EAS Journal of Nursing and Midwifery Abbreviated Key Title:EAS J Nurs Midwifery ISSN: 2663-0966 (Print) & ISSN: 2663-6735 (Online) Published By East African Scholars Publisher, Kenya Volume-2 | Issue-3 |May-June -2020 | DOI: 10.36349/EASJNM.2020.v02i03.004 *Corresponding Author: Jek Amidos Pardede 173 Research Article Family Support and Self-Esteem of Patient with Breast Cancer Jek Amidos Pardede*, Marthalena Simamora, Galvani Volta Simanjuntak 1Nursing Study Program, Sari Mutiara Indonesia University, Indonesia Article History Received: 13.04.2020 Accepted: 26.05.2020 Published:28.05.2020 Journal homepage: https://www.easpublisher.com/easjnm Quick Response Code Abstract: Background: Breast cancer brings negative impacts to women, particularly those who have undergone chemotherapy, not only physically but also mentally. The negative impacts on patients’ mental include a feeling of being failed playing their role as a woman, not having abilities to do anything, low self-esteem, and confidence loss. Thus, family support is necessary in anticipating negative self-esteem in breast cancer patients. Family support helps the patients maintain and increase their self-esteem. Objective: The objective of this study is to analyze the relationship between family support and self-esteem in patients with breast cancer undergoing chemotherapy at Haj Adam Malik Central Hospital. Methods: The study employed analytical correlational design with cross sectional approach. The research samples included all breast cancer patients who were undergoing chemotherapy at Haj Adam Malik Central Hospital in Medan City. The sampling selection of this study used total sampling technique; hence the total sample number was 34. Spearman test was performed in data analysis. Result: The study suggested that 64.7% of the respondents received good family support and 66.7% of the respondents had high level of self-esteem. Besides, it was also obtained that there was a moderate correlation between family support and self-esteem of patients with breast cancer (p=0.01< α 0,05 with r = 0.432). The results imply that the better family support is the higher the level of self-esteem of patients with breast cancer undergoing chemotherapy will be. Therefore, it is recommended that each of family members gives support to patient in the form of care, information, and instrumental support, so that the patient will have better self-esteem and quality of life. Keywords: Family support, Self-esteem, Breast cancer. Copyright © 2020 The Author(s): This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY-NC 4.0) which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited. INTRODUCTION Breast cancer is a disease caused by uncontrolled growth of breast cells or breast tissues (Taufan, 2011). The risk factors that are associated with breast cancer include reproductive factors, endocrine factors, diet and genetic or family health history (Rasjidi, 2009). World Health Organization (2013) reported an increasing trend of incidence of breast cancer in countries throughout the world from time to time. In 2012, the number of breast cancer cases among women was 17 million and increased to 21 million cases in 2013. It is suggested that there are nearly 230.000 new breast cancer cases every year in Europe, while 170.000 new cases are found each year in the United States. Based on the estimate of Globocan, International Agency for Research on Cancer (IARC), there will be 18.1 million new cancer cases (17.0 million cases excluding nonmelanoma skin cancer) and 9.6 million death cases caused by cancer (9.5 million cases excluding nonmelanoma skin cancer) in 2018. Breast cancer has become the most common type of cancer that caused the highest mortality rate among women in Indonesia (Masriadi, 2016). Overall, the prevalence of cancer in Indonesia is 1.4 per 1000 people; meanwhile the province with the highest prevalence of cancer is Yogyakarta with the prevalence is 9.6 per 1000 people. In Medan City, approximately 786 cases of cancer were found in 2014. The result of the preliminary survey conducted by the researchers suggested that there were 458 patients suffering from breast cancer at H. Adam Malik Central Hospital (Medical Record of Haji Adam Malik Central Hospital). Breast cancer affects human life in various sectors on daily basis. Breasts are not only for breast milk production, but also have aesthetic value for women so that they bring psychological meaning to women (Hawari, 2004). Physical changes caused by the disease, procedures and medical treatment results in psychological problems in breast cancer patients which eventually affects their self-esteem (Kamelia, 2012). In many cases, patients with breast cancer perceive negatively on themselves leading to negative perceptions on their roles as housewife or wife. On the Jek Amidos Pardede et al., EAS J Nurs Midwifery; Vol-2, Iss-3 (May-June-2020): 173-177 © East African Scholars Publisher, Kenya 174 process of undergoing chemotherapy, it is likely that patients grow various kinds of negative feelings and thoughts, such as low self-esteem, anxiety, hopelessness, rejection, and enthusiasm and confidence loss. Therefore, support from family members and society will help the patients undergoing chemotherapy to improve their self-esteem (Listyowati, 2012). Family plays crucial role in how patients shape their self-esteem. The self-esteem of patients with breast cancer is the reflection of how family members regard the patients and their disease. Each of family members should be able to teach the patients how to accept their health condition and commit to medical treatment procedures for their healing. If family has a holistic and consistent positive self-esteem, it will provide a loving and caring environment to the patient. With family support, it is easier for the patient to carry out their activities and overcome challenges related to the disease. Besides, the feeling of being loved and cared brings positive emotions and helps them deal with their problems (Stuart, 2014). Based on the discussion, it is intriguing for the researchers to analyze the relationship between family support and self-esteem in patients with breast cancer undergoing chemotherapy at Haj Adam Malik Central Hospital in Medan City. RESEARCH METHOD This study was an analytical correlational study using cross sectional approach. The research population was breast cancer patients undergoing chemotherapy at Haj Adam Malik Central Hospital in Medan City. Through total sampling technique, 34 people were selected as research samples. A set of questionnaire were administered to measure the relationship between family support and self-esteem of patients with breast cancer who underwent chemotherapy. The collected data were analyzed using Spearman Rho Test. RESULTS The demographic characteristics of respondents in the study were majorly in the age range between 46-60 years old (47.1%), married (73.5%), and senior high school graduates (55.9%) (Table 1). It was also obtained that the category of family support toward breast cancer patients undergoing chemotherapy was majorly good, 64.7% (Table 2), while the level of self- esteem of patients with breast cancer who underwent chemotherapy was high 61.8% (Table 3). The results of statistical test using spearman correlational calculation obtained that p= 0.01 (p<0.05) and r= 0.432 (0.4 – 0.5, moderate correlation strength) indicating that there was a significant correlation between family support and self-esteem of breast cancer patients undergoing chemotherapy at Haj Adam Malik Central Hospital. Therefore, it is suggested that the better family support is, the higher the level of self- esteem in breast cancer patients undergoing chemotherapy is. Table 1. Frequency Distribution of Characteristics of Cancer Patients at Haj Adam Malik Central Hospital Characteristics n % Age - 30 - 45 years - 46 - 60 years - > 60 years 10 16 8 29.4 47.1 23.5 Marital Status - Single - Married - Divorced/ Widowed 3 25 6 8.8 73.5 17.6 Education - Elementary - Junior High - Senior High - Higher Education 2 8 19 5 5.9 23.5 55.9 14.7 Total 34 100 Table 2. Frequency Distribution of Family Support of Breast Cancer Patients at Haj Adam Malik Central Hospital in Medan City Family Support n % Good Bad 22 12 64.7 35.3 Table 3. Frequency Distribution of Self-esteem of Breast Cancer Patients at Haj Adam Malik Central Hospital in Medan City Self-esteem n % high low 21 13 61.8 38.2 Table 4. The Result of Spearman Test on Family Support and Self-esteem of Breast Cancer Patients Undergoing Chemotherapy at Haj Adam Malik Central Hospital in Medan City Family Support Level of Self-esteem Total r p High Low n % n % n % Good Bad 17 4 50.0 11.8 5 8 14.7 23.5 22 12 64.7 35.3 0.43 0.012 Total 21 61.8 13 38.2 34 100 DISCUSSION Family Support Data in Table 2 shows that the majority of the respondents received good category of family support. Many of the respondents reported that they received advices from their family about their medication. Their family also gave information related to their disease, reminded the patients to undergo chemotherapy and medical check-ups regularly. Besides, their family also accompanied the patients undertaking medication procedures. Family support plays crucial role in the recovery process of ill family member, since it lifts Jek Amidos Pardede et al., EAS J Nurs Midwifery; Vol-2, Iss-3 (May-June-2020): 173-177 © East African Scholars Publisher, Kenya 175 patient’s motivation and improve health rate (Husni, 2012). The result of this study is in line with that of Sari, et al. (2012) which found that most of breast cancer patients received good family support (22 patients or 64.7%). It can be implied that family support is one of the important aspects in patients who undergo chemotherapy. It is because the support from their family can encourage patients during their chemotherapy process. The patients feel loved and cared despite their poor health condition. Self-Esteem in Breast Cancer Patients The results obtained that the level of self- esteem of patients in this study was majorly high (61.8%) (Table 3). The patients reported that they felt worthy, confident, and positive with their situation. Besides, they also reported that they could communicate with their family members and others. The patients also received support, love, and care from their family. The result of this study according to the result of the result was conducted Leite (2015) about evaluation of self-esteem in cancer patients undergoing chemotherapy treatment, the research found higher frequency of patients with high self-esteem, but some of them showed average or low self-esteem. The scale showed a Cronbach's alpha value of 0.746, by considering its acceptable internal consistency for the evaluated items. No independent variables showed significant associations with self-esteem. Low self- esteem may occur because there is self-rejection, a feeling of being incapable, shameful, and not worthy. Occasionally, patients find it is difficult to accept their condition, so that it is necessary to teach and motivate patients to be aware of their health status and commit to the medical treatment (Pardede, et al. 2015). Breast cancer is still one of the most common health issues among women in Indonesia. Woman who is diagnosed to be suffering from breast cancer needs adaptation to her condition. A factor affecting adaptation of a newly diagnosed breast cancer patient is optimism toward healing. This factor is necessary in breast cancer patients because it plays a crucial role in upbringing hope on patient’s healing (Wardiyah, 2014). Cancer is not just a disease that affects the body, it is so terrifying to the extent that it affects a person’s confidence in their ability to be in control of their life. (Lee, 2000). Self-esteem is one of the psychological element which may deteriorate when the patient tries to adapt to the problem, deal with their suffering and take control over incidence that has resulted because of the disease. (Leite, 2015). The Relationship between Family Support and Self- Esteem of Breast Cancer Patients Statistical analysis using Spearman correlational calculation obtained that p value = 0.01 (P<0.05) with r= 0,432 indicating that there was a significant correlation between family support and self- esteem in breast cancer patients undergoing chemotherapy at Haj Adam Malik Central Hospital in Medan City in the year of 2017. The results suggested that the correlation strength was moderate (0.4-0.5) The correlation and positive contribution found in the study was because most of the respondents received good family support and had high self-esteem. It was found that 22 (64.7%) out of 34 respondents undergoing chemotherapy received positive support from their family, and 17 (50.0%) out of 34 respondents had high level of self-esteem. Only 5 respondents (14.7%) had low self-esteem. In addition, from the total of 12 respondents with bad family support, 4 respondents were suggested to have high self-esteem (11.8%) and 8 respondents had low self-esteem (23.5%). Family support is an important factor in breast cancer patients. and our results showed that higher family support was associated with seft esteem. A prospective study following the patients for 23 years also reported that higher family support was related to lower levels of depression at baseline and quicker improvement of depression. (Kamen, 2011) Family support is a vital factor for people who are facing problems. The support they receive may encourage them to commit to medication procedures such as chemotherapy. Family support plays a crucial role in improving patient’s mental state and spirit which eventually improve their self-esteem (Sari et al., 2012). Patients with breast cancer may find various alternations in their life. The changes may occur not only on their physic but also on mental condition which affecting their self-esteem. Self-esteem is the result of individual judgment or evaluation toward oneself leading to self-worth. In many cases, breast cancer patients undergoing chemotherapy perceive themselves as weak individuals, imperfect, hopeless, unattractive, not worthy, being isolated and rejected from the society, fearful, hopeless, anxious, and depressed. Moreover, breast cancer patients who are undergoing chemotherapy also experiences psychological impacts caused by their health condition, such as fear of death, of being burden to others, of being abandoned by their family, and self-concept disorders (Rahmadiliyani, 2014). Generally, social support from patients’ close people such as friends and health personnel brings optimism to patients that affect their self-motivation to gain healing. Family support is crucial in anticipating Jek Amidos Pardede et al., EAS J Nurs Midwifery; Vol-2, Iss-3 (May-June-2020): 173-177 © East African Scholars Publisher, Kenya 176 psychological problems in breast cancer patients (Wardiyah, 2014). Emotional supports which include positive emotional expressions, empathy, and care toward the patients may lead them to feel better and attain their spirit back despite their poor health condition (Permatasari, 2016). Adequate support from the family is proven to be associated with lower mortality in cancer patients, high healing rate, better condition of cognitive functions and emotion health. Positive and motivating support from family helps improve ones’ self-esteem, so that they are more confident facing challenges caused by their disease (Purwanti, 2013). CONCLUSIONS 1. The Category of family support in breast cancer patients undergoing chemotherapy at Haj Adam Malik Central Hospital in Medan City was good. 2. The category of self-esteem in breast cancer patients undergoing chemotherapy at Haj Adam Malik Central Hospital in Medan City was high. 3. There was a significantly moderate correlation between family support and self-esteem of breast cancer patients undergoing chemotherapy at Haj Adam Malik Central Hospital in Medan. RECOMMENDATIONS To Patients It is suggested that breast cancer patients undergoing chemotherapy to remain motivated and commit to medication procedures and believe in themselves that they will be healed. To Nurses It is suggested that nurses improve their care services to patients particularly in giving psychological supports and approach as well as encouraging the patients to anticipate low self-esteem in cancer patients. It is because low self-esteem in cancer patients may negatively affect their healing process. 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