de la salle health sciences institute

DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School

COPING STRATEGIES OF CANCER SURVIVORS EXPERIENCING SYMPTOMS OF POST-TRAUMATIC STRESS DISORDER

A Research Paper Presented to the Faculty of the Special Health Sciences High School

In Partial Fulfillment of the Requirements for the course Research in Daily Life I

AQUINO, CZARINA LIANNE I.

PADILLA, CHLOE C.

BERNARDO, HOLLY CHRISTIENNE T. PEREYRA, CHARLES GABRIEL M. BESANA, ADRIAN S.

SARABIA, MAFELLAINE DIANNE T.

May 2018

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ABSTRACT The study entitled, “Coping Strategies of Cancer Survivors Experiencing Symptoms of Post-traumatic Stress Disorder” seeks to find the experiences, coping strategies and significant behavioral changes observed within cancer survivors with symptoms of Post-Traumatic Stress Disorder. A qualitativedescriptive research design and snowball sampling which is a type of purposive sampling was used by the researchers. The data gathered through the semistructured in-depth interview that was adapted from the Coping Strategies Inventory was used by the group to come up with a phenomenon, theory, or conclusion that could be established from the findings gathered. Results show that different coping strategies elicited by the patients were due to the physiological and psychological changes that happened right after contracting the illness which had led to post-cancer behavioral changes after surviving cancer. Based on the findings discussed, cancer creates stress to both the physical and psychological state of the survivor which was mainly due to the medical interventions and the effects it has caused on the survivor’s body which has started the development of the stress that had allowed coping strategies to gain ground, which includes religion, animated procrastination, avoidance, normalization, and reframing. Due to the memory retained during the occurrence of the illness the survivors were shown to have psychological changes, recurrent flashbacks of events, lifestyle changes, and impaired social relations. It highly

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School recommends to further explore the study, have a bigger sample size to gain more research knowledge, conduct more researches on patients who have had cancer relapses, and if possible conduct the study to those who have been clinically diagnosed with post-traumatic stress disorder.

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TABLE OF CONTENTS

PAGE TITLE PAGE

1

ABSTRACT

2

TABLE OF CONTENTS

4

LIST OF TABLES

5

LIST OF FIGURES

6

INTRODUCTION Background of the Study

7

Statement of the Problem

14

Conceptual Framework

14

Significance of the Study

16

Scope and Limitation of the Study

17

Definition of Terms

18

METHODOLOGY Research Design

21

Population and Sampling

22

Respondents of the Study

24

Research Instrument

25

Data Gathering Procedure

25

Data Analysis

27

RESULTS AND DISCUSSION Results and Discussion

29

Conclusions

45

Recommendations

46

REFERENCES

48

APPENDICES

64

4


LIST OF TABLES PAGE Table 1. The Demographics of Cancer Survivors

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Experiencing Symptoms of Post-traumatic Stress Disorder

Table 2. The Experiences of Cancer Survivors

29

during Their Malignancy Period

Table 3. The Coping Strategies of Cancer Survivors

31

Experiencing Symptoms of Post-traumatic Stress Disorder

Table 4. The Significant Post-Cancer Behavioral Changes Observed in Cancer Survivors

38

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LIST OF FIGURES PAGE Figure 1. A Conceptual Framework in Acquiring the Coping Strategies of Cancer Survivors Experiencing Symptoms of Post-traumatic Stress Disorder

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INTRODUCTION Background of the Study Recently, there has been a growing interest in problems pertaining mental health among various age groups and backgrounds. There has also been an increase in cancer patients over the years as observed by the National Cancer Institute, and with the patients’ diagnosis comes along some repercussions that could be potentially debilitating in terms of physical and psychological wellbeing. One of the most common is Post-traumatic stress disorder. Post-traumatic stress disorder or commonly known as the acronym PTSD, is a health condition pertaining to the mental health condition, which is usually caused by the occurrence of traumatic or a terrifying event in a person’s life, such as a life-threatening condition, military combat, natural disasters, and other events that is perceived by a certain person as a truly traumatic event according to Mayo Foundation for Medical Education and Research (2017). Post-traumatic stress disorder is a mental illness which could modify the overall behavior of a person and can affect his/her family as well. People diagnosed with posttraumatic stress disorder may relive the event via intrusive memories, flashbacks and nightmares; avoid anything that reminds them of the trauma; and have anxious feelings they did not have before that are so intense their lives are disrupted. They may start to take up harmful habits and actions as a defense or coping mechanism along with gradual or sudden withdrawal from family and

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School friends, in some cases there would be chronic pain that may possibly be debilitating depending on the intensity. Sara Staggs (2017) cites that the symptoms of post-traumatic stress disorder may vary from person to person so that is why there are different criterions ranging from Criterion A till H along with a subtype called Dissociation. Knowledge of post-traumatic stress disorder has great importance for identifying the coping mechanisms of people suffering from this disorder. In the case of cancer survivors, given that they have been diagnosed with a life-threatening disease, the prevalence of post-traumatic stress disorder or at least showing symptoms of it has to be considered.

Post-traumatic Stress Disorder among Cancer Survivors Many researchers have indicated cancer as one of the causes of posttraumatic stress disorder to patients. Lead study author Caryn Mei Hsien Chan (2017) of the National University of Kuala Lumpur, has said that despite the fact the post-traumatic stress disorder is more commonly associated with typical traumatic events, such as accidents or natural disasters, patients who have been diagnosed with cancer, have undergone treatment or survived it, most of them will still experience symptoms even if it is not does not necessarily manifest into the full-blown disorder since it is still an immense threat to one’s life. An encounter with a chronic disease like cancer can be very stressful and agonizing. Patients would have to wait for their doctor’s diagnosis, hear that they have cancer, deal with the treatments like surgery, chemotherapy, radiation

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School therapy, targeted therapy, and immunotherapy, and its side effects, worry about the bills and other finances, and overthink about what their fate would be as they try to defeat this infamous malady. Accompanying the stress and anxiety that a cancer patient experiences, there is a chance that they may suffer from posttraumatic stress disorder. Based from the given research conducted, it can also be added that cancer survivors may also be afflicted with post-traumatic stress disorder some time after their final treatments as it takes time for symptoms to start presenting itself thus leading to the various coping strategies the individuals start to take up.

Cancer Cancer is a life-threatening genetic disease which stems from abnormally dividing cells which may eventually infect other areas of the body such as tissues through the blood and lymphatic systems. Cancer has earned a spot in the leading causes of death worldwide (WHO, 2015) and in addition to this, the most common type of cancer that has afflicted millions is lung cancer causing 1.69 million deaths. Cancer can emerge from any part of the body for the human body consists of trillions of cells. Usually, human cells grow and divide to form another cell or sets of cells whenever the body needs it, when the cells age, it degenerates and is replaced with new ones. However, in cancer cells, the systematic replacement of cells is destroyed, the cells become abnormal and those cells that are supposed to die already survive and even create new cells

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School that are not needed by the system, these scenarios can lead to tumors and cancers eventually if left untreated. There are about a hundred types of cancer and it has various causes especially in the modern era, some of which are common like tobacco smoke, nicotine, ultraviolet radiation, and asbestos. There are also numerous types of cancer that corresponds to certain parts of the body. Moreover, there are several main types of cancer. The first one is Carcinoma which develops from skin or from the lining of internal organs. Sarcoma begins from fat, muscle, bone or any supporting tissue within the body. Leukemia develops from the blood forming tissue which will then start to abnormally multipurpose and enter the blood stream. Lymphoma along with multiple myeloma which both stem from cancer cells afflicting the immune system. Meanwhile the last one is central nervous system cancers which affect the various parts of the nervous system like brain and spinal tissue. Cancer usually develops in older people, in which 87% of those who were diagnosed with cancer in the year 2018 are those who are 50 years old and older (Alteri et.al, 2018). In the year 2018, the estimated number of new cancer cases reach 1,735,350 and 609,640 is the number representing the estimated amount of cancer deaths in the United States (American Cancer Society, 2018).

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Coping Strategies Coping strategies are defined as the psychological patterns that individuals use to better manage their thoughts, feelings and actions that they may encounter during the various and gradual stages of disease, treatment or any other highly stressful situation (Franklin, 2014). Coping strategies is used by afflicted individuals which can be divided into psychological and behavioral responses as well it provides protection from the negative from whatever traumatic event or stressor the individual may be experiencing or has experienced it in the past (Swim & Hyers, 2001). Coping may also refer to the actions that are employed by a person during times of stress in order to alleviate some form of anxiety. Each and every person has their own coping strategy which could either be conscious or unconscious. Under the various coping strategies there are three major categories, namely: Active coping, Passive coping, and Avoidance. These different coping strategies may be matched along with others and works differently for each individual according to their situation as well as what suits their mental state during the given time of the stress. In relation with posttraumatic stress disorder, its defining feature is that the response comes after a certain traumatic event which then causes the affliction. According to Ogburn (2015), individuals may start to form their own self-strategies before consulting with a psychiatrist or without them or any close affiliate recognizing it as the beginning of post-traumatic stress disorder. These coping mechanisms may be

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DE LA SALLE HEALTH SCIENCES INSTITUTE

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Special Health Sciences High School positive or negative or, in other words, either beneficial or maladaptive for the patient’s journey towards rehabilitation. A considerable amount of research has been conducted regarding cancer and post-traumatic stress disorder separately but little research has been done on both within the same aspect. Post-traumatic stress disorder and Cancer are correlated in terms of the post-treatment aspect of coping. Generally, treating post-traumatic

stress

disorder

includes

counselling,

medications,

and

psychological therapies. Some strategies to cope up with the disorder are sticking to the treatment plan, getting enough sleep, exercising regularly, eating a healthy diet, avoiding coffee and cigarette, preventing the use of alcohol and drugs, learning new habits, and encompassing oneself with understanding and supportive people (PTSD, 2017). Some of the coping strategies according to the National Center for PTSD, as cited by Ogburn (2015) are the following: Maladaptive

Coping

Mechanisms

is

defined

as negative

coping

mechanism that deter an individual’s full psychological recovery and it falls under avoidance symptoms which can be common for patients suffering with post-traumatic stress disorder. These kinds of coping mechanisms are eventually harmful because the two key factors in a successful recovery are social support and confrontation of the traumatic event. Avoidance of these two key factors diminishes the progress that is being made towards full recovery. Another Maladaptive coping method is Emotional Dysregulation wherein the

DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School individual may start to become violent and aggressive in order to distance themselves from other people as well as making them constantly paranoid which is called Hyper-vigilance. The last common coping mechanism that develops along with post-traumatic stress disorder is Substance Abuse which refers to the interference of the chosen substance, either alcohol or drugs, in the daily life of the individual. Post-traumatic stress disorder is also considered a risk factor for addiction and vice versa. Likewise, positive coping strategies which promote the success rate for recovery over time and one of which is Constructive Coping Mechanisms. A common strategy is Group Therapy or group support since social support is a necessity in the road to recover. Other individuals that are going through or have gone through the same dilemma may help form a bond as well as acceptance of help from others. The aims of the study are (1) to determine the factors that primarily cause the emergence of symptoms of post-traumatic stress disorder among the cancer survivors; (2) to know and understand the coping strategies that patients elicit knowing the existence of their condition; (3) to spread awareness and further knowledge about the symptoms of post-traumatic stress disorder in relation to cancer; and (4) to contribute to the thorough research of post-traumatic stress disorder that could be conducted by future researchers.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Statement of the Problem The study entitled, “Coping Strategies of Cancer Survivors Experiencing Symptoms of Post-traumatic Stress Disorder” seek to answer the following questions: 1. What experiences made cancer survivors develop symptoms of posttraumatic stress disorder? 2. What are the coping strategies of cancer survivors experiencing symptoms of post-traumatic stress disorder? 3. What are the significant behavioral changes observed within the cancer survivors?

Conceptual Framework INPUT Demographics of Cancer Survivors experiencing symptoms of Posttraumatic stress disorder 

Age



Sex



Type of cancer



Current health status

Coping strategies

PROCESSING

OUTPUT

Analysis of data through semistructured interview.

Coping strategies of cancer survivors experiencing symptoms of Posttraumatic stress disorder are determined.

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Special Health Sciences High School Figure 1. A Conceptual Framework in Acquiring the Coping Strategies of Cancer Survivors Experiencing Symptoms of Post-traumatic Stress Disorder The paradigm above presents the Input-Process-Output model to show the relationships of variables. The researchers came up with the conceptual framework that served as the basis for conducting the study. The main foci of the study are the cases of the coping strategies of individuals who are survivors of cancer and are experiencing or have had experienced symptoms of posttraumatic stress disorder within the vicinities of Cavite and Batangas. The inputs of this research include the demographic profile of the cancer survivors who have experienced symptoms of post-traumatic stress disorder such as their age, sex, type of cancer, and their coping strategies in which they are the main body to be analyzed on the different coping strategies. The respondents’ statements were the basis for analysis of these strategies. It was done through the informal interview composing semi-structured and open-ended questions. Moreover, the process

was

done

by

gathering

necessary

data

through

an

unstructured/informal interview. Furthermore, certain survivors were interviewed on how their holistic state is affected by the coping strategies that they employed. Then, the acquired data was analyzed and interpreted. The output was the result of the subjective interview of each patient and the coping strategies that the research team has retrieved from the respondents themselves.

DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Significance of the Study The study was conducted to discover the most common strategy that would give each individual the highest chance of improvement in the overall condition of the cancer survivors. Thus, the results will be beneficial to the following: Society. This refers to a large group of people living together in an organized way, making decisions about how to do things, and sharing a particular culture and beliefs. The growing number of cases related to cancer may result to an increase of post-traumatic stress disorder cases that is why the researchers aimed to make this condition familiar with everyone. Society will not only be aware but will also be able to help apprehend the current situation of individuals suffering from post-traumatic stress disorder. Government. This refers to a group of people with the authority to govern a country or state. The government helps provide the needs of individuals suffering from illnesses, disabilities, and disorders. This study will be the way for them to become knowledgeable and acquainted with the situation and be able to enforce laws and regulations that are of help to individuals with post-traumatic stress disorder. Health Care Providers and Medical Field. This study will contribute additional information in the field of mental health and allow health care professionals to deliver better health services. This will also signal them to realize the seriousness of the issue and prepare to attend to the needs of individuals with

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School cancer and at the same time suffering from mental illness, particularly posttraumatic stress disorder. Researchers and Research Community. This refer to an individual or group of individuals interested in conducting research and studies related to the coping strategies of cancer survivors experiencing symptoms of post-traumatic stress disorder. The ideas presented may be used as reference data in conducting new researchers or in testing the validity of other related findings. This study will also serve as their cross-reference that will give them initial background or an overview of the topic discussed.

Scope and Limitation of the Study The study is only focused on the coping strategies that the researchers would retrieve from their potential sources. The respondents were only limited to cancer survivors who were within the age group of 18 and above. The location limit was only the within the vicinities of Cavite and Batangas. In this research the group covered varying coping strategies that are used by the cancer survivors who experienced symptoms of post-traumatic stress disorder. In addition to this, patients afflicted with disease that are potentially communicable were excluded from this study. Lastly, the researchers only obtained respondents who were willing and agreed to be part of the study.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Definition of Terms The following words and phrases are the commonly used terms in this paper: Avoidance. Your Dictionary (n.d.) defined avoidance as the process of staying away from something or someone. Avoidance is used in this study as a theme of a coping strategy where cancer survivors avoid conversations about their experiences, as well as the objects and places that remind them of it. Cancer. MedicineNet (n.d.) defined cancer as an abnormal growth of cells which tend to proliferate in an uncontrolled way and, in some cases, to metastasize. In this paper, it is a class of related diseases characterized by abnormally dividing cells. Coping Strategies. Oxford Reference (n.d.) defined coping strategies as a system that individuals or groups have worked out to deal with a social and/or emotional situation that would otherwise be intolerable. In this paper, these are the specific efforts employed by cancer survivors in reducing and dealing with stressful events caused by occurrence of cancer. Mental Health. World Health Organization (2014) defined mental health as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. In this paper, mental health is the cancer patient’s state of well-being whether or not they can cope with stressors specially being clinically diagnosed with cancer.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Normalization. Normalization is defined as one way of adapting to a condition, and is comprised of several coping strategies that enable individuals and families to maintain typical life patterns while acknowledging the presence and significance of the illness (Hilton, 1996; Knafl & Deatrick, 1986; Miles, 1979; Robinson, 1993; Strauss et al., 1984, as cited by O’Neal, 2007). In this research, normalization is a coping strategy used by the cancer survivors to perceive their condition as normal through establishing relationships with other people who experienced the same experiences they had. Procrastination. Mindfit Hypnosis (n.d.) defined procrastination as a practice of carrying out less urgent tasks in preference to more urgent ones, or doing more pleasurable things in place of less pleasurable ones, and thus putting off impending tasks to a later time. In this study, procrastination is purposefully postponing a certain task or thoughts by means of doing unrelated actions in order to delay the burden of the object of a person’s avoidance. Reframing. Morin (2018) defined reframing as a technique used in therapy to help create a different way of looking at a situation, person, or relationship by changing its meaning. Reframing in this study is a coping strategy which pertains to as to how the cancer survivors remained positive and optimistic in spite of their experiences while battling against cancer. Symptoms of Post-traumatic Stress Disorder. Mayo Clinic (2017) defined post-traumatic stress disorder (PTSD) as a mental health condition that was triggered by a terrifying event — either experiencing it or witnessing it.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event. In this research, post-traumatic stress disorder was used as a basis of how the cancer survivors felt or psychologically reacted during and after their malignancy period.

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METHODOLOGY

Research Design The researchers conducted a case study with in a qualitative-descriptive research design focusing on the experiences of selected cancer survivors experiencing symptoms of post-traumatic stress disorder within the vicinity of Cavite and Batangas provinces as they battle against the said mental illness. The proponents used this method because it is the most appropriate method for the study. The form of interview was semi-structured wherein the “respondents have to answer open-ended questions” (Corbin and Strauss, as cited by Jamshed, 2008). Semi-structured interviews are “not highly structured, as is the case of an interview that consists of all closed-ended questions, nor is it unstructured, such that the interviewee is simply given a license to talk freely about whatever comes up” (Zorn, 2010). The researchers provided a selfdeveloped questionnaire that served as the guide in the interview and as an instrument in data gathering. A PTSD Screening Questionnaire was adopted from Barends Psychology Practice for symptom checking of each individual respondent. Moreover, as one of the basis for the guide questionnaire, the Coping Strategies Inventory was utilized by the researchers as a reference to seek in-depth information from the selected respondents. In line with this, the researchers focused solely on the qualitative characteristics of the respondents and their coping strategies during the time of their destitution. Qualitative data

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School was obtained to know the specific experiences encountered by cancer survivors for them to develop post-traumatic stress disorder and identify the coping strategies and rehabilitation practices they used. Researcher Robert K. Yin described the case study as “an empirical inquiry that investigates a contemporary phenomenon in depth and within its real-life when the boundaries between phenomenon and context are not clearly evident; and in which multiple sources of evidence are used” (as cited by Soy, 1997). Case study is "defined by individual cases, not by the methods of inquiry used” (Stake, as cited by Cohen and Crabtree, 1994). Case studies allow a researcher to investigate a topic in far more detail than might be possible if they were trying to deal with a large number of research participants (nomothetic approach) with the aim of ‘averaging’ (McLeod, 2008). In addition, as cited by Ridder (2017), case study inquiries scientifically investigate into real-life occurrences, in-depth and within its environmental setting. It can either be an individual, a group, an organization, an event, a problem, or an anomaly. This method was used so that the researchers may visualize the situation and get a more complete picture of what is happening.

Population and Sampling The researchers opted for respondents of the study based in the locality of Cavite and Batangas provinces. The population of the study was the people of any type of cancer, male or female, and within the age group of 18 and above

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School having the symptoms of post-traumatic stress disorder residing within the vicinity of the research locale. The sample was from accessible and available cancer survivors who have agreed to participate in the research study. The sampling technique that was utilized by the researchers is snowball sampling under purposive sampling to acquire the best possible respondents that provided beneficial data that was used in the study as well it may be beneficial for future researches that will be conducted. Purposive sampling is a “technique widely used in qualitative research for the identification and selection of information-rich cases for the most effective use of limited resources” (Patton, 2002). A snowball sampling is a research method, where research participants recruit other participants for a test or study. It is used where potential participants are hard to find, snowball sampling is a non-probability sampling method. It does not involve probability (Stephanie, 2014). According to Babbie (2007), snowball sampling is considered some form of accidental sampling. It is usually used if the potential respondents are hard to find. In this study, finding a respondent who met the researchers’ qualifications was difficult as cancer survivors with symptoms of post-traumatic stress disorder are very rare and usually, they do not want to participate or their family does not want them to participate because of the seriousness of the topic. Purposive sampling technique is appropriate for this study due to the fact that the qualifications for the respondents were very specific and meticulous selection is required. The sampling technique focuses on particular characteristics of the population and thus the most appropriate

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School technique to be used that will enable the researchers to answer the research questions. Respondents of the Study Respondents of the study were the available cancer survivors experiencing symptoms of post-traumatic stress disorder from the vicinities of Cavite and Batangas. Selection of a maximum of five cancer survivors must fit the few qualifications that the researchers have set. The following qualifications are: 1. In the age group of 18 years old and above 2. Has experienced symptoms of post-traumatic stress disorder 3. Resides at the vicinities of Cavite and Batangas. 4. Is a cancer survivor Survivor A. 51 years old. She resides in Tanauan, Batangas. She was previously diagnosed with breast cancer on the year 2010. Survivor B. 54 years old. She resides in Bacoor, Cavite. She was previously diagnosed with breast cancer on the year 2016. Survivor C. 18 years old. He resides in Dasmariñas, Cavite. He was previously diagnosed with Leukemia on the year 2009. Survivor D. 21 years old. She resides in Bauan, Batangas. She was previously diagnosed with Leukemia on the year 2011 where she was declared cancer free at the year 2012 but relapsed on the year 2014.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Research Instrument The researchers used a questionnaire adopted from Barends Psychology Practice to check the symptoms of post-traumatic stress disorder within the respondents. A self-developed questionnaire which is partially based on the Coping Strategy Inventory (CSI) which was adapted from the Lazarus “Ways of Coping” questionnaire (Folkman and Lazarus, 1981) was then used in gathering the data acquiring the coping strategies of the selected cancer survivors with symptoms of post-traumatic stress disorder. The questionnaire in the group’s research was open-ended which has opened more room for rapport with the respondent which has increased the depth of the interview whenever there was a particular stressor which pertains to the respondent’s cancer. The questionnaire covered the actual problem experienced by the respondent, strategies in making the respondent less threatened by his/her condition, support that he/she has, emotions that the patient feels or has felt, denial of the condition, his/her wishful thinking, and the level of social withdrawal of the respondent.

Data Gathering Procedure The proponents of the study conducted the data gathering through various procedures. A conjoint meeting within the research team took place in order to know the target respondents and the locale where they may be assembled. To gather respondents, the researchers used the means of technology through the

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School help of social media such as posting in Twitter and sending private messages in Facebook Messenger to find potential participants. Then, the researchers examined various models and theories pertaining to their topic to create a selfdeveloped questionnaire that is valid, appropriate or applicable for the study. After selecting and finalizing the tools that were used for data collection, the researchers set out to find respondents residing in the vicinity of Cavite and Batangas provinces. The researchers acquired their data through the use of direct method or interview method that was semi-structured which has been sufficient for previous case studies. The data was gathered with the help of the selfdeveloped questionnaire made by the researchers that was adapted from the Coping Strategies Inventory which acted as a printed guide in obtaining the necessary qualitative data which are the experiences and coping strategies each respondent has employed. The researchers retrieved the information such as the actual problem experienced by the respondent, strategies in making the respondent less threatened by his/her condition, support that he/she has, emotions that the patient feels, denial of the condition, his/her wishful thinking, and the level of social withdrawal of the respondent. All the satisfactory information gathered was compiled and confidentially kept. The researchers constructed a request letter addressed to the director of the institution for the permission of conducting the said study. At the same time, the proponents procured a letter addressed to the respondents. Once the letter

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School of consent was released and granted for permission in conducting the study, the researchers then advanced in carefully interviewing the respondents. The interviews took place in a private room or where the participant felt comfortable while being interviewed. During the interviews, the researchers ensured total confidentiality, as well as rapport with the selected respondents. The researchers used an audio and/or video-recording data collection, depending on the respondent’s preference. In addition, the researchers maintained a collection of data through field notes to complement the audio-taped interview if a videorecording is not permitted. Field notes allowed the researchers to jot down specific impressions, expressions, behaviors, and nonverbal cues that may not be adequately captured through an audio-recording. The researchers then reviewed the respondents’ answers to the questionnaire wherein they transcribed and translated the interview. After collecting data, the researchers held a meeting to talk about the information gathered and to share viewpoints and findings during the data gathering. The researchers had a final meeting to discuss the gathered data and come up with a phenomenon, theory, or conclusion established from the findings. All of the procedures were welldocumented for confirmation.

Data Analysis After the researchers have collected the qualitative data from interviews and questionnaires, the researchers compiled, analyzed, and interpreted the

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School data from the respondents. With the data interpreted, it was discussed as the results of the study and drew conclusions on what are the coping strategies of cancer survivors experiencing symptoms of post-traumatic stress disorder. According to Bodgan & Bilken (2003) data analysis is often accomplished by coding, category formation, and theme extraction using techniques such as pattern matching which involves relating observations and theory. Analysis continues until saturation or the fulfillment of the results of the data. The researchers came up with different themes that helped in segregating the responses of the respondents as to what are their stressful experiences, the coping strategies they used, and how they changed after their malignancy period.

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RESULTS AND DISCUSSION

In this chapter, results, analysis, discussion, and interpretation were presented. The objectives of the researchers are to identify the experiences of cancer survivors while they were on their malignancy period, the coping strategies they used to handle their post-cancer stress, and the significant postcancer behavioral changes observed in them. The data discussed here were gathered by means of an in-depth interview and were presented in tables.

Table 1. The Demographics of Cancer Survivors Experiencing Symptoms of Post-traumatic Stress Disorder Participant

Age

Gender

Cancer Type

Year Diagnosed

Survivor A

51

Female

Breast Cancer

2010

Year declared Cancer Survivor 2015

Survivor B

54

Female

Breast Cancer

2016

2016

Survivor C

18

Male

Acute Lymphoblastic Leukemia

2009

2018

Survivor D

21

Female


2011 - 2012 Relapse: 2014

2017

Survivor E

25

Female


2009

2012

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Table 1 shows the demographical data of five cancer survivors who have been recruited to achieve the objectives of the study. Before eliciting the indepth interview, the researchers had gathered the demographics which include the age, gender, cancer type that the respondent has, year diagnosed, and the year the participant was declared as a cancer survivor. Four of the participants are female and only one of them is male. The age range of the respondents yielded within the interval of 18 as the youngest and 54 as the eldest. Based on the data gathered, the most prominent cancer types on the participants were breast cancer and Acute Lymphoblastic Leukemia (ALL). Moreover, Survivor D stated that she had relapsed with the same type of leukemia, after 2 years of being cured with the first occurrence of her disease.

Table 2. The Stressful Experiences of Cancer Survivors during Their Malignancy Period Themes Medical Intervention (MI)

Experiences Medical Examinations(MI-ME), Chemotherapy(MI-CT), Surgery(MISR), Drugs(MI-D)

Physiological Change (PHC)

Hair loss(PHC-HL), Absence of the breast(PHC-AB)

Table 2 shows the stressful experiences of cancer survivors during the time they have cancer. The stressful experiences that were sorted out based on the response of the participants were gathered through an open-ended in-depth interview which was conducted by the group in the place where the respondents were comfortable with.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School During the interview, the researchers elicited a question asking the survivors about the experiences that made them become stressed. The first stressful experience is the Medical Intervention (MI) given to them. Included in this are medical examinations where the patients experienced getting their blood collected which made them develop fear of sharps/needles, chemotherapy which is a treatment widely used for cancer, which kills the dividing cells (Nordqvist, 2017), surgery for the removal of the cancer cells within the breast and various medicine intake they have had to endure throughout the process of their cancer-treatment. According to a recent study, medical interventions had medium effect on the stress of the respondents and its impacts in regard with the quality of life in the case of its symptoms through pain (Barre et.al., 2015). Survivors A and B underwent through a Modified Radical Mastectomy which is a type of mastectomy where both of the entire breasts are removed. Patient B also mentioned that she was stressed with all of the medications prescribed by her doctor. She showed the researchers a copy of her medical records and there is a long list of medications and other treatments needed for her. The second experience of the survivors is the Physiological Change as the outcome of the medical procedures they went through. All five of them experienced hair loss as a result of their Chemotherapy. Most of them mentioned that losing their hair made them embarrassed and shy to face other people. Hair loss, which is chemotherapy-induced according to Rugo, Klein, et.al. (2017), is a common and distressing adverse effect. As a matter of fact, Survivor C affirmed that it certainly was a traumatic experience to see his hair fall one by one and as a result, he values his hair further subsequent from his illness. One more physical change is the absence of the breasts of breast cancer survivors as the aftermath of mastectomy. Survivor B in particular has had both of her breasts removed, where she

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School described feeling and looking “off” due to recent body amputation. According to the American Society of Clinical Oncology, one out of four women who were diagnosed with breast cancer starts to experience certain symptoms of post-traumatic stress disorder. Certain aspects of the disease and treatment itself may be the cause of negative experiences due to the pain the patients experience all throughout and it may also come as a sudden shock for the patients due to the sudden onslaught of lifechanges which require fast-adjustment. Likewise, these experiences during their malignancy period brought about several occurrences that may have stimulated obscured post-traumatic stress disorder symptoms.

Table 3. The Coping Strategies of Cancer Survivors Experiencing Symptoms of Post-traumatic Stress Disorder Themes Religion (RN)

Experiences Attending mass(RN-AM), praying(RN-P), going to a spiritual leader(RN-SL), joining church organizations(RN-CO)

Count

Animated Procrastination (AP)

Doing household chores(AP-HC), watching television(AP-WT), using social media(AP-SM), playing online games(AP-OG), eating(AP-E), sleeping(AP-SL), exercising(AP-EX)

5

Avoidance (AV)

Refusal to talk and think about it(AV-RT), avoiding objects and places that relate to the experience(AV-OP), detachment from people(AV-DP)

3

5

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Normalization (NZ)

Reframing (RF)

Establishing relationships with people with common experience(NZ-RCE)

5

Thinking positive(RF-TP), poking fun about the issue(RF-PF)

5

Table 3 shows the coping strategies used by the cancer survivors in battling the stressful experiences they had been through. Coping strategies may differ based on the person himself, beliefs, culture, and environment. According to Folkman and Lazarus (1980), as cited by Azizi (2011), coping is basically defined as the cognitive and behavioral attempts of the person to alleviate his stress and anxiety based from his perception caused by the problems and experiences he has been. During the interview, the researchers observed that the cancer survivors have many similarities when it comes to coping with their stress after being a cancer patient. Although the interviewed cancer survivors were not aware that they are experiencing symptoms of post-traumatic stress disorder, the respondents still listed coping strategies that are relevant to what post-traumatic stress disorder diagnosed patients do. Based on the data that had been gathered from the in-depth interview, the different coping strategies had been sorted out into five categories, which includes the religion (RN), animated procrastination (AP), avoidance (AV), normalization (NZ), and reframing (RF). A majority of the researchers’ respondents have employed healthy and positive coping strategies by taking up

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School a more rigorous spiritual practice and using religion (RN) as a way of obtaining security in healing from their disease. For the participants of this study, religious activities including mass attending (RN-AM), praying (RN-P), going to a spiritual leader (RN-SL), and joining church organizations (RN-CO) helped the survivors cope up with stress. All five of them stated that they pray to the Lord everyday and attend mass. In particular, Survivor B mentioned being a part of a church organization and talking to some spiritual leaders like a pastor head and a bishop. Significant findings indicate that religion is a very relevant health coping resource for some people dealing with specific health issues (Rodriguez-Galan & Falcon, 2017). Another coping mechanism that the respondents have used is animated procrastination (AP) which bears the tendency of a person to put off a certain task by using physical activities to help them deter their thoughts towards a certain subject or towards doing a certain responsibility. All the respondents stated that they use the things under animated procrastination as their coping strategy. Doing household chores (AP-HC) is more prominent to Survivor A and Survivor B. Survivor D said that she has a passion for cooking. She said that cooking and doing household chores have been part of their daily routines. Basic chores divert their minds from heavily thinking about their illness. Watching television (AP-WT) is also part of all the respondents’ coping strategy. Sitting before the television, eases their mind and calms and relaxes them. By doing this, they are letting out their stress through relaxation. Survivor C said he spend lots of watching the television in order to relax. According to

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Survivor D, she likes watching television rather than going out for a movie. Survivor A and Survivor B both occasionally watches television. They both watch television together with their families. Since we are in an advanced technology generation, social media has also been part of the daily lives of many. For cancer survivors, it is very important to spend time on less stressful activities and over-fatigue. Social media (AP-SM) is part of their coping strategies maybe because of the rewarding entertainment it showcases to the users. As for Survivor E’s case, the doctor advised her to use computer to divert her attention. She uses social media and goes live streaming to distract herself and made her forget the pain she is experiencing. Survivor D stated that she plays online games (AP-OG) as a coping strategy to decrease the stress level and distract her from thinking about her illness. Playing online games helps her to be in good vibes. Eating healthy foods rich in different vitamins and minerals is vital to cancer patients and cancer survivors. The respondents stated that instead of thinking about their illness, they would engage to lots eating (AP-E) but still with moderation. Sleeping (AP-SL) is essential to every person most especially when you are sick. The respondents stated that lack of rest leads them to being stressed. For them, sleeping is a way of alleviating anxiety and gives them peace of mind. Sleeping acts as their coping strategy to battle the emotions they are feeling.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Sleep is very important to cancer patients but some of cancer patients, even survivors, have trouble in sleeping because they dream of their stressful experiences. To keep their bodies in great shape, exercising (AP-EX) is advisable for them. Exercising not only conditions one’s body but also lets out their stress. The respondents stated that exercising is a good way for them to be a healthier version of themselves. Additionally, doing physical exercises has a positive effect on lowering mental stress and depression (Khabiri and Mohammad, 2009, as cited by Azizi, 2011). Survivor A stated during the interview that she jogs every morning to have a healthier body. Avoidance (AV) is also one of the coping strategies that Survivor A stated during the interview. She said sometimes she avoids talking about her malignancy (AV-RT) because the experiences sometimes feel like coming back. Survivor A’s doctor also advised her not to seriously think about her illness because it may build up stress and leads to straining herself. Survivor B also does not give lots of time thinking about her tumor and surgery. Although she still feels the pain from her bilateral mastectomy, she avoids thinking more about it. Survivor C stated that he does not think about it as well. As discussed in the background of the study, avoidance is one of the Maladaptive Coping Mechanisms which is a negative coping strategy as it deters the individual’s full psychological recovery. Survivor C does not avoid talking about it but he stated that he does not think about his illness as something negative but instead, he

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School sees it as an inspiration to continue fulfilling his dreams. He showed all the positivity among the respondents and was always in good mood and avoids stress at all times. Survivor D said that she does not avoid talking about her illness but minimizes thinking about it. Stress starts whenever she thinks about it. Survivor D is also positive and likes to shares her experiences and advises to patients with the same condition. Some objects may remind the cancer survivors the times when they were still in bad condition. The respondents mentioned that they avoid the objects (AV-OP) that make them remind their illness and the challenging experiences they have been through. Survivor A said that she dislikes seeing her bonnet that she used during chemotherapy. Her bonnet makes her sad and tends to think about the pain again. Survivor D stated that seeing the regional hospital where she was confined during her malignancy period worn-outs her. The researchers found that objects associated to their malignancy period makes them stressedout and reminds them about their painful experiences. People who are not related to cancer patients or people who are not close to the cancer patients are the persons some of the respondents avoid. Avoiding the judgment of others and avoiding the people who will look at them differently are the reasons why some of the respondents tend to avoid people (AV-DP). Survivor A said that she avoids people who ask her about what stage of breast cancer she had. Survivor D stated that she sometimes avoids her classmates who visit her surprisingly because she does not want them to see

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School her in that state. In addition to that, during the period where she is still in recovery state and having her chemotherapy, she avoids going outside because according to her, some people might judge her for not having hair and looking different. Another coping mechanism is normalization (NZ) wherein the person seeks out solace and understanding in those who have experienced similar situations

as

them.

Contrasting

the

Maladaptive

Coping

Mechanism,

normalization is under the Constructive Coping Mechanism which is a positive coping strategy as it promotes success rate for recovery over time. Forming a bond with other individuals that are going through the same dilemma may help an individual achieve acceptance of help from others. There are some clinics where patients with the same type of cancer can go to. Survivor D said that establishing relationships with patients (NZ-RCE) with the same condition helps her to relieve her stress. Talking about her illness and sharing it to other patients gives her strength. Moreover, Survivor E said that she tends to share her experiences with other people mainly to give inspiration to them and inform that this specific condition can be contracted in various ways whether you take care of yourself or not. Reframing (R) on the other hand, means that the survivors have opted to use common optimism to help them overcome the stress they experienced or are experiencing post-cancer. The respondents decoded that the cancer survivors use thinking positively as a helpful and one of the best coping strategy

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School in cancer recovery. Some of the respondents stated that they always think positive thoughts because stressing themselves on thinking about bad memories is not advisable. Their attending doctors advised them as well to think only positive and happy thoughts and restrain themselves from being negative. Survivor E mentioned that seeing other people, especially those who are younger than her experiencing the same as her, she thought that she can survive the illness and all the pain just like how the other cancer patients do it, she thinks that being stressed about the event only brings forth even more stress. Some of the respondents also believe that thinking positively helps them to recover faster. However, only Survivor A had mentioned that she was very serious about her case and she does not want to make jokes about it unlike the other four participants who are okay with making fun about their experiences. In fact, poking fun about the issue (RF-PF) somehow made their stress go away according to them. Survivor D said during the interview that since she belongs to a clinic of patients with Leukemia, she and other patients always laugh and pokes fun about their illness. According to her, poking fun about their illness is not a big deal for them because they are open and close to each other. Additionally, it is a way of distracting themselves from the pain of having malignancy. These data (Table 3) shows that more cancer survivors turn to a positive coping strategy such as connecting with a higher power, interacting with people,

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School and looking at things optimistically, more than a dismissive coping strategy like avoiding everything the surrounds the person to escape the agony.

Table 4. The Significant Post-Cancer Behavioral Changes Observed in Cancer Survivors Themes Psychological Changes (PSC)

Experiences Mood swings(PSC-MS), paranoia(PSC-P)

Count 3

Recurrent Flashbacks of Events (RFE)

Nightmares(RFE-NM), occasionally reminiscing the event(RFE-ORE)

4

Lifestyle Change (LC)

Diet(LC-DT)

5

Social Relations (SR)

Isolation(SR-I), detachment from other people(SR-DOP), restriction from completing societal roles(SR-RSR)

3

In addition to the several experiences the respondents underwent, Table 4 describes that there are significant behavioral changes after the illness observed within the survivors. The researchers found that these changes might be due to the stressful experiences they had undergone and the therapies and medical interventions they did. There were four themes that emerged from the interview. These includes the psychological changes (PSC) which include distress due to trying to cope with a diagnosis (Cancer Center Community, 2013) that the respondent had experienced, recurrent flashbacks of events in relation with their current condition such as the feeling of the event happening

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School again (Tull, 2018), lifestyle changes brought forth by their condition, and their social relationships that is the interaction of the patient with his/her surroundings (Sztompka, n.d.). The Psychological Changes (PSC) includes mood swings (PSC-MS) and paranoia (PSC-P) or the feeling of being anxious or fearful on certain things to the point where a person feels under threat. Three out of four respondents responded that they had psychological changes on their selves. Only Survivor C had not shown mood swings and paranoia. The three other participants admitted that they became easily irritated possibly because of the medical procedures they went through. They also mentioned about being paranoid every time some changes happens to them. They stated that they easily get irritated sometimes because of their illness and even after being declared as cancer survivors. According to Survivor D, it is one of the side effects of chemotherapy. Chemotherapy is known to have adverse effects to the patients. Being diagnosed with cancer and receiving treatments causes them to change moods easily. They feel irritated at times even at simple situations. Research has shown that inflammatory cytokines can enter the brain and affect many of the brain circuits and chemicals that are involved in depression, anxiety, fatigue, and impairment in memory and concentration (Miller, as cited by National Comprehensive Cancer Network, Inc., 2018). Survivor D also shared that behavioral changes can be observed with cancer patients and survivors due to blood transfusion. Blood transfusion is the transfer of blood of the donor to the patient in need. Survivor D shared to the respondents her

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School experience to blood transfusions wherein she has observed that her personality changes through time. This effect may be due to the different blood being transferred to her coming from different people. Survivor D also said that if she experiences some pain on her body, she immediately assumes that her cancer is back. Consequently, she now takes extra care of herself. Life after being diagnosed with cancer cannot be predicted. The researchers found out that the respondents sometimes think about their future, their life after recovery, their family, and what will they be through time. The respondents told the researchers that they developed paranoia. “Paranoia involves intense anxious or fearful feelings and thoughts often related to persecution, threat, or conspiracy (Mental Health America, 2018). They became paranoid to things that they fear. Due to paranoia, their mental health becomes affected too. The second theme is the Recurrent Flashbacks of Events (RFE) where the participants experience nightmares (RFE-NM) and they occasionally reminisce the events (RFE-ORE). Like the previous theme, the three female participants experienced these and only Survivor C did not. Some of the respondents told the researchers that sometimes, due to deep thinking about their cancer, they dream about it. As described by the respondents, these are nightmares where they feel like pain is coming back. The researchers found out that they did not experience nightmares until they were diagnosed with cancer.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School In connection with nightmares, the researchers also elicited that cancer survivors occasionally reminisce the events. The respondents stated that sometimes their experiences during their malignancy period tend to reoccur and attack them. Survivor E is experiencing recurrences of events related to her medical condition by means of having dreams about the event in which according to the patient herself might come from her experiences of pain, because of chemotherapy sessions which occurred for about 4-5 times in one week. This became a change to the respondents. Next theme is the Lifestyle Change (LC) which solely involves diet (LCDT) or the food intake of the survivors. The five participants all said that they observe their proper diet like eating more nutritious and less oily food because they are scared that if they eat even one wrong food, they will have relapse or experience again the symptoms of their illness, or more extremely, they will acquire a new illness, which is bad for them. They also monitor their eating habits like always eating on the right time with the right amount of food. After recovering from cancer, the survivors stated that they became more conscious and careful to the food they are going to eat. The researchers found out that cancer survivors changed their diet and avoided food that known to have an effect to their physical health. Survivor A stated that she switched to nutritional food such as fruits and vegetables and other herbal medicines rather than fatty and oily food. Same with Survivor A, Survivor B maintains a healthy

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School diet. Survivor C stated that he avoids fast food and likes home-cooked meals. Survivor D stated that she avoids salty food and likes to cook her own meals. The last theme for Table 4 is social relations (SR). Under social relations on the behavioral changes of cancer survivors is isolation (SR-I). The researchers were able to identify that some of the respondents isolate themselves from others. Both Survivors A and B isolated and detached themselves from other people for the reason of not wanting to talk about it. They said people would always ask them about their current condition and that made them withdraw themselves from others. Survivor D, on the other hand, experienced a different conflict. She was restricted from going to school and even going to work because it might cause her over fatigue. The feeling of being detached from other people is another behavioral change that the respondents stated. The researchers were able to elicit that after their treatment, they felt being detached from others. Given that having cancer is extremely dangerous and life-threatening, cancer survivors are then restricted to completing societal roles such as working and studying at school. Survivor A stated that she stays at home. Survivor D shared that after she had relapsed to the same condition, she was advised by her doctor to stop attending school because it strains her. Over-fatigue is one of the reasons why Survivor D is prohibited to attend school and work. Survivor D was allowed to stay at home and occasionally go out. To lessen her boredom at home, Survivor D uses social media platforms to have an online shop. With this,

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Survivor D was able to cope up with her stress and divert herself to talking to people on the Internet.

Conclusion Based on the findings discussed, conclusions can now be drawn. After conducting a thorough, in-depth interview with the cancer survivors, the researchers were able to come up with a conclusion that being diagnosed with cancer creates stress to the physical and psychological state of a survivor. Medical interventions and physiological changes that a cancer patient is undergoing through can start the development of stress within the individual thus, aggravating the situation and the weight they are carrying. Cancer survivors experiencing symptoms of post-traumatic stress disorder had behavioral changes that affect their current life. The researchers were able to find out that cancer survivors have no idea that what they are experiencing are already symptoms of post-traumatic stress disorder. The most common event for all of the participants that triggered their stress is going through Chemotherapy. It is extremely painful but, worth it after hearing the doctor say you survived. Second, being declared as a survivor of cancer does not mean it is the end of their sufferings. Cancer survivors need to endure the stress caused by the occurrence of their illness. To cope up, they need various strategies that would work for each of them. Being religious is definitely the most used strategy of the cancer survivors to alleviate their stress. Keeping one’s self busy,

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School interacting with other people, and thinking positively and being optimistic follows. Third, there are significant changes that can be observed in the cancer survivors as a result of the medical procedures given to them and the overall experience of battling against cancer. Lifestyle change has the highest count since it is the only category which can establish an improvement in the cancer survivor’s life. Fourth, no matter what type of cancer a person has, his/her experiences, coping strategies, and changes observed within him/her do not significantly differ from others with a completely dissimilar type of cancer. They share common experiences from their malignancy period thus, they develop common coping strategies. Lastly, it can be concluded that cancer occurrence impacts the person holistically: physically, emotionally, and spiritually. Moreover, it has its positive and negative effects on the individual’s life.

Recommendations This research provides five recommendations. First, the researchers recommend to further study about the occurrence of post-traumatic stress disorder on cancer survivors: personal experiences, coping strategies, and significant changes observed on them. Second, the researchers would like to recommend having a bigger sample with different types of cancer. Having a larger sample size will gain more research and knowledge about the experiences of cancer patients or survivors in different types of cancer. Third, the researchers recommend to further conduct study about the experiences of

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Special Health Sciences High School relapsed cancer patients. It can be of help to present a comparison between the relapsed and non-relapsed cancer patients. Fourth, they recommend collecting insights

of

mental

health

professionals,

particularly psychologists

and

psychiatrists, and oncologists to gain additional background and more relevant information about the study. Lastly, the researchers recommend that if possible, conduct a research about the cancer survivors diagnosed with post-traumatic stress disorder to fully obtain the coping strategies used by the people experiencing the disorder itself.


References

Addison, C. C. et al. (2007, December 31). Psychometric Evaluation of a Coping Strategies Inventory Short-Form (CSI-SF) in the Jackson Heart Study Cohort. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732399/ Ajdukovic, D. et al. (2013, August 7). Recovery from Posttraumatic Stress Symptoms: A Qualitative Study of Attributions in Survivors of War. Retrieved from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0070579 American Cancer Society. (2017, February 13). Common Cancer Types. Retrieved from https://www.cancer.gov/types/common-cancers Antonovsky, A. (1979). Health, Stress, and Coping. San Fransisco: JosseyBass. Antonovsky, A. & Kats, R. (1967). The Life Crisis History as a Tool in Epidemiologic Research. Journal of Health and Social Behavior, 8, 15-20. Anxiety and Depression Association of America. (n.d.). Posttraumatic Stress Disorder (PTSD). Retrieved from https://adaa.org/understandinganxiety/posttraumatic-stress-disorder-ptsd# Art Therapy. (2016, April 18). Good Therapy. Retrieved from https://www.goodtherapy.org/learn-about-therapy/types/art-therapy

48

DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Alteri, et al. (2018). Cancer Facts and Figures 2018. Retrieved from https://www.cancer.org/content/dam/cancer-org/research/cancer-factsand-statistics/annual-cancer-facts-and-figures/2018/cancer-facts-andfigures-2018.pdf Avoidance. (n.d.). In Your Dictionary. Retrieved from http://www.yourdictionary.com/avoidance Azizi, M. (2011). Effects of Doing Physical Exercises on Stress-Coping Strategies and the Intensity of the Stress Experienced by University Students in Zabol, Southeastern Iran. Procedia - Social and Behavioral Sciences, 30, 372-375. doi:10.1016/j.sbspro.2011.10.073 Babbie, E. (2008). The Basics of Social Research. Retrieved from https://books.google.com.ph/books?id=1_lSEh6AAfYC&pg=PA205&dq=S nowball+sampling&hl=en&sa=X&ved=0ahUKEwju9urop7aAhUKmJQKHY9-C-4Q6AEIKDAA#v=onepage&q&f=false Barre, V., Padmaja, G., Saxena, R., & Rana, S. (2015). Impact of medical intervention on stress and quality of life in patients with cancer. Indian Journal of Palliative Care, 21(2), 203. doi:10.4103/0973-1075.156503 Bogdan, R. C., & Biklen, S. K. (2003). Qualitative research in education: An introduction to theory and methods (4th ed.). Cancer-Related Post-Traumatic Stress. (2015). PubMed Health. Retrieved from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032735/

49

DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Cancer Statistics. (2017, March 22). Retrieved from https://www.cancer.gov/about-cancer/understanding/statistics Carolyn Boyce, P. N. (2006, May). Conducting In-Depth Interviews. Retrieved from http://www2.pathfinder.org/site/DocServer/m_e_tool_series_indepth_inter views.pdf Case Studies. (2017). Research Methodology. Retrieved from https://researchmethodology.net/research-methods/qualitative-research/case-studies/ Chan, et al. (2017). Course and Predictors of Post-Traumatic Stress Disorder in a Cohort of Psychologically Distressed Patients With Cancer: A 4-Year Follow-Up Study. Wiley Online Library. doi: 10.1002/cncr.30980 Cherry, K. (2017, May 20). What Is Group Therapy and How Does It Work? Retrieved from https://www.verywellmind.com/what-is-group-therapy2795760 Chittem, M. (2014). Understanding coping with cancer: How can qualitative research help? Retrieved from http://www.cancerjournal.net/article.asp?issn=09731482;year=2014;volume=10;issue=1;spage=6;epage=10;aulast=Chittem Cognitive Model of Post Traumatic Stress Disorder (PTSD). (n.d.). Retrieved from https://psychologytools.com/cognitive-model-of-ptsd.html Cohen, D., & Crabtree, B. (2006, July). Qualitative Research Guidelines. Retrieved from http://www.qualres.org/HomeCase-3591.html

50

DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Cohen, F. (1984). Coping. In J.D. Matarazzo, S.M. Weiss, J.A. Herd, N.E. Miller & S.M. Cohen, H. (2017). An Overview of Post-Traumatic Stress Disorder (PTSD). Psych Central. Retrieved from https://psychcentral.com/disorders/ptsd/an-overview-of-post-traumaticstress-disorder-ptsd/ Cohut, M. (2017, November 20). Many grapple with PTSD after a cancer diagnosis. Medical NewsToday. Retrieved from https://www.medicalnewstoday.com/articles/320100.php Coping Strategies. (n.d). Science Direct. Retrieved from https://www.sciencedirect.com/topics/medicine-and-dentistry/copingstrategies Coping Strategy. (n.d.). Oxford Reference. Retrieved from http://www.oxfordreference.com/view/10.1093/oi/authority.201108030956 37845 Coping Strategies Inventory 32 Item. (n.d.) Scribd. Retrieved from https://www.scribd.com/document/228795681/Coping-StrategiesInventory-32-Item Crossman, A. (2017). Understanding Purposive Sampling: An Overview of the Method and Its Applications.ThoughtCo. Retrieved from https://www.thoughtco.com/purposive-sampling-3026727

51

DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Emery, R. (n.d.). Post-traumatic stress disorder. Britannica. Retrieved from https://www.britannica.com/science/post-traumatic-stress-disorder Emotional / psychological: Managing Cancer Treatment Side Effects | CTCA. (2001, January 01). Retrieved from https://www.cancercenter.com/community/managing-sideeffects/emotional-psychological/ Folkman, S. & Lazarus, R. S. (1988). Coping as a mediator of emotion. Journal of Personality and Social Psychology. 54 (3): 466–75. Retrieved from 10.1037/0022-3514.54.3.466. PMID 3361419. Franklin, P.M. (2014). Psychological Aspects of Kidney Transplantation and Organ Donation. In Kidney Transplantation – Principles and Practice (7th ed.). (pp. 698-14). Retrieved from ScienceDirect Glanz, K., et al. (2002). Health Behavior and Health Education. Theory, Research and Practice. San Fransisco: Wiley & Sons. Haggerty, J. (2013, August 24). Psychodynamic Therapy. Retrieved from https://psychcentral.com/lib/psychodynamic-therapy/ Hoffman, M. (2017, November 20). High Incidence of PTSD Among Cancer Patients. Retrieved from MD Magazine: http://www.mdmag.com/medicalnews/high-incidence-of-ptsd-among-cancer-patients Hypnosis. (n.d.). Psychology Today. Retrieved from https://www.psychologytoday.com/us/basics/hypnosis

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Jamshed, S. (2014, September). Qualitative research method-interviewing and observation. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194943/ Krohne, H.W. (2002). Stress and Coping Theories. Johannes GutenbergUniversität Mainz Germany. Retrieved from http://www.burnout.nl/docs/Krohne-Stress-history-overview.pdf Kumari, R. (2016). Coping strategies of PTSD patients. Journal of Clinical Oncology, 7(10), 1036-1038. Retrieved from https://search.proquest.com/openview/1d5a1dd14aa93bb9cd1fcbf92e1d5 caa/1?pq-origsite=gscholar&cbl=2032134 Latour, K. (2014, June 16). Support for Chemotherapy-Induced Peripheral Neuropathy.Cure Today. Retrieved from https://www.curetoday.com/publications/cure/2014/summer2014/supportfor-chemotherapy-induced-peripheral-neuropathy Lazarus and Folkman Transactional Model of Stress and Coping. (n.d.). Psychology Concepts. Retrieved from http://www.psychologyconceptsmcom/lazarus-and-folkman-transactionalmodel-of-stress-and-coping/ Lazarus, R.S. (1966). Psychological Stress and the Coping Process. New York: McGraw-Hill.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Lazarus, R.S. & Cohen, J.B. (1977). Environmental Stress. In I. Altman and J.F. Wohlwill (eds.), Human Behavior and Environment. (Vol 2) New York: Plenum. Magtubo, C. A. (2016). Mental Health in the Philippines: By the numbers. Retrieved from https://today.mims.com/mental-health-in-the-philippines-by-the-numbers Marlow, L. (2014, June 15). Post-Traumatic Stress Disorder after Cancer.Cure Today. Retrieved from https://www.curetoday.com/publications/cure/2014/summer2014/Supportfor-Chemotherapy-Induced-Peripheral-Neuropathy Martin, B. (2015, May 3). In-Depth: Cognitive Behavioral Therapy. Retrieved from https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/ Mayo Foundation for Medical Education and Research. (2017, October 25). Post Traumatic Stress Disorder (PTSD). Retrieved from https://www.mayoclinic.org/diseases-conditions/post-traumatic-stressdisorder/diagnosis-treatment/drc-20355973 McLeod, S. (n.d.). The Interview Method. Retrieved from https://www.simplypsychology.org/interviews.html Medical Definition of Cancer. (n.d.). MedicineNet. Retrieved from https://www.medicinenet.com/script/main/art.asp?articlekey=2580 Mental health: a state of well-being. (2014). World Health Organization. Retrieved from http://www.who.int/features/factfiles/mental_health/en/

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Mills, et al. (2010). Organizing Your Social Sciences Research Paper: Writing a Case Study. Retrieved from http://libguides.usc.edu/writingguide/casestudy Mind. (2013). Post-traumatic stress disorder (PTSD). Retrieved from https://www.mind.org.uk/information-support/types-of-mental-healthproblems/post-traumatic-stress-disorder-ptsd/#.Wo20JFpubIV Morin, A. (2018). The Definition of Cognitive Reframing: Mental Health Terms Used in Treating Troubled Teens. Retrieved from https://www.verywellmind.com/reframing-defined-2610419 National Comprehensive Cancer Network. (n.d.). Retrieved from https://www.nccn.org/patients/resources/life_with_cancer/managing_sym ptoms/mood_changes.aspx NCI Definition of Cancer Terms. (2018, April 23). National Cancer Institute. Retrieved from https://www.cancer.gov/publications/dictionaries/cancerterms/def/cancer Nordqvist, C. (2017, December 14). Chemotherapy: What it is, what to expect, side effects, and outlook. Retrieved from https://www.medicalnewstoday.com/articles/158401.php Ogburn, Z. (2015). Best Practices for Treatment of Post-Traumatic Stress Disorder. Retrieved from https://pdxscholar.library.pdx.edu/cgi/viewcontent.cgi?article=1181&conte xt=honorstheses

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School O’Neal, C. A. S. (2007). The Development of the Normalization Assessment Measure. Retrieved from https://etd.library.vanderbilt.edu//available/etd03272007-162342/unrestricted/ONealDissertation.pdf Palinkans, L. A., Ph.D., et al. (2016, September 1). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012002/ Parekh, R. (2017). American Psychiatric Association. Retrieved from https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd Parenteau, S. C. (2008). The Mediating Role of Secular Coping Strategies in the Relationship between Religious Beliefs and Adjustment to Chronic Pain: The Middle Road to Damascus. Retrieved from https://kuscholarworks.ku.edu/bitstream/handle/1808/4215/umi-ku2629_1.pdf;sequence=1 Patton, M. Q. (1990). Qualitative evaluation and research methods (2nd ed.). Newbury Park, CA: Sage Publications. Retrieved from https://researchbasics.education.uconn.edu/purposive-sampling/ Petrinec, A. B. (2014). Coping Strategies and Post-Traumatic Stress Symptoms in Post-ICU Family Members. Retrieved from https://etd.ohiolink.edu/!etd.send_file?accession=case1396604673&dispo sition=inline

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Philippine Cancer Statistics. (2012). GlobalCan. Retrieved from http://www.cancerindex.org/Philippines Phipps, S., et al. (2017). American Psychiatric Association. Postraumatic Stress and Psychological Growth in Children with Cancer: Has the Traumatic Impact of Cancer Been Overestimated?, 32(7), 641-646. Retrieved from https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd Post-Traumatic Stress Disorder (PTSD). (2017). Breastcancer.org. Retrieved from http://www.breastcancer.org/treatment/side_effects/stress_disorder Post-traumatic stress disorder (PTSD). (2017, December 22). Mayo Foundation for Medical Education and Research. Retrieved from https://www.mayoclinic.org/diseases-conditions/post-traumatic-stressdisorder/symptoms-causes/syc-20355967 Post-traumatic stress disorder (PTSD). (n.d.). NHS. Retrieved from https://www.nhs.uk/conditions/post-traumatic-stress-disorder-ptsd/ Post-Traumatic Stress Disorder and Cancer. (2016, January). Retrieved from https://www.cancer.net/survivorship/life-after-cancer/post-traumaticstress-disorder-and-cancer Post-Traumatic Stress Disorder and Cancer. (2017, May 24). Retrieved from https://www.cancer.net/survivorship/life-after-cancer/post-traumaticstress-disorder-and-cancer Post-traumatic Stress Disorder. (2015, June). Royal College of Psychiatrists. Retrieved from

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School http://www.rcpsych.ac.uk/healthadvice/problemsanddisorders/posttrauma ticstressdisorder.aspx Post-Traumatic Stress Disorder. (2016, February).The National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorderptsd/index.shtml Post-traumatic Stress Disorder. (n.d.). Retrieved from http://www.apa.org/topics/ptsd Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. (n.d.). National Center for Biotechnology Information. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK56506/ Psychological Debriefing For Post-Traumatic Stress Disorder. (n.d.). Retrieved from https://www.div12.org/treatment/psychological-debriefing-for-posttraumatic-stress-disorder/ PTSD Checklist. (n.d.). Barends Psychology Practice. Retrieved from https://www.barendspsychology.com/complex-ptsd/ptsd-checklist/ PTSD. (n.d.). Beyond Blue. Retrieved from https://www.beyondblue.org.au/the facts/anxiety/types-of-anxiety/ptsd PTSD: National Center for PTSD. (2007, January 01). Retrieved from https://www.ptsd.va.gov/public/PTSD-overview/basics/what-is-ptsd.asp Qualitative Research Design. (n.d.). Retrieved from

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School https://researchrundowns.com/qual/qualitative-research-design/ Qualitative Research Designs. (n.d.). Retrieved from http://www.umsl.edu/~lindquists/qualdsgn.html Rapaport, L. (2017). Cancer survivors often living with PTSD. Reuters. Retrieved from https://www.reuters.com/article/us-cancer-ptsd/cancersurvivors-often-living-with-ptsd-idUSKBN1DK2CV Ridder. (2017). The Theory Contribution of Case Study Research Designs. Retrieved from https://link.springer.com/article/10.1007/s40685-0170045-z. Rodríguez-Galán, M. B., & Falcón, L. M. (2017). Religion as a coping mechanism for health problems and depression among aging Puerto Ricans on the Mainland. Journal of Religion, Spirituality & Aging, 30(2), 130-153. doi:10.1080/15528030.2017.1413031 Rugo, H. S., Klein, P., Melin, S. A., Hurvitz, S. A., Melisko, M. E., Moore, A., . . . Cigler, T. (2017). Association Between Use of a Scalp Cooling Device and Alopecia After Chemotherapy for Breast Cancer. Jama, 317(6), 606. doi:10.1001/jama.2016.21038 Salmon, L. (2017). The importance of case studies in social research. Retrieved from https://www.changeworks.org.uk/news-and-events/blog/theimportance-of-case-studies-in-social-research Shirey, M. R. (2009). Stress and Coping in Nurse Managers: A Qualitative Description. Retrieved from

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School https://scholarworks.iupui.edu/bitstream/handle/1805/1866/MRShirey%20 Dissertation%20PDF%20E%20090106%20Rev%20ii.pdf;sequence= Some cancer patients may be at risk of PTSD. (2017). NHS Choices. Retrieved from https://www.nhs.uk/news/cancer/some-cancer-patients-may-be-riskptsd/ Soy, Susan K. (1997). The Case Study as a Research Method. Retrieved from https://www.ischool.utexas.edu/~ssoy/usesusers/l391d1b.htm Staggs, S. (2017). Posttraumatic Stress Disorder (PTSD) Symptoms. Psych Central. Retrieved from https://psychcentral.com/disorders/ptsd/posttraumatic-stress-disorderptsd-symptoms/ Stallman, H. M. (2017). Coping Planning: A patient- and strengths-focused approach to suicide prevention training. Australasian Psychiatry. Retrieved from https://doi.org/10.1177/1039856217732471 Stephanie. (2014). Snowball Sampling: Definition, Advantages, and Disadvantages. Retrieved from http://www.statisticshowto.com/snowballsampling/ Statista Team. (2014, March 26). Number of cancer deaths worldwide in 2015, by major type of cancer. Retrieved from https://www.statista.com/statistics/288580/number-of-cancer-deathsworldwide-by-type/

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Stress (n.d.). Canadian Cancer Society. Retrieved from http://www.cancer.ca/en/cancer-information/cancer-journey/living-withcancer/stress/?region=on Sutton, J. & Austin, Z. (2015). Qualitative Research: Data Collection, Analysis, and Management. The Canadian Journal of Hospital Pharmacy. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485510/# Syrjala, K., PhD, & Yi, J., PhD. (2018). Overview of psychosocial issues in the adult cancer survivor. Retrieved from https://www.uptodate.com/contents/overview-of-psychosocial-issues-inthe-adult-cancersurvivor?search=Cancer%20and%20PTSD&source=search_result&selec tedTitle=3~150&usage_type=default&display_rank=3#H1156245562. Sztompka, P. (n.d.). Social Relations. Retrieved from https://www.alleydog.com/glossary/definition.php?term=Social+Relations Tobin, D. (1984). User Manual for the Coping Strategies Inventory. Retrieved from Peer Support: http://www.peersupport.edu.au/wpcontent/uploads/2014/08/Coping-Strategy-Indicator-Guide.pdf Traeger, L. & J. A.-R. (2012). Evidence-Based Treatment of Anxiety in Patients With Cancer. Journal of Clinical Oncology. 30(11) Tull, M., & Gans, S. (n.d.). How Can I Identify Triggers for PTSD Flashbacks and Minimize Attacks? Retrieved from https://www.verywellmind.com/copingwith-flashbacks-2797574

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Twente, U. o. (n.d.). Transactional Model of Stress and Coping. Retrieved from https://www.utwente.nl/en/bms/communication-theories/sorted-bycluster/Health%20Communication/transactional_model_of_stress_and_c oping/ Types of PTSD. (2016). Psych Central. Retrieved from https://psychcentral.com/lib/types-of-ptsd/ U. S. Department of Veteran Affairs. (2017, August 18). PTSD: National Center for PTSD. Retrieved from https://www.ptsd.va.gov/public/treatment/therapy-med/treatment-ptsd.asp U. S. Department of Veteran Affairs. (2017, September 15). PTSD: National Center for PTSD. Retrieved from https://www.ptsd.va.gov/public/PTSDoverview/basics/what-is-ptsd.asp Weiss (eds.), Behavioral Health: A Handbook of Health Enhancement and Disease Prevention. New York: Wiley, 1984. What is Cancer?. (2015, February 9). National Cancer Institute. Retrieved from https://www.cancer.gov/about-cancer/understanding/what-is-cancer What is Exposure Therapy?. (2017, August 18). American Pyschological Association. Retrieved from http://www.apa.org/ptsd-guideline/patientsand-families/exposure-therapy.aspx What is Procrastination?. (n.d.). Mindfit Hypnosis. Retrieved from http://www.mindfithypnosis.com/what-is-procrastination/

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Wolf, A. (2013, August 8). Conjoint Therapy. Retrieved from http://annwolflpc.com/services-therapy/conjoint-therapy/ Zorn, T. (2010). Designing and Conducting Semi-Structured Interviews for Research. Retrieved from http://home.utah.edu/~u0326119/Comm417001/resources/Interviewguidelines.pdf

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APPENDIX A COMMUNICATION LETTERS

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APPENDIX B INTERVIEW GUIDE QUESTIONS PTSD Symptom Screening

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Research Questionnaire

1. What are some of the traumatic experiences you have experienced in relating to your illness/ previous illness?

2. How did you deal with the stress during that time? Both personally and along with your family.

3. What strategies or practice did you do or are currently doing to help yourself deal with the stress that stemmed from the traumatic event?

4. Would you consider the specific methods you used as effective or not? Explain how.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Coping Strategies Inventory

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APPENDIX C TRANSCRIPTION

SURVIVOR A I = Interviewer R = Respondent Demographics I: What’s your age? R: 51 I: What type of cancer were you diagnosed with? R: Breast (cancer) I: When were you diagnosed? R: Year? I: Yes. Do you still remember? R: October 2010. PTSD Symptom Screening I: Have you experienced or witnessed a life threatening event that caused intense fear, helplessness or horror? R: When I was sick? I: Yes R: Yes, of course.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Please answer yes or no if you have experienced the following: Repeated, distressing memories, thoughts, fantasies and/or dreams? R: When I was sick? Like I’m always remembering it now? I: Yes R: Yes, of course. I: Even in your dreams? R: Yes, sometimes. I: Acting or feeling as if the event was happening again? (Flashbacks) R: No. I: Were there things that remind you of your sickness and then it causes you stress? R: Yes, whenever I see a bonnet. I: Do you avoid thoughts, feelings, or conversation about it? R: Yes, I avoid it. I don’t want to talk about it. I: Do you avoid activities, places, or people who remind you of it? R: Yes, I avoid them, too. I: Do you lose interest in significant activities of your life? R: Just with eating some particular food like those with oil. I: Do you feel detached from other people? R: I just avoid those people asking “what stage of cancer do you have?” I: Do you feel that your range of emotions is restricted?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: Yes. I don’t want other people to talk about it so I just refuse to show my emotions. I: During the period you have cancer, did you sense that your future has shrunk? R: Of course, I worried about my husband and children. I: Do you have problems with sleeping? R: Before when I was newly diagnosed but today, not really. I am good at sleeping. I: Do you get irritated easily? R: Yes. I really get irritated easily sometimes. I: Do you have problems concentrating doing things? R: Yes I: Have you experienced feeling “on guard” R: Not really. I: Do you get startled easily? R: Yes. Research Questionnaire I: Have you experienced any trauma during your medication? For instance, when you’re in the hospital or during your chemo? R: Yes, of course. When they were collecting my blood and injecting me. I: Are you afraid of sharps/needles? R: A little. I just bear the fear and pain because that’s the treatment.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: How did you deal with the stress during that time? Both personally and with your family/friends. R: Of course I thought about my husband and children. I need to fight and be cured. I: Did you think you’ll be cured? R: Yes, for my family. I’m still young that time and I don’t want to die early. I: Did you go through a rehabilitation period as prescribed by your doctor? R: No. The doctor just told me to stop thinking about it, sleep, and rest a lot. I: What treatment or medications did you use to lessen your stress? R: Ah herbal. I: Herbalife? R: Yes. Also, boiling guyabano, leaves, and eating fruits. I: What strategies or practice did you do or are currently doing to help yourself deal with the stress stemmed from the traumatic event? R: I always think positive and I also exercise. I: Do you think the methods that you used were effective? R: Effective, yes. Coping Strategies Inventory I: Do you try to see the issue from several perspectives? R: Yes I: Do you try not to think about the issue? R: Yes

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Do you seek advice about the issue from people close to you? R: Yes I: Do you feel like you have to allow the issue to run its course? R: Yes, of course. I: Do you get upset and express your anger about the issue? R: Yes I: Do you spend time with nature (e.g. walking) so you can have strength to cope with the issue? R: Yes I: Do you try to become involved in other things (work, hobbies) to distract yourself from the issue? R: Yes I: Do you make jokes about the issue? R: No, of course. I: When you think about the issue, do you tell yourself that things could be much worse? R: I think about it sometimes. I: Do you postpone thinking about the issue? R: Yes I: Do you talk with people you can trust about the issue? R: Yes I: Do you just accept the issue and give up trying to do anything about it?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: It already happened so might as well accept it. I: Are you unable to develop a plan to resolve the issue? R: Sometimes, I lose hope. I: Do you vent your emotions about your frustration with the issue? R: Yes I: Do you seek comfort about the issue through meditation or prayer? R: Yes I: Do you use alcohol and drugs to distance myself from the issue. R: No. I: Do you use daydreaming to avoid the issue? R: Yes I: Do you get stuck when you try to think of ways to address the issue? R: No, not really. I: Do you think talking to other people about your sickness relieve some stress? R: No I: Do you go to a religious leader or spiritual advisor for guidance about the issue? R: No. I just attend mass. I: Do you find yourself laughing about the issue? R: No I: Do you confront the issue in ways you believe will make a difference? R: Yes, of course.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Do you try to be positive and look on the bright side of things? R: Yes I: Do you try to forget about the issue hoping it will resolve itself? R: Yes I: Do other people not know about the issues you have to deal with? R: All of them know about it. I: Do you spend time evaluating your options for resolving the issue? R: Yes I: Do you spend time doing things for others in order to take your mind off thinking about the issue? R: Yes I: Are you sarcastic about matters related to the issue? R: No I: Do you seek to learn something about yourself from the issue? R: Yes I: Do you just ignore the issue? R: Yes. I don’t want to talk about it. I: Do you enlist the support of others to tackle the problems associated with the issue? R: Yes I: Even though you want to resolve the issue, do you find yourself doubting that anything can really be done about it?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: No. I didn’t doubt that I will be cured. I: Do you struggle to find ways to handle the issue? R: Yes. I: Do you lash out as a way of dealing with the issue? R: Yes I: Do you try to connect with a higher power or essence? R: Yes, from God. I: Do you try to find things to do to keep yourself busy so you don’t have to worry about the issue? R: Yes. [I: like what?] When I was newly diagnosed, I read the bible. After being cancer-free, I engaged myself with household chores like cooking and cleaning the house. I: Do you tell yourself that other people have bigger issues in their life than yours? R: Yes, of course. I know it’s not only me. There are worse cases than mine. I: Do you act as though the issue isn’t affecting you even though it really is? R: Yes I: Do you seek guidance from people who you believe can help you address the issue in a meaningful way? R: Yes I: Did you and prepare yourself for whatever outcome is going to happen? R: No, because I’m scared of what might happen.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Do you press forward with an action plan that will change the way the issue will turn out? R: Yes I: Do you make several efforts to address the issue in different way? R: Yes I: Do you feel so overwhelmed by the issue you break down and cry? R: Yes I: Do you try to gain understanding about the issue from religious beliefs or faith? R: Yes, of course. I: Do you watch television or movies instead of concentrating on the issue? R: Yes I: Do you talk to yourself in ways that will help you see the issue less negatively? R: Yes. I always tell myself that I will be cured. I: Do you pretend the issue isn’t as serious as it really is so it doesn’t seem quite as bad? R: Yes I: Do you just learn to live with the issue? R: Yes I: Do you develop strategies that will empower you to effectively deal with the issue? R: Yes

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Does the issue causes you to be irritable with others? R: Yes I: Do you place your trust in a divine power that is mindful of your struggle with the issue? R: Yes I: Do you turn to food or eating as a way of forgetting about the issue? R: Yes I: Do you poke fun at things related to issue? R: No I: Do you pretend the issue doesn’t exist? R: Yes I: Do you turn to others who have had similar issues for guidance and direction? R: Yes I: Do you talk to professional people for help with the issue? R: Yes, doctors. I: Are you aggressive in your approach to confronting the issue? R: Yes. I get mad. I avoid talking about it. I: Do you immerse yourself in other things in order to take your mind off the issue? R: Yes I: Do you seek help from groups who are addressing similar issues? R: No, just the family.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Do you make comments that reflect humor about the issue? R: No I: Do you get so exhausted with the issue you just accept things the way they are? R: Yes I: Do you procrastinate doing things that might make difference with the issue because they seem hard to do? I : What experiences made you develop the stress of having a cancer? R: My medication (chemotherapy) made me scared and stressed. I: What strategies did you use to cope with the stress of having a cancer? R: Doing household chores.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School SURVIVOR B I = Interviewer R = Respondent Demographics I: Age? R: 54 I: What type of cancer were you diagnosed with? R: Breast Cancer I: When were you diagnosed? R: 2016 in the month of August PTSD Symptom Screening I: Have you experienced or witnessed a life-threatening event that caused intense fear, helplessness or horror? R: Yes I: What is that life-threatening event? R: The life-threatening event that I had witnessed is the case that happened to my mother. Just like me she also had breast cancer. During that time, I wasn’t diagnosed with cancer yet, but my mother during that time was already dying. We saw the pain and the struggle, the time that I really cried for her knew that she was already saying goodbye. That event concerning my mother up until now is still fresh in my mind. I: Do you want to take a little break?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: No. It is fine. I: Do you re-experience the event in at least one of the following ways? Repeating distressing moments, thoughts, fantasies, or dreams? R: Repeated? I: Yes R: Maybe in the case of my mother especially the times I saw her struggle, it really left a mark in me in which up until now the events are still fresh within me, the pain she had experienced. I: Do you experience that within yourself too? R: Well, my case was a painful one but if you always complain about it and think of it as painful, you couldn’t move forward, because pain is a part of healing. I: Acting or feeling as if the event were happening again. R: Not really. I: Intense physical or emotional distress when you are exposed to things that remind you of the event. R: Yes. I: Do you avoid reminders of the event and feeling numb compared to the way you felt before in three or more of the following ways: Avoiding thoughts, feelings or conversations about it. R: No. I: Avoiding activities, places or people that remind you of it. R: No.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Blanking on important parts of the event. R: What do you mean by blanking? I: it is like you tend to forget the significant parts of the event. R: Not really, I can even tell you what exactly happened one by one. I: Ok, losing interest in significant activities of your life. R: It is because I can’t. I: So, feeling detached from other people R: No. Maybe when the condition was still at its emerging stages, because I was commonly staying at home, but it didn’t really come to a point where I avoided the people around me. I: So, feeling your range of emotions is restricted. R: Not really. I: Sensing that your future has shrunk. For example, you don’t expect to have a career, marriage, children or a normal life span. R: No. It is because I have a family, children, maybe the thing that had an issue was my job. It is because of my ailment that prevented me from doing work. I: Problems sleeping. R: During the process, sleeping is really a problem, they alway gave me sleeping pills or vitamins that promote sleep. I: Irritability or outbursts of anger. R: Sometimes. I: Problems concentrating.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: Sometimes. I: Feeling on guard. R: Explain. I: It is like the circumstance where you always try to protect yourself from others. R: Yes. Because bumping to me hurts. My wound might open due to it. I: An exaggerated startle response. R: Explain. I: Example, in a scenario where you were disturbed you reacted a lot more violently. R: Maybe sometimes. Because sleep is really fundamental for me. Of course when someone is noisy, especially that child over there you could not sleep well. Research Questionnaire I: What are some of the traumatic experiences you have experienced in relating to your illness or previous illnesses? R: Uhm, Traumatic, I only had traumatic experiences during the process because it is very painful even before I have undergone the operation as prescribed by my physician, it is just like you didn’t expect the feeling when the condition had started, when you had found a tumor that is painful to touch, which had really progressed into a full-fledged cancer, in which from there I was caught by surprise for I didn’t expect a little growth in my body to have a very significant effect to me as represented by the complications that arose. The experience itself of having the pain was traumatic in the very least.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: So, are you cancer free? R: No. The oncologist still can’t declare it, the doctor said that I should continue the medications for five years. I: 5 years? R: I have had the medications for 2 years already I: So you already had the medical intervention for 2 years, and so far it has been good? R: Yes. However, the pain is still there it is because of the existing operations on my two breasts, so the lymph nodes are gone. It is painful and it is inflamed as well. I: Ok so, how did you deal with the stress during that time, both personally and along with your family? R: I dealt with it by just living normally, even though the pain was still there, I tried to do the things that I normally do although not as intense as before. Such as household chores, I do it slowly. I talked to my family about my case and told them to be more sensible and extra careful around me for bumping with me could cause intense pain. I: Ok so you deal with stress sometimes by praying? R: Yes. That is my main way of dealing with the stress brought about by the illness, Lord is always there for me. I: Ok. R: He is the entity I am asking for strength, so I can overcome everything.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: So, did you go through a rehabilitation period as prescribed by your doctor? Even the medications that has been given to you. R: Yes. When we say rehabilitation, my understanding about it in relation to my case is the advice given by the professionals, it is when the doctors tell me not to carry heavy objects and eat a lot. Actually, I can still do the things I usually do, but with moderation. At all times when possible, just eat healthy foods instead of junk food. I: Ok, so what rehabilitation process did you undergo that helped you deal with the symptoms that came along with your PTSD (Post-Traumatic Stress Disorder). R: Follow, just follow the rules, all I’m saying is just follow the instructions of your doctor, in what medications you should take and the amount of intake prescribed. Just like that. I: So, that is right but, R: It is a bit far off. I: No. not really, since you had not undergone any rehabilitation or even have PTSD itself, let us put the question in this way. What had you done, since you are experiencing symptoms, in which at times you can’t control your temper, feel heavy stresses, and you always remember the event, how did you deal with it? R: My approach about those things is that if I continue to be angry I will be at a great disadvantage because it is prohibited and if I become negative about the condition I am experiencing I would just divert my attention to other things. I do

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School household chores, I do things that would make me happy, and I talk to people that would be always there for me especially when I experience pain. Like that. I don’t focus on things that would make me feel more of the event. Because if you think about looking awful, or feeling down, nothing is going to change especially if you let the situation engulf you. In which you will just lie in bed and let yourself look awful. I: Ok so, what strategies or practice did you do or are currently doing to help yourself deal with the stress that stemmed from the traumatic event? R: Just live normally, doing the things you usually do. For example: household chores, gardening, sightseeing, bathing at the beach, interacting with nature, and number one is I don’t forget to pray to the Lord. I always pray to him, talk to my churchmates, cell group members, pastor head, and bishop. Just like that. It really helped me a lot. That is why look at me now, I am very positive, and I know that my family and God is always there for me. That is why I keep getting stronger everyday. I: So, would you consider the specific methods as effective or not? Explain how. R: Yes, it is so effective, because if you don’t forget the Lord who gave us the life who you always thank him for, he gives you the strength. Stay with God for he gave us life. Let us be positive looking forward, have faith, and move on. Coping Strategies Inventory I: Just answer yes or no depending on whether or not you agree with the given statement from the checklist and just write it down on the paper as well.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: I try to see the issue from several perspectives. R: Yes I: I try not to think about the issue. R: No I: I seek advice about the issue from people close to me. R: Yes I: I feel like I have to allow the issue to run its course. R: Yes I: I consider what resources I can access in order to meet the demands the issue requires of me. R: Yes I: I get upset and express my anger about the issue. R: No I: I spend time with nature like taking a walk so I can have strength to cope with the issue. R: No. I don’t do anything like that. I: I become involved in other things like work, hobbies or intellectual pursuits to distract myself from the issue. R: Yes I: I make jokes about the issue. R: Yes but only sometimes I: When I think about the issue I tell myself that things could be much worse.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: No I: I postpone thinking about the issue. R: No I: I talk with people I can trust about the issue. R: Yes I: I just accept the issue and give up trying to do anything about it. R: No I: I am unable to develop a plan to resolve the issue. R: No I: I vent my emotions about my frustration with the issue. I: I vent my emotions as in I let it out. R: No I: I seek comfort about the issue through meditation and prayer. R: Yes I: I use alcohol or drugs to distance myself from the issue. R: Alcohol? No alcohol but drugs yes I kind of needed that. I: I try to understand how I might grow as a result of the issue. R: Yes. I: I use daydreaming to avoid the issue. R: huh? Daydreaming? That’s dangerous. No. I: I get stuck when I try to think of ways to address the issue. R: No

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: I find myself just needing to talk to others about the issue in order to relieve some stress. R: Yes I: I turn to a religious leader or spiritual advisor for guidance about the issue. R: We need that. Yes. I: I lose myself in activities that make it difficult for me to focus on the issue. R: Yes. I: I find myself laughing about the issue. R: Now? Present or past? I: Present. R: Yes I: I confront the issue in ways I believe will make a difference R: Yes I: I try to be positive and look on the bright side of things in spite of the issue. R: Yes I: I forget about the issue hoping it will resolve itself. R: No I: Others generally don’t know about the issues I have to deal with. R: No. Rarely because they all know. I: I spend time evaluating my options for resolving the issue. R: Yes

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: I spend time doing things for others in order to take my mind off thinking about the issue. R: No I: I am sarcastic about matters related to the issue. R: No I: I seek to learn something about myself from the issue. R: Yes I: I just ignore the issue. R: No I: I enlist the support of others to tackle the problems associated with the issue. R: Yes I: Even though I want to resolve the issue, I find myself doubting that anything can really be done about it. R: No I: I struggle to find ways to handle the issue. R: No I: I lash out as a way of dealing with the issue. R: No I: I try to connect with a higher power or essence example is deity, God, Alah, Buddha etc. R: Yes. There is. We go for God. I: I find things to do to keep myself busy so I don’t have to worry about the issue.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: Yes I: I tell myself other people have bigger issue in their life than mine. R: Yes I: I act as though the issue isn’t affecting me even though it really is. R: Yes I: I seek guidance from people who I believe can help me address the issue in a meaningful way. R: Yes I: I wait and prepare myself for whatever outcome is going to happen R: Yes I: I press forward with an action plan that will change the way the issue will turn out. R: Yes I: I make several efforts to address the issue in different ways R: Yes I: I feel so overwhelmed by the issue that I break down and cry R: Yes I: I try to gain understanding about this issue from religious beliefs or faith. R: Yes I: I watch television or movies instead of concentrating on the issue. R: Yes. That’s all I did. I: I talk to myself in ways that help me see the issue less negatively.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: Yes I: I pretend the issue isn’t as serious as it really is so it doesn’t seem quite as bad. R: Yes I: People who know me well are not aware of the stressful issues in my life. R: No I: I just learn to live with the issue. R: Yes I: I develop strategies that will empower me to effectively deal with the issue. R: Yes I: The issue causes me to be irritable like moody with others. R: No I: I place my trust in a divine power that is mindful of my struggles with this issue. R: Amen. Yes. I: I turn to food or eating as a way of forgetting about the issue. R: Yes. I: I poke fun at things related to the issue. R: Yes I: I’m good at finding productive ways to resolve the issue. R: Yes

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: I turn to recreational activities as a way to manage my feelings about the issue. R: Yes I: I pretend the issue doesn’t exist. R: Yes I: I turn to others who have had similar issues for guidance and direction R: Yes I: I resign myself to accepting the issue the way it is. R: Yes I: I talk to professional people for help with the issue example a doctor or therapist. R: Yes I: I am aggressive in my approach in confronting the issue. R: Yes I: I seek solitude and peace about the issue through sources that help me connect with my spirituality. R: Yes I: I immerse myself in other things in order to take my mind off the issue. R: Yes I: I find myself denying there is any “real” issue so that I don’t have to face it. R: Yes I: I seek help from groups who are addressing similar issues

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: Yes I: I spend time thinking the best approach to addressing the issue. R: Yes I: I make comments that reflect humor about the issue. R: Yes I: I get so exhausted with the issue I just accept the things the way they are. R: Yes I: I procrastinate doing things that might make a difference with the issue because they seem hard to do. R: Yes I: If the people who are close to me knew about the issues I have to deal with they would be surprised. R: Yes

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School SURVIVOR C I = Interviewer R = Respondent Demographics I: Age? R: 18 I: What type of cancer were you diagnosed with? R: Acute Lymphoblastic Cancer I: When were you diagnosed? R: 2009 PTSD Symptom Screening I: Have you experienced or witnessed a life threatening event that caused intense fear, helplessness or horror? R: Yes I: Please answer yes or no if you have experienced the following: Repeated, distressing memories, thoughts, fantasies and/or dreams? R: No I: Acting or feeling as if the event was happening again? (Flashbacks) R: No I: Intense physical and/or emotional distress when you are exposed to things that remind you of the event? R: Yes

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Answer yes or no if you avoid reminders of the event and feel numb, compared to the way you felt before, in 3 or more of the following ways: I: Avoiding thoughts, feelings, or conversations about it? R: No I: Avoiding activities, places, or people who remind you of it? R: No I: Blanking on important parts of it? R: Yes I: Losing interest in significant activities of your life? R: No I: Feeling detached from other people? R: No I: Feeling your range of emotions is restricted? R: No I: Sensing that your future has shrunk (for example, you don’t expect to have a career, marriage, children, or a normal life span)? R: No I: Please answer yes or no if you are troubled by two or more of the following: I: Problems sleeping? R: No I: Irritability or outbursts of anger? R: No

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Problems concentrating? R: Yes I: Feeling “on guard”? R: No I: An exaggerated startle response? R: No Research Questionnaire I: What are some of the most traumatic experiences you have experienced in relation to your illness? R: Traumatic experiences? At first, the way of medication is through injection, no not injection but through IV. As a child, you’re not used to getting pricked by needles and I wasn’t usually brought to hospitals so it was a first-time encounter for me in my life. For me it was not that normal which served as a traumatic experience for me to not get treated because they just kept injecting and injecting me with stuff, also and as time passes by I became okay with it. Another experience was my hair loss, it was what gave me confidence. For me, I really gave value to my hair especially now, since it’s long. So, for me, it also served as a trauma. I: So, second question, how did you deal with stress during that time both personally and along with your family? R: Oh, maybe because my lifestyle is still normal. In other words, the treatment was just an additional activity in my daily life. It didn’t really affect me. In other

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School words, it only became stressful when the treatments would cause me to get tired. So, my coping mechanism really was just sleeping and eating and making myself stronger because I was really getting weaker and weaker. It would give you stress physically but emotionally, it did not affect me. I wasn’t really affected emotionally though I did have trauma considering what happened to me during the treatment through injection but I did cope up with it because I got used to it. In other words, getting used to it is eventually how I coped up to it. Then, in terms with my family, they also helped cheer me up because who else is going to cheer you up, really only my family was there to help me in terms of the treatment, taking me to the clinic, to the doctor, yeah like that so basically, cheering up, eating and sleeping. I: So, did you go to a rehabilitation period as prescribed by your doctor? R: Rehabilitation? Considering that our rehabilitation is a form of medication, maybe we were rehabilitated in a way that they also treated me because I really didn’t know what of rehabilitation it was. I: In other words, after your cancer. R: Treatment? After the cancer there was really no rehabilitation process anymore. Was only through recovery process and no rehabilitation process happened, no isolation or whatsoever because after the treatment, I entered school immediately, at grade 7. So, after the 3 and a half years I stopped, through the span of time of treatment, after the medication process I entered

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School school and as far as I know, there was no rehabilitation process that happened. I think my rehab was when I entered school. I: Wasn’t your body shocked that you entered school right after your treatment? R: My body wasn’t shocked because I chose to enter school myself because its hard to be left out, in other words it is more shocking to enter school too old so for me, I force myself to catch up because since the process of the medication, I really wanted to go to school, I told my parents that I really wanted to enter school because what happened was there was a time that I forced them o let me enter school, they made the move to make me go to school. But what happened was the school rejected me because I have complications in health and the school is to blame if something happens to me. So, I wasn’t that shocked because I pushed myself that I really wanted to enter school. I: So, there wasn’t any rehabilitation that happened? R: None. I: So, in other words, the medications you took is only for your illness? R: Yes. It was only for the cancer, for it to be treated. I: So, were eating and sleeping the things that you used as coping strategies? R: Coping mechanisms? Yes, most importantly in my health, in other words, it was normal, like normal people without illnesses. What’s prohibited in healthy people is also prohibited in us cancer patients like a healthy lifestyle, being stressed isn’t allowed which is really bad for us. Staying up late is also a no-no. Eating past the right time is also not allowed.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: But did you experience those things the period after your cancer? Have you tried some of those?” R: Yeah, I tried them but there was a need for these things to be limited, in other words, minimize them. Also, our cravings because if we get used to those habits, we will do it as we want. So, as much as possible we need to minimize those things, in other words, other people they cut it off, but for me I don’t cut it off totally. I minimized them, like at least once a month in trying this and that. I consider it as a reward for myself if I did something great like having a perfect score in a quiz. Sometimes reward for myself but it’s not much for example, junk food. If a pack is much for normal kids per day, I’d have a pack for a week or even month because my parents also monitor me. In terms of food, they text me for example when I’m at the dorm, they’d ask me what I’ve eaten for the day. Absolutely monitored. Because we would be rest assured to yourself that when the illness relapse, you wouldn’t be at fault. Because as a survivor, you aren’t totally cured in regards to cancer. In other words, we all have cancer cells especially in us who had complications in cancer. So, there is a possibility that the illness will come back and we are rather more prone because we had it already. I: So next, what certain rehabilitation process did you undergo to help deal with the symptoms that came along with your trauma? R: Maybe, I don’t know. The process that I accepted it, in other words, maybe acceptance. Acceptance because I am ill so maybe things are like this so

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School through the process, maybe getting used to it and that, I accepted it because for me, nothing will happen if you won’t accept because that part is more on the emotional side but if in the physical side, I have nothing against it because I am sick. I accepted that I am sick that I need to accept its side effects of the medication that has a bad effect on the body like for example, hair loss. So, uhm I don’t know. I really don’t know. I: So, in the case of your cancer, you actually feel pain. In other words, what do you do in order to alleviate the pain, to just even lessen it? R: So, the only thing the doctors prescribe so that we won’t experience the pain is they let us sleep. We have a certain drug that they prescribe, it’s actually just antihistamine, because it has a drug for sleeping and also anti-allergies. Because there was a time that during the treatment, we had allergies on the said drug. And we took antihistamine, which is a combination of anti-allergy and a sleeping drug. That’s the only thing they do to us. Then when I’m at home, I make myself busy so at least I wouldn’t feel the pain too much, because the pain is the thing that triggers our brain. So, in order for my body to not feel pain, I make myself busy. I: In what way would you say you do to say you’re busy? R: I watch TV, and also, I sleep because to be honest, there are a lot of things that are prohibited to us. We shouldn’t get too tired, we shouldn’t get stressed. We can’t sweat too much because it might lead to another disease that would be harder to treat because I’m undergoing medication, so it would be doubled.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School Prevention is the only thing I do, so they let us lie on the bed, sit and do nothing, like spoon feeding. All the foods are served by my parents. I: Was there a point in your life that you experienced anxiety? Like you were feeling down? R: Anxiety? I wasn’t a kid like that, who sees everything negatively. The illness is already there. What you need to do is accept that you are sick because if you would disregard it then it would take longer time and it might get worse which was already said by your doctor himself and why not just accept it? That’s what I do. I accepted the fact that I really am sick. So, I think I don’t have anxiety and as far as I know I wasn’t that stressed, I just followed my doctor to not be stressed. I: How old were you exactly? When you were diagnosed? R: Exactly diagnosed? I was exactly 9 years old. I: And when were you exactly cancer free? R: Cancer free, total cancer free was just this January 2018. 8 and a half, 2009 then January 2018 I: Would you consider that specific method effective? R: For me, it is effective because It is me, mine myself. I don’t know if it would be effective because it depends on the personality of the individual. Because there are other patients that are not like me, with my point of view also, because that is where the way a person accepts a thing varies. For me, when I know that it is already factual, the information given to me, I’ll accept it. Like what the

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School doctor said, I am sick. I know that from the doctor himself, and from the experiences that he had patients diagnosed, which is accurate. For me, I’ll accept it because there are tests or lab results out so acceptance on factual information that were given to me. So, I really don’t know if I can consider it effective for others but for me, it really is. I was able to cope up with all of the things, in other words, dealing with stress. But honestly, I did not deal with stress, because once I accepted that you have complications like these with your health. You won’t be stressed if you follow the process of medication. And more on dealing with the physical side because that’s the thing you need to strengthen. There are many times wherein your body will get weak after the medication process, it is chemotherapy and not only it is tiring but it also is weakening. So, what I did was to maintain my healthy lifestyle. If you’re tired, get rest. If you feel sick, drink the medication. I followed what the doctor said. In other words, it only is obedience. Maybe that was what brought me to this point. Not really cancer- free but as a survivor. All of us are not cancer-free. I: What do you say are the main factors that helped you to accept that you were sick? R: Factor? Maybe the truth, that according to the lab results, what they will test is he specimens got from you. So, whatever is shown to you based on the lab results, those are factual information that you can say you have abnormalities in your body, that if you bring to the doctor, they will know. So, more on factual information and diagnosis of the doctor.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: So those were what really helped you? R: Yes, to accept, because if only persuasion from the parents, they don’t know you’re sick. You will base more on acceptance if you know that you really are sick. Because in yourself, you actually feel something. And you don’t know what that is, in other words, for me, I didn’t know my disease. For one and a half year, I’ve experienced many feelings that are very unknown to me. And now, I know the answer. So, you really need to accept that you don’t have those experiences anymore. I: In terms of relationships, who do you think helped the most with your illness? R: My mother, because since the beginning, she was the one who brings me to the doctor for check-up, laboratory tests and all throughout the medication for three and a half years, I’m with my mother so it really was my mother. I: Excluding your family, what are your other support systems that you think helped you? R: Maybe more on the patients that are like me. We were together in the clinic for the sick children. All of them are sick. All were children, not only me. So that was what served as motivation for me that I would get better because my companions are also fighting with it. I’m fighting with them. It wasn’t only me fighting in the journey, and with this case, it wasn’t only me experiencing. If I see patients who finished the medication, and survived, why not me too? So, in other words, that was my motivation to get better. It helped me to cope-up, a coping mechanism, and became a motivation for me to get better. If you don’t

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School have motivation, what would ever happen to you? If you won’t get motivated to get healed, what do you want to do in life? Maybe, for me. Because if you won’t be better? What would we ever do? I: So, you would like talk with each other do you like talk with the other patients as well? R: Yes, in other words, we see each other as classmates because every day, they are with me. I’m with them every day. In other words, for three and a half years, there were people finishing the medication and would go back to the clinic, will say greetings and it came to the time when I was finished with the medication, and we just go back and forth from where we came from. Coping Strategies Inventory I: Just answer yes or no depending on whether or not you agree with the given statement from the checklist and just write it down on the paper as well. I: I try to see the issue from several perspectives. R: Yes I: I try not to think about the issue. R: No I: I seek advice about the issue from people close to me. R: Yes I: I feel like I have to allow the issue to run its course. R: Yes

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: I consider what resources I can access in order to meet the demands the issue requires of me. R: Yes I: I get upset and express my anger about the issue. R: No I: I spend time with nature like taking a walk so I can have strength to cope with the issue. R: No. I don’t do anything like that. I: I become involved in other things like work, hobbies or intellectual pursuits to distract myself from the issue. R: Yes I: I make jokes about the issue. R: Yes but only sometimes I: When I think about the issue I tell myself that things could be much worse. R: No I: I postpone thinking about the issue. R: No I: I talk with people I can trust about the issue. R: Yes I: I just accept the issue and give up trying to do anything about it. R: No I: I am unable to develop a plan to resolve the issue.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: No I: I vent my emotions about my frustration with the issue. I: I vent my emotions as in I let it out. R: No I: I seek comfort about the issue through meditation and prayer. R: Yes I: I use alcohol or drugs to distance myself from the issue. R: Alcohol? No alcohol but drugs yes I kind of needed that. I: I try to understand how I might grow as a result of the issue. R: Yes. I: I use daydreaming to avoid the issue. R: Huh? Daydreaming? That’s dangerous. No. I: I get stuck when I try to think of ways to address the issue. R: No I: I find myself just needing to talk to others about the issue in order to relieve some stress. R: Yes I: I turn to a religious leader or spiritual advisor for guidance about the issue. R: We need that. Yes. I: I lose myself in activities that make it difficult for me to focus on the issue. R: Yes. I: I find myself laughing about the issue.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: Now? Present or past? I: Present. R: Yes I: I confront the issue in ways I believe will make a difference R: Yes I: I try to be positive and look on the bright side of things in spite of the issue. R: Yes I: I forget about the issue hoping it will resolve itself. R: No I: Others generally don’t know about the issues I have to deal with. R: No. Rarely because they all know. I: I spend time evaluating my options for resolving the issue. R: Yes I: I spend time doing things for others in order to take my mind off thinking about the issue. R: No I: I am sarcastic about matters related to the issue. R: No I: I seek to learn something about myself from the issue. R: Yes I: I just ignore the issue. R: No

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: I enlist the support of others to tackle the problems associated with the issue. R: Yes I: Even though I want to resolve the issue, I find myself doubting that anything can really be done about it. R: No I: I struggle to find ways to handle the issue. R: No I: I lash out as a way of dealing with the issue. R: No I: I try to connect with a higher power or essence example is deity, God, Alah, Buddha etc. R: Yes. There is. We go for God. I: I find things to do to keep myself busy so I don’t have to worry about the issue. R: Yes I: I tell myself other people have bigger issue in their life than mine. R: Yes I: I act as though the issue isn’t affecting me even though it really is. R: Yes I: I seek guidance from people who I believe can help me address the issue in a meaningful way. R: Yes I: I wait and prepare myself for whatever outcome is going to happen

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: Yes I: I press forward with an action plan that will change the way the issue will turn out. R: Yes I: I make several efforts to address the issue in different ways R: Yes I: I feel so overwhelmed by the issue that I break down and cry R: Yes I: I try to gain understanding about this issue from religious beliefs or faith. R: Yes I: I watch television or movies instead of concentrating on the issue. R: Yes. That’s all I did. I: I talk to myself in ways that help me see the issue less negatively. R: Yes I: I pretend the issue isn’t as serious as it really is so it doesn’t seem quite as bad. R: Yes I: People who know me well are not aware of the stressful issues in my life. R: No I: I just learn to live with the issue. R: Yes I: I develop strategies that will empower me to effectively deal with the issue.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: Yes I: The issue causes me to be irritable like moody with others. R: No I: I place my trust in a divine power that is mindful of my struggles with this issue. R: Amen. Yes. I: I turn to food or eating as a way of forgetting about the issue. R: Yes. I: I poke fun at things related to the issue. R: Yes I: I’m good at finding productive ways to resolve the issue. R: Yes I: I turn to recreational activities as a way to manage my feelings about the issue. R: Yes I: I pretend the issue doesn’t exist. R: Yes I: I turn to others who have had similar issues for guidance and direction R: Yes I: I resign myself to accepting the issue the way it is. R: Yes

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: I talk to professional people for help with the issue example a doctor or therapist. R: Yes I: I am aggressive in my approach in confronting the issue. R: Yes I: I seek solitude and peace about the issue through sources that help me connect with my spirituality. R: Yes I: I immerse myself in other things in order to take my mind off the issue. R: Yes I: I find myself denying there is any “real” issue so that I don’t have to face it. R: Yes I: I seek help from groups who are addressing similar issues R: Yes I: I spend time thinking the best approach to addressing the issue. R: Yes I: I make comments that reflect humor about the issue. R: Yes I: I get so exhausted with the issue I just accept the things the way they are. R: Yes I: I procrastinate doing things that might make a difference with the issue because they seem hard to do.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: Yes I: If the people who are close to me knew about the issues I have to deal with they would be surprised. R: Yes

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School SURVIVOR D I = Interviewer R = Respondent PTSD Symptom Screening I: Do you have recurring dreams when you had Cancer? R: Not that much, but back to the time when I have my illness, I have dreamed that I already have a very long hair even though I’m bald that time. Then everytime I dream about it, I feel happy because I had no hair for 3 years, and when I already had it in my dream, it’s very very gratifying. I: Having flashbacks during which it feels as if you are reliving the event? R: Everytime I undergo CBC in the clinic. I go to the clinic every month. Then, whenever I go there, it feels like we increase in number instead of decreasing. You will feel sorry for the babies, because there are babies who already grew up there. Everytime the situation is like that, I feel sorry for those babies. Other people were saying, “they are only babies, not eating anything but drinking milk only, how come they were afflicted with Cancer?” I: Next is experiencing physical, emotional, or psychological distress when you see or hear things that remind you of the event? R: Back to the time when I had Cancer, yes, I experienced distress. But now, I feel paranoid. Just a symptom of a little bit of pain, I tell to myself, “what if I have illness?” Everytime I had headaches, colds, mouth sores, bruises, that’s that

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School time I feel paranoid, because these are all the symptoms that you had Cancer again. I: Avoiding thoughts, emotions, or conversations related to the trauma? Do you avoid… R: Conversing about it? I: Yes, seems like that. R: When I just had my recovery back on 2011, because the people that time were not open about that kind of disease. I’m wearing my bonnet, mask and I’m pale. As in all of my hair in my body were gone. Here, as you can see, these arm hairs of mine were lost way back then. Then that time, I don’t want to talk about it because I feel ashamed. It feels like they will look at you from head to toe. You will be judged, “she will eventually die.” That’s the first time I had my Cancer. But when I had my relapse, of course I still feel ashamed because I became bald again even though that time I already had my long hair. I feel ashamed of myself, then… yeah. But, I’m open when it comes to talking about my Cancer, when someone asks me “did you have illness of like this and like that?” I’m open about it. And that’s why, other people can interview me about my Cancer. I: Avoiding people, places, events that might trigger memories of the trauma? R: Not really. But whenever I see the Regional Hospital, do you know that hospital? I: Is that the big…

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: It’s here in Batangas, because I’m always admitted there. Then I said to myself, “when I had my recovery, I will never ever get back there” because before we get to the SM, we need to make a turn to that hospital. I can remember how hard it is to be hospitalized in there. Especially it’s a public hospital. It’s very hard. I: Avoiding activities that you enjoyed or participated in before the trauma. R: Just like studying. As in I really really really want to go to school again. They say, “those who wants to study are the ones who didn’t even had the chance to go to school.” Yeah, that’s the thing I want to do, but can’t do anymore. Also, going out with friends. It is still the same for now, but lesser. I: Avoiding and feeling detached from other people. R: That’s when I had my first Cancer on 2011, and also on 2014 when I just had been diagnosed. My friends would visit me but I don’t want to. They want me to come with them somewhere to hang out. There was also this time when my classmate invited me on her debut. I think I’m 18 candles that time, when I didn’t attend because I feel shy. I’m bald and I look very different. When you had Cancer, you won’t notice it because instead of getting skinny we get fat because of steroids. Then, as the time passes by, it seems the body goes back to its normal figure. But you can still notice it since you’re bald, wearing mask. As in the face will look you different.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Do you avoid certain emotions, especially pleasant emotions? Because there are some people who doesn’t want to feel extremely happy, they will think that something bad might happen. Are you avoiding that? R: No, because when we are at the clinic, I have a lot of people around me who are at my age. Everytime we experience illness, we’re just happy together. I: Do you avoid thinking about or planning for the future, because you don’t know what’s going to happen after the chemotherapy? R: Sometimes I think about that like, “what would happen to me in the future?” because I won’t be able to study again now. I think about what other people say that chemotherapy does not totally heal the person from Cancer. For me, it just makes the cancer cells sleep, then after a while it will wake up and you will eventually have Cancer again. Based on what I have read, and what other people’s view or opinion, you will still die. It won’t heal your Cancer, instead, it will just lengthen your life. But other people have different insights, they think positive. I’m also thinking that way, but I have this side of mine that thinks about the negative one. So sometimes I chat him (pertaining to her boyfriend), and I say to him that he should study well because… oh wait, I’m crying. That… that you should study because what if I die… like that. It’s hard that my batchmates had left me already. They are all graduates and have jobs now. Then I asked myself, “how about me?” I’m not allowed to go to school. That’s why I thought, what if I grow old? What would I do, how can I live since I’m not allowed to study and work because I will get tired.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Do you experience inexplicable avoidance of memories related to the trauma? R: No. I make it as an inspiration, for me to take care well of myself because I don’t want to get back at it and undergo treatment again. I: Do you experience feeling easily annoyed or angry? R: Back to the time when I’m having my chemotherapy, yes. Now it’s still the same, but lesser. The side effects of chemotherapy are like that on all of us. It is hot in the body. You will feel cold, but we will still feel hot. We easily feel angry, annoyed, even though there is nothing to be angered or annoyed about. I: Do you experience being unable to sleep soundly or comfortably? R: When I’m having my chemotherapy, yes. Because there is something that is painful, your head aches. You will feel different pains that time, that’s why it’s hard to sleep. I: Oh, so it really does have a lot of side effects. R: Yes. I: Do you experience feeling constantly alert, as if waiting for something to happen? Do you know the feeling when you’re being observant... R: on my surroundings? I: Yes. That’s why you feel like you’re protecting yourself because you’re thinking that something might happen to you? R: Yes, I’m like paranoid that if this happens or that, I relate it to Cancer even though it’s not really related. I: Do you feel that your range of emotions is restricted?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: That’s… when I’m crying. I’m just alone and I don’t have someone to talk to. I: Do you sense that your future has shrunk? For example, you don’t expect to have a career, marriage, children, or a normal life span? R: Yes. That’s what I’m thinking because as I’ve told, I don’t go to school anymore. Then I’m not allowed to work even if I wanted to. I also thought that my batchmates had left me already. My former batchmates, they are all graduates now and have work already. Then my other batchmates now, my classmates back in college, they are about to graduate. I thought that, “I was being left out, how will I follow them?” Then, how about when we had reunion, they have something to talk about while me, I’m being left-out. I: What are some of the traumatic experiences you have underwent in relation to your illness or previous illness? R: Not that much. Only when… oh wait, can you repeat the question again? I: What are some of the traumatic experiences you have underwent in relation to your illness or previous illness? So have you experienced something that is really traumatic not just something that is frightening? R: That happened to me? I: Yes. R: When I was admitted to ICU. That’s the time when I’m about to have my birthday. Before that time, he (pertaining to her boyfriend) and his brother gave me a hamster. As in I really really want a pet. Then, that time I didn’t know I’m not allowed for that. Hamsters are smelly, right? I even brought it with me on my

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School room, because I’m overjoyed about it. Whenever I go I bring it with me, even when I’m sleeping. Sometimes I even wake up in the middle of the night just to peek at the hamster. Then that’s the time when I didn’t realize I have inhaled it already. I had a fever afterwards and I don’t know the reason why. I had it for no reason, I don’t even have colds but I’m having my chemotherapy that time. Then, when I can’t take it anymore, I felt like I’m about to have a black-out. As in when I’m standing up, I’m having a black-out I can’t move on my own. That’s the time they admitted me, and they found out that my platelets are low. As in my CBC have fallen that time. My doctor thought that I have Dengue, because that time Dengue was circulating everywhere. So they admitted me to the Regional Hospital. The findings there were Sepsis, the infection in the blood, then Dengue and Pneumonia. As in I had many findings, and my urine accompanies a lot of pus. That time was September 19 and my birthday is September 23. I really remember that I am unconscious for 5 days. Then on my birthday, that’s the time I got okay. I can’t eat that time. We’re at the ICU, there are 4 beds, then I’m on the second one. All the patients who were brought there were already wearing tube. When my doctor told me I was about to be admitted at the ICU, I got scared. Because, when you are being brought to the ICU, it feels like you are about to die. Then all of the patients adjacent to me were wearing tube just to breathe. But as for my situation, I have air-conditioner but I have oxygen and there was an electric fan in front of me, because if there’s none, I won’t be able

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School to breathe. I have my IV line here and here, then my BP that time reached 40 over 50. I: It’s low… R: Yes. As in I can’t stand. If I stand, I blackout. Then, I can’t go to CR because if I do I will fall down. Also, I had diarrhea that time and I’m wearing diaper. I’m in bed for 5 days, unconscious. I’m not eating, and when my dad asks me what do I want to eat, I just say apple. He told me that while I’m chewing it, I eventually fall asleep. As in I can’t eat that time, it is one of the side effects of making the BP high. The other one is IV line for antibiotics while the other is IV line for making my BP high. Then, I have more on my finger, the oxygen for the body. I find it hard to breathe that time, leaving aside the electric fan from the oxygen. My dad also told me that I hallucinated. We’re at the ICU and only me and my dad are in the room. We stayed there for 2 weeks and all of the patients beside me are dying. We’re in the middle, there are 2 here, then there is 1 here. As in all of the patients who were admitted there used tubes already then eventually dies. There was patient beside me, who was being revived but can’t no longer take it. I think he’s/she’s 18 years old that time. I saw with my naked eye how he/she died. After that incident, we were not able to eat because the appearance of that patient changed a lot. That time I’m reminding my father because I have my savings back then. Then my dad told me that I said to him, “dad, I have my savings there, get it” that’s the time he cried. I: But, are you conscious that time?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: I don’t know. I: How are you that time? Was your eyes open but you know what’s happening around you? R: Uhm, they told me I’m crying because I’m having a hard time to breathe. But I didn’t use a tube to support my respiration. Only oxygen and electric fan. There were times I can’t breathe, and I just let my chest be rubbed to ease my breathing. Because, only half of my lungs is white. Here, it’s okay while here it’s white. Nonetheless, it should be all black. That’s why when I’m turning on my side, I feel like I’m drowning. That’s how it felt. I’m reminding my father, I told him to make my grandmother come home from Bicol for me to see, and that’s when he cried. My doctor told me that when I didn’t survive in the ICU, then the negotiation was over. Like, he can’t do anything about it, I’ll just wait for my time to come because I have a lot of diseases like the infection on my blood. I also have my Cancer that time, then Dengue and Pneumonia and they told me I have a lot of pus in my urine. I: So it was on your first cancer when you had these all of diseases? R: It was on the second time I had Cancer. I: Oh, so it’s when you had relapse? R: Yes. I: Okay number two question, how did you deal with the stress during that time? Both personally and with your friends or family.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: That time, there were times I just cry at night. Because before that, before… what do you call that? The second time I had my Cancer, my doctor told me to undergo treatment again, but I refused to since I will die anyway. It’s like expenses again. The expenses will be high before you get to be treated. Then as the time passed by, it was getting better. Since it feels like I gain a lot of friends. When you’re in the clinic, it’s just the happiness that we feel since we’re a lot. The feeling when you’re in the clinic is heavy, but with their presence it lightens up the heavy feeling. However, whenever I get home, when I vomit, I can’t take it anymore, my head aches a lot, I vomit because of the chemotherapy. I just say to my dad that I can’t handle it anymore. I’m too tired. But, even though I’ve said that, I’m still okay as of the moment. I: But did you experience stress with your family or friends? R: No. They support me. There were times that they would visit me even though I don’t want to. They will just come to me without me knowing, like surprise. I: Did you go through a rehabilitation period as prescribed by your doctor? R: No. I: So, after you had your recovery, you just go to your clinic? Like for follow-up checkup? R: Yes. After I had my chemotherapy, I undergo CBC every month. I: What strategies or practice did you do or are currently doing to help yourself deal with the stress stemmed from the traumatic event? R: Strategies that I’m doing right now?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Yes. R: So that I could no longer think of it? I: Yes. R: I’m having my online shop. When I’m having my chemotherapy, I thought that I need to focus on something that would entertain me. Back then, I’m not taking my online shop seriously, because you’re just going to post then you will have a lot of person to talk to. Then up until now, that was 2016 by the way, I still manage my online shop because I thought to myself that if I stopped my managing it, there is nothing left I can do. It’s wearisome at home since only we’re only 3 at the house, my grandmother and my father. I don’t have any brothers or sisters that’s why it’s saddening. Then I use Facebook, chatting with my friends, and I also play ROS. I: Would you consider online shopping to relieve stress as effective or not? R: Yes. Because when you’re having an online shop, you get to ask a lot of people. Then I also get to be friends with my suppliers, and customers. It helps relieve stress. Like I get entertained by it. I: Like you’re being diverted to other things? R: Yes. I: Next question, do you have a hard time concentrating whenever you have a problem? R: Yes. During the time I was undergoing chemotherapy like as in my mind just felt out of it you really can’t focus on other things.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: How oftendo you have sleep problems? R: Everytime I have chemotherapy only. That’s 4 times a week, 5 times a week… I: You weren’t… cause isn’t there people who are easily frightened. If you startle them, they will really get frightened. When you had cancer, did you have a time wherein every little thing can easily startle you? R: Not really. Research Questionnaire I: What experiences made you develop symptoms of post-traumatic stress disorder? A while ago someone said about needles. Do you have the same experience? R: Needle? I: Yes, and the chemotherapy itself. R: Just the same. Because you will really feel different in chemotherapy. It has a lot of side effects like you will feel very weak after you have it. I: Can you say something about the effects of chemotherapy? R: Vomiting, stomach pain, headache, and the one that joins the joints hurts. Especially on the need, there are times when I couldn’t walk. Another side effect is the hair loss, getting pale, as in even the eyelashes fall off. All of it was because of the chemotherapy, all of your hair will be lost. That’s why when had hair, we’re very very glad, like we comb and comb our hair. I also don’t know how many times I got bald. There was this time I felt happy when my hair

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School became long. That’s why whenever I can already go outside because I have hair, but when my hair starts to fall off again I cried. I said to myself, “I already had my long hair, it’s saddening.” I: Are you doing any rehabilitation practices? R: None I: Is there anything else you want to share? R: That happened? I: Yes. Anything actually. Whatever you want to share. R: Wait. Don’t you guys have any other question to ask me so that I have an idea, just an idea. I: History? Any history of cancer? R: Before I got sick, they said none but my dad’s cousin, my grandfather and my great grandmother, cousins as well I think. My dad’s cousin had leukaemia as well. He was in the middle stage. His chemo was the medicine type, he just drank tablets and got injected. Like that. That’s when we found that, perhaps we really did have a history, because of my dad’s cousin had leukaemia as well although his type was different. I: Did anything significant happen in your life when you got cancer? R: Like? I: Anything. R: Uhm, nothing much.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: If there is any advice you can give for the people who get stressed after getting cancer, what advice will you give them? R: Advice to prevent cancer? Like that? I: Yes R: Uhm, refrain from...let’s say for example you’re stressed. Basically, high grades aren’t important, you should take care of yourself more. You have high grades, yes, but if you’re just gonna get sick then what’s the point of it all? Uhm..they told me that as well but I prioritised high grades that’s why I get stressed. I chose studying over taking care of myself. I: It should be balanced R: Yes, it should be balanced. Take care of yourselves. Avoid staying up late, by 10 you should be asleep or at least 10, 11... Coping Strategies Inventory I: Here, just answer yes or no. And if you have anything more to share just say it. First, I try to see the issue from several perspectives. When you had cancer, did you keep having different thoughts? Like did you try being positive, did you have different perspectives during the time you had cancer? R: That’s related to the chemo I was telling you a while ago. In my research, chemo is no longer effective, it’s only working to prolong life. As if right now, the cancer cells are asleep. They’re not yet awake as if I’m still better right now, but soon they’re gonna wake up and spread again. And I’ll have cancer again. I have a positive side that says, “oh I’ll get better.” I just trust in the Lord that I

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School won’t get sick again. But there’s still this part where there’s just a lot of side effects. Cause if you undergo chemotherapy, all of it dead, good cells bad cells, dead. That’s why there are times wherein we literally do not have hair because our immune system is weak as if it’s holding unto nothing anymore. That’s why if I even just get a common cold , let’s say for example you have a cold and we talk, just like that I’ll get infected ,. That’s because of chemo, cause as in everything dies because of it, that’s where our bodies get weaker. I: Next one, I try not to think about the issue. As if you try to really avoid it when people talk about it? or you avoid thinking about it? R: Every time I think about it, yes. But if we talk about it, I am open about it. There are times that I had a schoolmate, whose dad had been diagnosed, newly diagnosed with leukemia. He is very old already that’s why his type is AML, which is the most progressive. That’s where I advised them on what to do, less stuff to do so as not to harm the patient. I’m open about it just to warn people what not to do. I: Next is, I seek advice about the issue. Do you ask for advice? R: Yes. With someone who doesn’t have leukemia but whose cancer is a tumor. I asked them what they do, what they eat. So whatever they eat, I would eat the same. Like that. I: Here, it seems like it says here is, I feel like I have to allow the issue to run its course. Since you’ve had cancer already, it’s as if you just let it go with the flow in your life?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: Yes. Because nothing will happen if you think about it over and over again. Just keep moving along. If something happens, just go along. I: Here, I get upset or express my anger about the issue. Did you feel as if, you were angry or getting frustrated whenever the issue is brought up? R: No not really. It was okay for me. I: Next, I spend time with nature so I can have strength to cope with the issue. Did you take a walk, or did you want to go to a picnic. The park? R: No, until now all I do is stay at home. If I go out, it’s only if there’s a meetup for my online shop, just that. As in, if I’m home I won’t really go out. I: Here, I become involved in other things such as work, hobbies or intellectual pursuits to distract myself from the issue. So, for you, you got involved in your online shop? R: Yes. I: If you think about your issue with cancer, do you say to yourself that there is a possibility that it might get worse? Like that. As if you’re saying to yourself that, it could be worse? R: Right now it’s like that. That is why even if something small happens to me, I get easily paranoid cause I think “I think I’m getting sick, this is worse cause with my luck, I even relapsed. Same, same type of leukemia. But, if next time it became more severe, I won’t be able to handle it anymore. Because the chemotherapy would be much more difficult.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Uhm, do you refrain from thinking on… when you had cancer? Like do you keep yourself on thinking about it, the time when you had cancer? R: Now there are times I think about it, but not often. Back then, when I’m just starting to have cancer, whenever I see the IV line, whenever I smell the alcohol and whenever I see the cottons, I feel like I’m going to vomit. That’s when I’m just starting the chemotherapy, like my body is adjusting. I: Do you talk to other people who you trust about when you had cancer? R: Yes. I’m open about it. I: Do you just accept the issue and give up trying to do anything about it? R: Uhm, yes. But now I just think that I’m finally healed now, up to the time when I’m already a survivor. I just think of the positive side that soon I can go back to school again, studying. My uncle said, “everything happens for a reason” maybe now is not my time but soon I would be able to study and find a job. He told me that not all people who get an education will automatically have a nice life. Others that don’t get a proper education, they still end up making a good life for themselves. Maybe he says this isn’t really the time for me, maybe soon. And everytime he says words of wisdom, I get inspired. I: Who is the person you draw strength from? R: My uncle always gives me advice. He’s the youngest brother of my father. He’s the one who pushed me to get treatment again. Cause I really didn’t want to get treated. Then we’re also near in terms of age. Not that close though. Then everytime he gives us advice, it’s really inspiring.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Do you vent out your feelings everytime you get frustrated over the issue? R: Until now? Now no, I just think positive now that everything would be okay. I: It says here that I seek comfort about the issue through meditation or prayer. Do you think that prayer helps you to lessen the stress that you experience? R: Yes. Everytime I’m about to sleep, I just pray that I recover continuously, to be better again. I: You don’t use alcohol or drugs to take away the issue? R: No because we’re not allowed. Even coke is not allowed on us. I: Next is, do you try to understand how you might grow as a result of the issue? R: For now yes because I’m getting used to this way with what I’m doing. Back then, I love salty foods, but now I’m taking lesser than before. I’m the one who cooks at home, and my dad told that I’m afraid of salts. Because I put salt, but not the Magic Sarap, not the vetsin, just salt. I: Do you daydream to avoid the issue? R: Sometimes I think about getting back to school again, like I’m studying. That it’s what I’m doing. I: Whenever you think about the issue, is there a point in your life where you felt being stuck? R: Like that because the things that I’m doing are limited. Like the things that I could do is until there only. But I think that it’s only for now, that as the time passes by it would different, because I’m getting better and better. I can gradually do the things that I can’t do now.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Here, do you think that talking with others relieve your stress? R: Yes because I don’t have siblings, if I have problems I have no someone to talk to. I’m getting open to other people. Do you know that it’s better to be open on others who you don’t know because they won’t judge you, instead of the one who you knew for so long like this and like that. There are times when I talk to others who I don’t know to lessen my stress. I: Do you turn to a religious leader or spiritual advisor for guidance about the issue? R: Like pray-overs? I: Yes, like that. R: My grandmother’s sibling, because they are in Manila. Everytime they go here, they do pray-overs. Especially when I have my cancer. I: It says here that I confront the issue in a way I will make a difference. Like, do you look for positive ways in the issue knowing that something good will happen? R: Yes. Because now I just think of this as a test for God won’t give you anything that you can’t handle. I: You’re always positive right? Like you’re looking at things that whatever happens in the end is something good will happen to you? R: Yes. I: Are you trying to forget about the time when you had cancer?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: When I’m being hospitalized, if I feel like vomiting, if I feel my head aches. I don’t want to go back to that time because it’s so difficult to handle. I: Are there who don’t know what you’ve been through? R: Yes. Our neighbors who just keep on gossiping. I: Do you spend time evaluating your options for resolving the issue? R: Whenever I go outside with my friends. I’m down for it just when I’m allowed to take away the thought of what happened like that. I try a lot of things, I will play games to divert my attention since I’m alone at home. As in only older people are in our neighborhood, I don’t have friends in there. My friends are far from me, that’s why we only use social media to communicate from one another. I: Do you spend time doing things for others in order to take my mind off thinking about the issue? R: Yes. Because my grandmother… like my grandmother, she’s the one I’m with at home. Whenever she have checkups, I accompany her and I also buy her medicines. Like I take care of her to take my mind off thinking about I got sick. I thought to myself that, “I’m okay now” I can take care of her, I can accompany her to hospital like that. I: Do you seek to learn something about yourself from the issue? R: I don’t think so. I: Do you just ignore the issue?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: No, instead I became more alert. Because if I did something wrong, ate something bad, it would trigger the cancer cells to be more alive again and make your body much worse. I: Do you seek support from those who are close to you? R: Yes. I: It says here, even though I want to resolve the issue, I doubt myself doubting that anything can really be done about it? R: Yes, that’s what I often think about because there’s this positive side of me saying, “yes, I will be healed.” But, there is also this negative side that feels like the chemotherapy is just lengthening my life. Yes, I’m recovered now but how about soon, what if my cancer comes back what would happen to me? Will I still survive? Will I still be able to get recovered? Or will I die? Like that. To have leukemia is not a joke. Besides chemotherapy, you’ll have transfusion of blood where your personality will change. When I was interviewed before, I told them that different bloods have been transferred to me, and they told me it really does change your personality. I: Are you struggling to find ways in eliminating your stress? R: Like I’m running out of things to do? I: No. Like, are you struggling to find ways in solving your issue? R: No. I: Do you lash out as a way of dealing the issue? R: No.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Do you tell yourself that other people have bigger issues than you? R: Yes, I thought to myself that there are a lot of people out there who have more problems and chronic diseases than me, but they can endure it. So how about me? I can endure what they’ve endured. I: Do you act as though the issue isn’t affecting you even though it really is? R: Yes. Everytime… as in everytime the dosage of chemotherapy is high, because it has a lot of side effects. Like you’re being paranoid, your mind tends to fly from different thoughts you have in mind. Then you’re affected, it weighs on you but you don’t have someone to talk to. So at night, you just cry it out alone. I: Do you wait and prepare yourself for whatever outcome is going to happen? R: Yes. Especially when there were a lot of people who are dying. They say that whatever happens, it’s God’s will. Because I have gained a lot of experiences, if your time has come, you can’t do anything about it. Besides Leukemia, I have endured experiences a lot. I undergone surgery on my side because they thought that I have pus on my kidney. I had surgery in… where is that? PCMC. Philippines Children’s Medical Center in QC. When we’re having my surgery, after opening my side, they didn’t see anything pus. That time, we were told that we can file a complaint on them. They didn’t give the result of the CT scan, because that would be the proof that there’s really no pus. However, they still underwent surgery. I: Do you feel so overwhelmed about the issue you break down and cry?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: Yes, there are times… just like a while ago. I remember what I’ve been through was tough, but I managed to handle it. I: Do you try to gain understanding about the issue from religious beliefs or faith? R: Yes. I: Do you watch television or movies instead of concentrating on the issue? R: Television yes. Then K-drama, but do you know the time when you want to watch it but can’t finish it? Like from all the K-drama series I’ve watched, there are only 3 series I’ve finished. I: Do you talk to yourself in ways that help you see the issue less negatively? R: Sometimes, yes. I: Do you pretend the issue isn’t as serious as it really is so it doesn’t seem quite as bad? R: My peers in clinic, we just make quirks about it, we just laugh and laugh. As in our secretary told us that when we’re together, we’re really loud. We’re occupied and we just laugh and laugh. I: But if you’re in the clinic, just like you told that you laugh with your peers, do you make jokes about the issue? R: Yes. It’s fine. I: Do people who know you well are aware of that stressful issue in your life? R: Yes. I: Does the issue causes you to be irritable with others?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: No. For me, it’s fine. But back to the time when I had my illness, I feel shy talking about it. Now that I’m fine, I’m okay with it. I: Do you place your trust in a divine power? R: Yes. I: Do you turn to food or eating as a way of forgetting about the issue? R: No really. Because the foods that I want are not allowed to me. I: Do you turn to recreational activities as a way to manage your feelings about the issue? R: No. I: Do you pretend the issue doesn’t exist? R: No. I: Do you turn to others who have had similar issues for guidance and direction? R: Yes, my peers in clinic, we give each other advices. I: Do you talk to professional people for help with the issue? R: Our doctor. Because besides being a doctor, I also tell her personal problems. I: Do you get so exhausted with the issue you just accept things that way they are? R: Yes because the more I think of it, the more I become stressed. I become more paranoid, because when I get paranoid I tend to overthink. That’s why I lessen thinking.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School SURVIVOR E I = Interviewer R = Respondent Demographics I: Age? R: 25 I: What type of cancer were you diagnosed with? R: Acute Lymphoblastic Leukemia I: When were you diagnosed? R: 2009 in the month of August I: When were you declared as a survivor? R: 2012 in the month of January PTSD Symptom Checklist I: Have you experienced the following? First, are your memories reoccurring or do you get dreams about what happened to you when you had cancer? R: Dreams maybe. I: Dreams? Is it okay with you to share those dreams? R: Sometimes I dreamed that I was getting injected because if you’re doing chemotherapy, when you’re newly diagnosed they have you do it around four to five times a week that’s why I really can’t avoid thinking about it till it reaches my dreams. So, I was really affected through that too.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Next, having flashbacks during which it feels as if living the event. It is like you are remembering the event in a visual way. Having flashbacks brings you back the feeling of that event. R: Is it after my cancer? I: Yes. R: Maybe from time to time. I go back to this clinic every month because I felt attached here already. Then, I see some patients having their chemotherapy and I see myself in them. So, I can also feel what they are feeling at that moment while having their chemotherapy. Then, sometimes I get unpleasant news from social media like Facebook, it feels as if there is something heavy on my heart. I: What do you want us to refer to your cancer as, by the way? Just cancer? Malignancy? Tumor? Or just “my illness”? R: Cancer. I: Oh okay. I: Have you experienced any physical, emotional, or psychological distress whenever you hear anything that reminds you of the time you were undergoing chemotherapy? R: Emotional. Just emotional. I really tear up when it comes to that. I: Uhm okay. I: Do you avoid thinking or do you restrain yourself from venting out your emotions or any conversations related to it?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: For me, no. Because I wanted to talk about it. Because I wanted them to be inspired by me so they’re also informed about the type of illness we have is not just hereditary, you can also get it even without any family history of it, could be from what you eat or from the environment. So, I just want to inform them so what happened to me, won’t happen to them. So, I tell them that it’s hard especially financially, emotionally, and physically ‘because that’s what you’ll really fight against during chemotherapy. So, I tell them that while they still can, they should take care of themselves, don’t be careless. I: Are there any people. Places or events that you avoid? As if, they could trigger your memories? R: It doesn’t seem like there’s any I: Are there any activities you avoid that you used to enjoy and partake in before you were diagnosed with cancer? Then after, when you were declared a survivor, you started avoiding it altogether. R: There doesn’t seem to be any activities that I avoid but back then, I always used to go out to the mall, which was before I got sick. But nowadays I lay-low from that, ‘because what happened is that I rarely go out and when I’m here in the village, what happens is that I just end up going here (the clinic). Here is where I end up, I don’t go out to the mall, and I’m always wearing a mask. It turned into a habit of mine, because for others after their chemo is finished, they take off their masks and they don’t put it back on but for me, I still do it ‘cause

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School asides from being careful now, it turned into a habit. I can’t leave the house if I’ve forgotten it, I’ll really go back to get it if I have to. I: Next is, do you avoid people? Or do you feel detached from them? R: To other people? No I don’t think so. I: Next is, when you feel happy, do you think that you have to avoid that feeling because it’s a pleasant emotion so it seems scary to be happy. ‘Cause there are people that think like “Oh, I don’t want to be too happy ‘because something bad might happen later.” R: I don’t think so. In fact, I always want to be happy. I don’t want stressful. I: Do you avoid thinking about or planning for the future? ‘Cause you think your life won’t be that long R: No. I think about the future. I: Do you avoid any memories? R: No. I even talk about it. I: Do you easily get angry or annoyed? R: No. I: Do you have trouble sleeping properly? R: Oh, no. I: Do you have a hard time thinking clearly? R: No. I: Do you have a feeling that you’re always alert as if you think that, anytime something could happen to you?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: Yes. I: Do you get easily sad or scared? R: Not really. Research Questionnaire I: Have you experienced anything stressful during the time you were getting treated? Example is, in the hospital or treatment. What was something that was stressful for you? R: What comes to mind is the point where I told my parents they should stop the treatment because it was too hard physically; you’re getting weaker while suffering financially as well. So, I thought of that in the middle of the cycle. I: You don’t have anything close to the trauma that triggers you? R: I don’t think there’s any. I: Only chemotherapy right? R: Yes. Because what happened was that I was getting emotional whenever I talked about what I was going through because I think “wow I actually went through that, I survived it.” I: What about the hair loss? Were you stressed about that? R: I was depressed about it because you could really see that every time you brush your hair, the hair follows and falls out because at first they gave us medicine that makes your hair fall out so, I had hair fall three times but the first time, I got really depressed about it. During the second and third time, not anymore because I accepted it since I’m not the only one experiencing it, all of

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School us were and there were many who were even younger than me so I thought “They handled it, why can’t I?”. I’m always there on the positive side, I didn’t look at the negative because the doctor said, “If you’re depressed, if you’re stressed, your chemo will go to waste, your cancer cells will multiply if you don’t fight it.” I: But see, others shave their hair because they’re scared of actually seeing their hair fall out, did you also feel that? R: Before I started chemo, my hair was really long so, what my aunt did was that she cut it. Then when I was in the ICU, it didn’t totally fall out little by little, no, they straight up shaved it but it was okay with me because it was starting to feel like a hassle. I don’t really look good to have it long but have patches so, what I did was I shaved it. I just wore a cap but there at home, I go out without it because there’s nothing wrong with showing it so, for me, I never thought of wearing a wig. I: When you were in the ICU, what did you feel? R: When I was in the ICU, I really don’t know much because I was experiencing every pain imaginable, back pain, stomach pain, and after I didn’t know what happened because my sugar level went up, good thing they were able to do something about it because they rushed me to the hospital, if they didn’t then I’d be long gone by now, dead maybe. Because earlier that morning, that’s when they detected my sugar going up, I was comatose that time. But thank God it didn’t last long, only two days. Then, when I woke up I couldn’t walk for around one to two months, I needed help when walking.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Other than chemotherapy and hair loss, is there nothing else? R: Yes because when you’re here (at the clinic) you won’t feel the pain if you stay here in the clinic because the treatment isn’t just what you came here for. During our time, we were happy even the parents they forget that their children are sick because all of us get to share. Then, here we can even joke around and we can banter along with the doctor so, it was really happy in the clinic that’s why I wanted to stay here rather than at home during the time I was getting treated. I: How did you go through the stress of chemotherapy? Thinking about therapy, hair loss, what did you do to survive that? R: I just thought that I could get through it with the help of my family, friends, and relatives. I told myself that after this is over, I’m going to go back to my old life, I’ll be able to study again, I’ll be able to work. That’s what I thought so after the chemo I also told myself “God didn’t give me this challenge if He didn’t think I could take it.” I: When you finished the therapy, were you able to study after? R: Yes. Thank God. Because others, they can’t immediately go back to school. But the doctor told me when I was starting chemo, that after a year I can go back to school again but yeah, I didn’t happen. I was really hoping to go back, I was kind of sad about it too. My mom stopped me, she told me that I should finish my chemo first because others who go back immediately, end up relapsing. Back to zero. So, my mom got scared and I got scared too, that’s why

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I agreed to continue it. I won’t feel it anyways because it’ll be fast. So, I finished it first, I said “okay I’ll try to go back to school after six months.” Thank God, when I started studying again until I graduated, I didn’t get any serious illnesses. No side effects whatsoever even though school was stressful for me because you really can’t avoid that in college. Time management and not thinking about stress too much, especially during thesis. We need to be positive all the time. I: What course did you take? R: Business Management. I: Did you take any medicine to help lessen the stress? R: Nothing but I did take vitamins I: What are some of the practices or habits did you do to help with the stress during that time? What are the coping strategies you used? R: Our doctor told us that when we’re home, we should use the computer. So as to distract ourselves, I: So, basically, you like to use the computer? R: Yes. That’s where I discovered Kpop. I: What did you do to divert your attention from the stress? R: Maybe whenever I was with my friends, I was really happy with them, even just eating out. I: Were you outside often during your school days?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: Only in school. In a way, going to the mall was rare but meeting up with my high school friends, up to now, yes because when you’re bored at home they’ll come over and stay with me. I: Do you play online games when you still have cancer? R: No. I like live streaming and social media like Facebook only. I: Do you think the things you did were effective for you? R: Yes because it diverted my attention and I didn’t always think that I had an illness that serious. I: Did you experience or witness any life-threatening events that have caused you any feelings of fear or helplessness? R: Only chemotherapy and that time I had been at the ICU. I: Do you avoid thinking about or talking about your illness? R: No. I: When you were declared a cancer survivor, did you remove any memories? R: No. I: Do you lose interest in some activities in your life? R: No. I: Did you not reveal you’re through emotions post-cancer? R: Restricting my own emotions? Not really. I: Back then, did you think about your future? Your career? R: Yes. I: Do you feel/ think that your future is shrinking?

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Special Health Sciences High School R: No. I: Feeling on guard? Did you have this feeling? R: No. Coping Strategies Inventory I: Next is our checklist for the coping strategies. Please say yes or no if you have experienced any of the things we will say regarding coping strategies. If you

want

to

tell

something

about

it,

you

may

share

it

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us.

I: Do you try to see the issue from several perspectives? R: Yes. I think a lot on what will be the outcome of this. I: What are the side effects of chemotherapy? R: Physically, it was the weight loss. I’m diabetic so, it was hard because I was also taking steroids for a boost. The steroids effect on me was that, even if you don’t eat anything, you’ll gain weight but I really wanted to eat. When you’re taking steroids, you’re never full, which is hard because sometimes, you’ll wake up in the middle of the night hungry again. It was hard because my family all ate together meanwhile I was separated. I: Was your diabetes pre-cancer or because of the cancer? R: Yes I got it from the chemo drug. I became diabetic when I had cancer. I: So not all patients who undergo chemotherapy get diabetes, right? R: Yes. I think I am the only one from our doctor’s clinic so far. The worst thing is that when I got my first ever chemo drug shot, it rapidly showed adverse effects to me although the doctor told me that it has side effects like flu, fever,

DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School and the last is developing diabetes. Developing diabetes from chemo drug will only be effective or will show to you after few months but we were all in shock when it happened to me just after the first shot. I was the first patient with that case here so I was shocked as well as my doctor. I: Do you try not to think about the issue? R: There will still be times when I still think about it but I don’t emote myself and dig deep about it. You know, I still think about it from time to time especially that I am working in a stressful environment; I think about what would be the effect oh this stress to my next check-up and what would happen if the results were not good enough. Sometimes, there are times that you will get a red mark which means the result is higher or lower the normal range of the result. I: Do you seek advice about the issue from people close to you? R: Yes. I: Aside from the people here at your clinic, who are the persons you trust in giving you advices? R: My family. Even if I’m already at the legal age, sometimes I still can’t decide for myself and tend to seek advice from them. I: Do you feel like you have to allow the issue to run its course? R: Yes. I: Do you get upset and express your anger about the issue? R: Not really.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Do you spend time with nature (e.g. walking) so you can have strength to cope with the issue? R: I don’t need to. I: Do you like being outside or seeing nature? R: No. I just like to stay at home. I: Do you try to become involved in other things (work, hobbies) to distract yourself from the issue? R: My work. Then, sometimes if there are events regarding the Cancer Warriors, I usually attend to it. During the time that I am undergoing my chemotherapy, I told myself that if after completing my chemo sessions and find a job, I will surely help the foundation [Cancer Warriors]. I am still an active member of it. I: So those things that you were doing distracts you from the focus of having cancer, right? R: Yes. I: What are the hobbies that you are currently into? R: Now? I always stay inside our house or go to work. I divert all my attention to work most probably. I don’t think I have any hobby. I: Do you make jokes about the issue? R: Yes. For me, it’s okay. Sometimes I joke around with the nurses and my doctor. Joking around about cancer doesn’t offend me. I: In this clinic, are there already many survivors of cancer? R: Yes but I don’t know some of the other survivors from other batches.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: When you think about the issue, do you tell yourself that things could be much worse? R: Yes. I: Do you postpone thinking about the issue? R: No. I: Do you have fear of needles? R: None. I’m okay with any kind of needle as long as I will recover and get better. I: Are you afraid of hospitals? R: Not really but when an ambulance passes by and I hear the sound of it, I feel the fear of being inside it. When I was brought to the ICU, we had to ride the ambulance. That one time when I was stuck at the traffic jam, an ambulance passes by and I thought about the person inside it and what is his condition. My chest didn’t exactly tighten, only a slightly. I: Do you talk with people you can trust about the issue? R: Yes. I: Do you just accept the issue and give up trying to do anything about it? R: Yes. I: Are you unable to develop a plan to resolve the issue? R: Not really. I: Do you seek comfort about the issue through meditation or prayer? R: Yes.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Do you use alcohol and drugs to distance myself from the issue. R: No. I: Do you use daydreaming to avoid the issue? R: No. I: Do you get stuck when you try to think of ways to address the issue? R: No. I: Do you go to a religious leader or spiritual advisor for guidance about the issue? R: Yes. I: Do you attend mass regularly? R: Yes. I: Do you lose yourself in activities that make it difficult for you to focus on the issue? R: Its’s after, right? I think none. I only watch TV. I: Do you find yourself laughing about the issue? R: Yes. I: Do you confront the issue in ways you believe will make a difference? R: Oo. I: Do you try to be positive and look on the bright side of things? R: Yes. I: Do other people not know about the issues you have to deal with? R: No. All of them know about what I’ve gone through.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Do you spend time evaluating your options for resolving the issue? R: Oo. I: Do you spend time doing things for others in order to take your mind off thinking about the issue? R: Oo. I: Are you sarcastic about matters related to the issue? R: Not really. I: Do you enlist the support of others to tackle the problems associated with the issue? R: Yes. I: Even though you want to resolve the issue, do you find yourself doubting that anything can really be done about it? R: No. I : Do you struggle to find ways to handle the issue? R: No. I: Do you lash out as a way of dealing with the issue? R: No. I:

Do

you

try

to

connect

with

a

higher

power

or

essence?

R: Yes. I: Do you try to find things to do to keep yourself busy so you don’t have to worry about the issue? R: No.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Do you tell yourself that other people have bigger issues in their life than yours? R: Yes. I: Do you act as though the issue isn’t affecting you even though it really is? R: Yes. Sometimes. I: Do you seek guidance from people who you believe can help you address the issue in a meaningful way? R: Yes. I: Did you and prepare yourself for whatever outcome is going to happen? R: Yes. I: Do you make several efforts to address the issue in different way? R: No. I: Do you feel so overwhelmed by the issue you break down and cry? R: Yes, most especially when I am sharing my story. I: Do you try to gain understanding about the issue from religious beliefs or faith? R: Yes. I: Do you watch television or movies instead of concentrating on the issue? R: Yes, I like TV more. I: Do you talk to yourself in ways that will help you see the issue less negatively? R: Sometimes.

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School I: Do you pretend the issue isn’t as serious as it really is so it doesn’t seem quite as bad? R: Yes. I: Do you just learn to live with the issue? R: Yes. I: Do you develop strategies that will empower you to effectively deal with the issue? R: Yes. I am also thinking about what others around me would feel if I think negatively. If I put on so much stress, it will reflect to me. I always think that I should be positive. I: Does the issue causes you to be irritable with others? R: No. I: Do you place your trust in a divine power that is mindful of your struggle with the issue? R: Yes I: Do you turn to food or eating as a way of forgetting about the issue? R: No. I: Do you poke fun at things related to issue? R: No. I: Do you pretend the issue doesn’t exist? R: No. I: Do you turn to others who have had similar issues for guidance and direction?

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DE LA SALLE HEALTH SCIENCES INSTITUTE Special Health Sciences High School R: Yes I: Do you talk to professional people for help with the issue? R: Yes, my doctor. I: Do you immerse yourself in other things in order to take your mind off the issue? R: Yes. I: Do you find yourself denying that there is any “real” issue so you don’t have to face it? R: No. I: Do you seek help from groups who are addressing similar issues? R: Yes with the other members of Cancer Warriors. I: Do you spend time thinking about the best approach to addressing the issue? R: Yes. I: Do you get so exhausted with the issue you just accept things the way they are? R: Yes.

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