Student Research Award Winner

Spirituality and meaning-making in pre-menopausal women diagnosed with stage IV metastatic breast cancer

Pastoral counseling interventions may enhance meaning construction and promote a more positive quality of life.

By Cheryl Fisher

Volumes of research have focused on primary breast cancer and the experience of a terminal diagnosis, little research exists in the area of women’s experiences with Stage IV metastatic breast cancer (Warren, 2010). A diagnosis of Stage IV metastatic breast cancer means that cancer cells have spread from the primary site of the breast to other organs and body systems (e.g. bones, lymph nodes, blood, brain) and is accompanied by a 3 to 5 year survival prognosis. However, 20% of individuals diagnosed with Stage IV metastatic breast cancer live 10 years or more. This contributes to an experience of living with a chronic disease such as diabetes. While the disease is not curable, it requires symptom management (National Cancer Institute, 2011). In addition to this, a person may have lived many years with a sense of beating the cancer only to experience it recur with a vengeance of metastasis. The possible identity as a survivor may be challenged with the imminent threat of a non-curative, spreading, breast cancer (Vilhauer, 2011). In addition to survivor identity confusion, the construction of meaning for women is influenced by the social offerings of roles and expectations of a woman in society. Pre-menopausal (under the age of 45) may have expectations of partnering and bearing children. This becomes threatened if not obliterated by the invasive surgeries (mastectomies, hysterectomies) and treatments that propel younger women into early menopause.

Research continues to find that spirituality and religion assist in coping with and transformation of life stressors (Baumeister, 2001; Bellin, 2009; Breitbart et al., 2004, 2005; Ciarrocchi & Deneke, 2005; Piedmont, 2009a, 2009b). The majority of research involving spirituality and breast cancer focuses on the experience of older women (Avis et al., 2005). Yet, it appears that pre-menopausal women who are diagnosed with breast cancer experience more aggressive symptoms and greater psychological distress (Avis et al., 2005).So how do younger women find meaning in the violation and destruction of her body and the invasion of breast cancer in a society that objectifies women’s bodies? How does this diagnosis affect her relationship with her body, others and, in particular, the Transcendent? My research explores these questions.

This qualitative study examined the hermeneutics of Stage IV metastatic breast cancer in a group of five female co-researchers who were between the ages of 35 and 43. Written and oral data were collected to extract co-researchers’ interpretations of their physical and psychosocial experiences of living with Stage IV metastatic breast cancer. Findings suggest that these women experienced a tension of attachment and detachment in their relationships with regard to their bodies and their relationships with others that serves as a means of making sense of their experiences and serves as a coping mechanism. The qualitative data collected supported themes that indicated the women experienced the body as a medical object especially during times of treatments, and the body as a feminine object whereby they focused attention to physical appearance. In addition to physical manifestations, the co-researchers described the challenge of desiring honesty in relationship while experiencing relationship rejection and isolation. The women dis- cussed wanting to live with intention at times while wanting to feel ordinary at others. The issue of legacy and wanting to be remembered was a strong theme observed in the research, and all women looked for opportunities to tell their stories through blogs, books, articles and studies such as this one. In addition to these themes, the experience of God as provider of peace was reported by the woman to help them feel supported in a way that family and friends were unable to provide. In particular, the co-researchers discussed the impact of their illness on their experiences of sensuality and sexuality, and reported that the current pink ribbon breast cancer model excludes the experience of living with Stage IV metastatic breast cancer which contributes to the feeling of alienation and isolation.

The findings in this study support potential pastoral counseling interventions for pre-menopausal women living with Stage IV metastatic breast cancer that may enhance meaning construction and promote a more positive quality of life. In addition, a model of care is proposed that examines pre-morbidly characteristics along with the encounter of the sacred in meaning construction. This model may allow for clinical intervention at any point of the meaning construction process and provide clients with a sacred, healing space as clinicians model God’s compassion and commitment by entering the darkness of the client’s suffering and holding hope that speaks to generativity and remembrance, and be a healing presence on Earth.

About the Author

Dr. Cheryl Fisher is a Nationally Certified Counselor (NCC) and Licensed Clinical Professional Counselor (LCPC) in private practice in Annapolis, Maryland. She earned a MS and PhD in Pastoral Counseling from Loyola University Maryland. Dr. Fisher’s clinical work includes the treatment of survivors of trauma, dissociative disorders, and life transitions. Her work with abuse and domestic violence survivors earned her the Governors Recognition Award in 2010.

Dr. Fisher is an adjunct faculty member in the counselor education program for Grand Canyon University, and the psychology department for Anne Arundel Community College. She enjoys facilitating a foundational awareness of the role of spirituality in overall wellness.

Dr. Fisher’s current research, Meaning-Making and Spirituality in Pre-menopausal Women Diagnosed with Stage IV Metastatic Breast Cancer examines the role of spirituality and religion on meaning construction as it pertains to the disfiguration of body, the alienation of relationships, and the transformation of identity when living with advanced breast cancer.

Dr. Fisher resides in Annapolis with her husband, Steve and pet therapy dogs, Max and Lily, and has recently celebrated the birth of her first grandson.


Avis, N. E., Crawford, S., & Manuel, J. (2005). Quality of life among younger women with breast cancer. Journal of Clinical Oncology, 23(16), 3322–3330.

Baumeister, R. (1991). Meanings in life. New York, NY: The Guilford Press.

Bellin, Z.J. (2009). Exploring a holistic content approach to personal meaning. Dissertation Abstracts International, 71.

Breitbart, W. W. (2005). Spirituality and meaning in cancer. Revue Francophone de Psycho- Oncologie, 4(4), 237-240. doi:10.1007/s10332-005-0090-2

Ciarrocchi, J., & Deneke, E. (2005). Happiness and the varieties of religious experience; religious support, practices, and spirituality as predictors of well-being. Research in the Social Scientific Study of Religion, 15, 2009.

Piedmont, R. L., Ciarrochi, J. W., Dy-Liacco, G. S., & Williams, J. G. (2009a). The empirical and conceptual value of the spiritual transcendence and religious involvement scales for personality research. Psychology of Religion and Spirituality, 1(3), 162-179. doi:10.1037/a0015883

Piedmont, R. L., Werdel, M., & Fernando, M. (2009b). The utility of the Assessment of Spirituality and Religious Sentiments (ASPIRES) scale with Christians and Buddhists in Sri Lanka. Research in the Social Scientific Study of Religion, 20131-143. doi:10.1163/ej.9789004175624.i-334.42

Vilhauer, R. P. (2011). ‘Them’ and ‘us’: The experiences of women with metastatic disease in mixed-stage versus stage-specific breast cancer support groups. Psychology & Health, 26(6), 781-797. doi:10.1080/08870446.2010.496853

Warren, M. M. (2010). Uncertainty, lack of control and emotional functioning in women with metastatic breast cancer: A review and secondary analysis of the literature using the critical appraisal technique. European Journal of Cancer Care, 19(5), 564-574. doi:10.1111/j.1365-2354.2010.01215.x