevant to the issues that will arise; (2) Direct

interpretation, the case study researcher looks at one

example and draws meaning from it without looking

for many examples. It is a process of pulling data

apart and putting it back together to make it more

meaningful; (3) Researchers form patterns and look

for equivalence between two or more categories. This

equivalence can be implemented through a 2x2 table

showing the relationship between the two categories;

(4) In the end, the researcher develops naturalistic

generalizations through data analysis, these

generalizations are drawn through people who can

learn from a case, either their own case or apply it to

a population of cases.

4 RESULT

The results of data interview analysis using grounded

theory have 4 (four) concepts, they are social support,

optimism, self-management, and self-acceptance.

The concept of social support consists of 3 (three)

categories, family relationships, friendship

relationships and romantic relationships. Self-

acceptance consists of 1 (one) category, self-

disclosure. Self-management consists of 2 (two)

categories, emotion regulation and motivation.

Optimism consists of 2 (two) categories, hope and

confidence. Meanwhile the property of self-

acceptance concept is the property of forgiveness

which in the category of self-disclosure. The property

of self-management concept is the gratitude which in

category of emotion regulation.

Based on those data, the researcher views at the

pattern of post-treatment career life processes in MY

subject which had her own uniqueness. When MY

had treatment, she received social support from

family, peers, and husband who made her believe in

her recovery. The kinds of social support that MY got

from family were her mother helped her every day to

make fruit and vegetable juices that should be

consumed, her two children who always made her

happy when she was sad, her new husband who

always accompanied her during her periodic check-

up, and her colleagues who often visit her to give

encouragement while she had treatment. MY was a

career woman who worked in a company before she

had breast cancer. Now she required to minimize her

work. When MY was declared clear of her illness, the

social support for a career that she received in social

relations circle was not as she wants. She had debate

with her family because she wanted to back to work

while her family want her to stay.

Case Study: The Career Life Process after Treatment of Breast Cancer Survivors

The family was very worried about MY's

susceptible condition. However, MY received social

support from colleagues and the community to be

able to have activities as usual. MY was supported by

her friends to back to work, even though colleagues

had different concerns for MY before and after being

diagnosed with breast cancer. In addition, MY think

that she really had to work as she had responsible for

her family because MY should provide life for her

children after she got divorce from her ex-husband.

MY was also a member of the breast cancer survivor

community which made she had a different

perspective on her illness. Some of her friends in the

community were career women. MY saw that they

had the passion to work. MY said that illness is not an

obstacle for someone to work as long as they know

the portion of work that is not the same as before.

Social support was the first thing that MY think when

she was suffering from cancer until she was clear and

she could back to work. Here is the statement that the

researcher gets from MY condition:

"It's like.... I was happy because my process

from the beginning until I clear, my closest

circle helped me a lot. They really support me.

None keep away from me or hostile because of

my illness. So yeah I really enjoy it. I had job

before, and after I diagnosed, I should stop to

work but I was so grateful because my family,

my colleagues and my boy friend really

support me.. Now, I’m back.. even I'm out of

money because of my recovery, my family

really help me to solve that problem.."

Although what happened to MY was not

something easy, the social support that she got in her

social relationships made she accepting more. After

MY had the illness that weakened her, she went

through a divorce because of her ex-husband's was in

affair. MY should stop to work but had to pay for

hospital and children's education. Those situation

made her devastated. However, the social support

from her closest make her believe that she can

through her illness. MY began to realize the emotions

slowly. She wanted to against her life, she often think

that God has been very unfair in giving life, she cried

every day because she can't stand to face hard

situation, and finally she was able to forgive the

wounds in the past. The process of accepting her

situation made MY enjoy more in live the life. The

following statements are described MY's condition:

"I was so upset.... when I just got diagnosed,

my husband was in affair, so we got divorce. I

was very depressed.. I have two children, what

can i do with my condition then? I was so

angry. I was so disappointed with my

condition like....God... why this should happen

to me? Why not someone else? My life was so

difficult, isn't it enough? Finally... I was just

surrender. I always pray and realize that I can

go through this situation. After I got divorce, I

met someone and I can forgive everything in

the past. Alhamdulillah.."

When social support and self-acceptance are exist,

MY is able to take the control. This is showed by how

MY controls her emotions. When MY was working,

she had some emotions that sometimes enterupped

her such as she often got angry to her colleagues. MY

think that when she had cancer, she got angry easily.

However, MY slowly learned to put her emotions in

order. When MY was clear of cancer, she also had

self-possessed. Her negative emotions slowly

disappear because of her gratitude. Even though MY

is a cancer survivor, she is proud because she can still

have a career. Here are the following statements from

MY's condition:

"I thought that life must go on.. I was lucky and

grateful. I couldn’t take my control at the first

and got angry to everyone..hahahaha. I was so

stress !! I was out of money to pay the

treatment, I should stop working to focus on

my recovery. I'm better right now and happy

to back to work..to earn money. I am the first

children in my family. I should make life for

my children..they are my motivation to back to

work.."

Those changes make MY more optimistic in

living a life, especially at work. MY think that she has

to work hard to support her two children, although in

the future MY will be proposed by a man, but MY did

not want to be dependent women. MY's motivation to

back to life came from inside and outside. MY's

biggest motivation was from family. Besides that,

MY also made new hopes for his future life. MY think

that the past is a lesson. This failure and despair made

her stronger in life. Currently, MY think more

confident and ready to face the challenges of the

career changes that come after MY became a breast

cancer survivor. Here are the following statements

from MY's condition:

"..hahahaha I have to stay optimistic..just be

sure first, things will be realized later. Of

course I have hope for the future, I want to

have new husband for my children. I can't go

through this alone. The tuition fee is very

expansive nowadays..and..I'm completely

believe that not all women can go through this

ICPsyche 2021 - International Conference on Psychological Studies

ups and downs like me. Especially something

related to illness.."

The results of data interview analysis using

grounded theory have 4 (four) concepts, they are

social support, optimism, self-management, and self-

acceptance. The 2 (two) categories of social support

concepts are family relationships and friendship.

While 2 (two) categories of optimism are motivation

and self-efficacy. The 2 (two) categories of self-

management are emotion regulation and stress

coping. Self-acceptance consists of 1 (one) category,

self-adaptation. Meanwhile the property of social

support concept is the property of gratitude which in

the category of family relations. The property of

optimism concept is the property of hope which in the

category of motivation.

Based on these data, the researcher viewed at the

pattern of post-treatment career life processes in NK

subject who were different from MY. The pattern of

post-treatment career life processes in NK also has its

own uniqueness. Starting from social support

obtained from family relation and friendship. NK's

family is a harmonious family because she marriage

to her husband has been long enough. Every time she

had a problem, she always discussed it with her

family. The family always gave encouragement to her

by giving encouraging words, taking her for

treatment, checking regularly, and reminding her to

live a healthy life. In addition, her social relationship

with friends in the community is also quite good. She

became one of the administrators in breast cancer

community. The social support provided by her

friends in community made her think like she had a

companion. In terms of work, she got relief from the

company regarding working time. The following is

the statement from her condition:

“I get along with my family, because my

husband and I have also been married for a

long time. Also, the children have grown up,

so they already understand the condition of

their mother.. So far, the social support that I

have received is from my family.. then..

colleagues, and friends in the community.

Yes… I feel really grateful for my condition at

that time. There is someone who strengthens

me on my down condition.."

The social support obtained from social

relationships made NK very grateful for the current

situation. As long as she had treatment for breast

cancer and had become a cancer survivor, she had not

lost her job. She was grateful because with the

changes in her life pattern she had, she was still given

the opportunity by God to be able to live her life like

a career woman in common. Therefore, she made it a

habit to start a healthy lifestyle as a gratitude for the

social support she received so far. The social support

that she got made her again optimistic to live a life

after treatment.

NK's optimistic feeling came from the motivation

she got every day. The motivation that she got usually

came from social media and recitations that she often

followed. Her biggest motivation to be optimistic to

live her life also came from her family. She has two

teenage children who still have a long future ahead.

This situation made her be able to help her husband

for living through her job. In addition for motivation,

her optimistic feeling also came from her self-

confidence in living life. She believed in her abilities

in terms of helping the family's needs. However, on

the other hand, she did not feel confident in ability to

educate children. She often think like a failure in

educating children because she only had short time

for children at home because of her job. The

following is the statement from her condition:

“…if it wasn't for them, I don't know what it

would be.. I feel like I just have a new spirit to

continue my life. Moreover, when I got cancer,

many things changed.. so I was lucky, thanks

to them, I was able to get to this day.. and still

more optimistic.. because after all I also have

to back to work, right, earn more money..

mmm, I have to go through it.. The tuition fee

is also expensive now.. even though my

husband works, I also don't want to stay at

home.. because I'm bored too, later on, stress

will continue to make strange

thoughts...hehehehe".

NK's optimism made it easier for her to manage

herself. She admitted that she was an easily angered

person. This was due to the large workload that she

had and the effects of cancer treatment that made her

more sensitive. But over time, she became easier to

control her emotions. In addition, currently she had

good stress coping. In the past, when she was tired of

the burdens of life she was living, she often took it out

on her children and husband. However, now she think

lighter in her life because she had joined the

community. She took knitting courses and

community activities which reduced her stress. In

addition, she also routinely did sports for coping.

Sometimes, her husband also invited her to just relax

with their family to get rid of boredom with her

current condition. The following is the statement

from her condition:

"It was awful! When I was sick, I became a

sensitive person. Eager to get angry .. like very

Case Study: The Career Life Process after Treatment of Breast Cancer Survivors

sensitive. I also had a job... well, maybe

because I was tired, there were too many

duties from the office, finally I got angry to my

children.. hehehe.. It's just that... they knew

how their mom is hehehe. So that's why, my

husband also understands then.. sometimes

once a week or twice a week depending on

mood, my husband took me for walks.. now I

like did exercise every morning. I even bought

the equipment.. so if I had exercise or went for

a walk, it made my heart condition better..”

After the self-regulation process, NK could accept

the condition. The life process had by NK made her

more appreciate a life. At that time she think that there

were many things that should be improved from

herself and this moment brought a big change to her

life. Accepting yourself from mistakes in the past,

makes you easier to adapt to the environment you are

living in today. Although currently she had been

declared clear of breast cancer, she still had to adapt

to a new pattern of life. She slowly recognized the

new habits until she think comfortable with what she

was currently doing. Her self-adaptation in her work

is not an easy thing, but she continued to life it

gracefully. The following is the statement from her

condition:

"Now is mmm, yes.. more grateful for His

favor anyway. It's like I've been given a really

tough thing, and now I have to live a new life.

Yes, I feel that if.. oh yes.. this is my new

journey given by God, so I have to accept it.

Then, there are many things that can't be done

like before... so I have to adapt to that. Like,

for example, a job.. I didn't have cancer

before, wow.. I was a workaholic. When I got

cancer, that's like something remind me if it's

enough for work ... because my physic is really

weak. Now that I have been given the

opportunity from God to heal, I have to be very

careful... from the start, my intensity of work

is no longer like before And now I'm also

starting to get a healthy lifestyle."

5 DISCUSSION

The lifestyle changing had by MY and NK such as

raising physical activity or improving a healthy meal

could be done by the existence of social support.

However, health challenges that drive the need for

lifestyle changes made relationships shifting and also

isolation from friends and family made it difficult for

individuals to find support (Fong et al, 2016). Social

support created positive experiences that can directly

improve the whole of life quality (McDonough et al,

2014). The women being treated for breast cancer

also had job discrimination including failure to be

employed, rejection of job promotions, unwanted

transfers, or benefits denial which can affect the

perceptions of social support in this critical and

difficult situation (Bouknight et al, in Fong et al,

2016). It happened to NK in her career life.

She had rejection of job promotions and

allowance diminution that she usually received before

becoming breast cancer survivors. In contrast to MY

who was still in a normal career life without any

failures at work. According to a longitudinal study,

Courtens et al. (in Fong et al., 2016) assessed the

social support in mixed cancer survivors such as

(breast, colon, prostate, lung, and cervix) make the

amount of support network (eg, quantity) and amount

of social-emotional support (e.g., quality) tend to

descend over the time. Even the social support also

decreased after treatment, this did not happen to NK

and MY. Although currently they had been declared

clear of breast cancer, social support is still exist.

People who received direct guidance from family,

they think motivated, optimistic, and reassured that

they believe in their ability to go through this

situation. The role of the older people, often made a

positive and supportive feeling that helps the survivor

through difficult situation. People also learn not to do

something by observing the consequences of negative

family behaviors. Over the time, the career life of the

two subjects had changed from early life when

diagnosed of cancer until they were clear of cancer.

Those changes raised their own concerns and

challenges in their lives. This is in line with the results

of research from the American Society of Clinical

Oncology (2011) which states that when a survivor

has completed cancer treatment, some survivors need

a different type of support than before.

Cancer has an impact on people and those who

closest to them. Those statements can change the way

someone communicate to others or vice versa. Some

friends may become closer, while others may keep

away. Families may be overprotective, or they may

have run out of support. According to the American

Society of Clinical Oncology (2011), returning to

work is a sign of getting back into a normal routine

and lifestyle. Some survivors feel that they are treated

differently or unfairly. Others think that they are less

capable of doing the job. The impact is they feel

discomfort when dealing with colleagues or feel

embarrassed about changing the physical

appearances. This is different from what was happen

ICPsyche 2021 - International Conference on Psychological Studies

to NK and MY, the relief given by the company

makes them comfort in doing their jobs.

As we discuss before that many survivors face the

challenges when they continue their financial life.

Those challenges include job discrimination,

insurance difficulties, and persistent health

limitations that obstruct productivity (Gulbrandsen et

al, in Stepanikova et al, 2016). Financial instability

caused by medical expenses, absenteeism, and illness

related to job changes obstruct the ability of survivors

to adapt in financial and careers (Stepanikova et al,

2016). Further literature on cancer survivors suggests

that back to work is an important dimension of social

recovery after cancer but those work-related and

financial outcomes are also considered important

(Duijts et al, 2013). Feuerstein et al (2010) argue that

outcomes such as employability, job performance,

and retention at work (along with return to work) are

related to a number of factors, including demographic

background, legal, organizational positioning,

financial, physical condition, cognitive functional

ability , emotional and interpersonal, work demands,

and work environment. Moscowitz et al (2014)

explain that problems at work are associated with the

lower levels of employability. Meanwhile survivors

who report their condition at work are more likely

lose or leave their jobs because of the illness. Cooper

et al (2013) finds that back to work align with the

work-related-things, clinical, and psychological

factors that influences are varied among different

types of cancer.

Some of those challenges are rarely discussed. For

examples are career goals and financial postponed,

career derivation, lack of career direction, and limited

mobility and job advancement. Same as other cancer

survivors case (Zebrack et al, 2014), financial

problems are common. Self-expenditure and lack of

income represent a significant financial burden for

some survivors and families although most of them

are able to partially cover their financial losses

through their own or family savings and employer or

government benefits. The difficulty of health

insurance is another very stressful challenge. The

stable health insurance proves to be a strong

protective factor. Ceilleachair, et al (2012) emphasize

that support from employers plays a major role in

back to work process and in overall economic

adaptation.

Cancer survivors who work in a company are not

only a problem for the them and their family but also

for the managers they work for (Schultz et al, Hamzah

et al, 2020). The employment status of cancer

survivors have important implications for society, the

labor market, organizations and themselves, as the

impacts for their economic, social and psychological

(Shim et al, 2019). At the individual level, any job

interruption due to cancer and its treatment threatens

their personal income and economic (Moran et al,

2011). The meaning of work and the perception of

illness are individually related and influence the

choice to back to work. Returning to work may serve

as a way to move forward, out of the “sick role” and

return to a normal (Blinder et al, 2012). Others may

ask whether the effort required to back to work is

worth or find meaning in returning to work after had

a life-threatening illness (Tiedtke et al, 2012). Self-

perceived constraints and self-assessment of ability to

work are also factors that might influence survivors'

choices to return to the workforce (Sun et al, 2016).

Van Vuuren & Fourie (in Coetzee, 2015) view

career resilience as a product of an individual's ability

to adapt to circumstances changing, the work

acceptance with organizational changes, return to

work with new-different people, and demonstrate

confidence and willingness to take risks. In this case,

every cancer survivor who has been declared clear of

cancer must adapt to circumstances changing. As

same as subjects MY and NK had. They have to

return to restore economic conditions because of the

economic crisis had by the subjects while they were

in treatment. MY and NK subjects had to re-adjust

their life by returning to work in normal

circumstances. According to the results of Lidya's

research (2013) that the more breast cancer survivors

believe positive things will happen in their life the

more their impression and perception of their

physical, psychological, social, and environmental

health conditions are related to their breast cancer will

get better too. This is aligning with the results of data

analysis from both subjects that when they believe in

positive things in life, their impression and perception

of life will be positive. However, those aspects have

different patterns.

Those factors are related to personal values and

influenced by psychosocial factors such as

depression, anxiety, and stress. Thus important to

consider when designing interventions to support

women who are considering returning to work after

breast cancer treatment. The number of people living

without a cancer diagnosis is increasing every year,

and this has an impact on human resources. The

strategies to achieve comprehensive human mental

health should be considered to strengthen the

development of Human Resources globally,

including the establishment of strong leadership for

effective internal and external management and using

advanced communication and technological in health

care. The organizations should apply interventions to

Case Study: The Career Life Process after Treatment of Breast Cancer Survivors

facilitate cancer survivors return to work so they can

contribute as effective as before.

This study has several limitations including the

time available to complete this research is relatively

short, so researcher cannot conduct in-depth

interviews. Researcher did not conduct focus group

interviews because they did not have enough time to

do the research. In addition, the discussion of the

theories of the emerging concepts is not so deep. The

results of this study are used as advice for the

community, especially breast cancer and cancer

survivors. The career preparation should pay attention

to aspects that often appear in the career resilience

process of breast cancer survivors. The use of career

resilience theory can be used as a reference for the

development of intervention programs for cancer

survivors. The career resilience has a great influence

on the cancer survivors life who work.

6 CONCLUSION

Researcher concludes the process of post-treatment

career resilience in each subject. The results of this

study answer the questions and theoretical framework

of the problem because it has found a pattern of career

resilience processes for breast cancer survivors after

treatment. Although some of the topic that happen to

the two subjects has similarities, the pattern of life

processes of each subject would be different due to

their perspective life experiences.

The future research can discuss more about the

theories of the appearing concepts. The subjects taken

must be many more, not only in Jabodetabek area, but

involve subjects outside the area so the comparison

between cancer survivors in urban areas and cancer

survivors in the regions can be seen. The interviews

can also be conducted more deeply to make analysis

of the results more varied with the aim of enriching

the research results. Recommendations for scientific

development referring to research results are

expected to be able to make psychosocial intervention

steps for breast cancer survivors who want to

continue their careers.

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