EXPERIENCING THE SITUATION OF BEING WITH CANCER : SOME REVELATIONS

This article aims to reveal the meaning of being-with-cancer to oncologic patient, trying to comprehend them in their living, discerning the discovery of new ways to deliver care. This study is based on the qualitative research methodology phenomenological modality, realized with cancer patients who were aware of their diagnosis and were hospitalized at an institution specialized in oncology. Living a serious disease like cancer reverberates on the person’s life in a significant way and affects his/her entire Being. The physical and psychical restrictions deriving from the disease imply significant changes, which may make the person become dependent or withdraw from social companionship. Moreover, the person suffers due to financial disarrangements and may come across the need to interrupt or give up of important life projects. The comprehension of what is lived by the person with cancer indicates the relevance of transformations in the philosophy of his/her care, including the need to discuss and share feelings.

Además, sufre con los desajustes financieros y se ve con la necesidad de interrumpir o desistir de proyectos importantes para su vida.La comprensión de lo vivido por la persona con cáncer señala para la relevancia de transformaciones en la filosofía de su cuidado, incluyendo la necesidad de discutir y compartir sentimientos.
In Brazil, estimates for 2006 showed that there would be 472,000 new cancer cases, 234,000 among Brazilian men and 238,000 among women (2) .
Although several technological advancements in modern oncology have provided a better cure rate for malign tumors, incidence and mortality rates call the attention of public health authorities.
The fact that such an expressive number of the-world-with-others (3)(4) .
Cancer is a disease that has historically been associated to experiences permeated with suffering and pain, followed by death.Due to the death stigma involving the disease, when people see themselves in the world with cancer, they move from their everyday existence to a life in another world dimension, in which the possibility of death seems to be inevitable.Hence, they yearn not only for health care regarding the disease and its physical manifestations, but also for actions that express solicitude and understanding toward their ill existence (5) .
Social perception usually reflects the association of cancer to a shameful fatal illness, commonly considered a synonym of death, which isolates patients and cultivates pessimist feelings toward the disease.Considering the health care offered to cancer patients and the interest that nurses working at a specialized oncology service have in offering health care that takes their patients' needs into consideration, the present study proposal was developed: to reveal the meaning of being-with-cancer for oncological patients, aiming to understand their experience and to find new pathways for the health care they are offered.

T H E O R E T I C A L -M E T H O D O L O G I C A L FRAMEWORK
This study is founded on the qualitative research method -phenomenological mode, and was performed at an institution specialized in cancer treatment, located in Goiania, a city in the state of Goias.
The experience of becoming ill with cancer is a phenomenon with different particularities.Only people who live through this situation are capable of attributing the meaning of being-with-cancer and, thus, revealing their experience.Taking these facts into consideration, this study was performed with eleven oncological patients, aware of their cancer diagnosis, who were hospitalized at the health institution selected for the research during the data collection period.
Patients were interviewed by one of the study authors.
The number of study participants was determined by the data saturation criterion (6)   , adopted in qualitative research, in which information convergences and divergences indicate when data collection is finished.These convergences are referred to as invariants and express the essence of the study phenomenon (7) .
The research was developed in accordance with the recommendations of the National Health Council, Resolution 196/96 (8) .the phenomenological approach, which presupposes a sense of exchanging experiences, in which care and respect for people should always exist (9) .
Data analysis was based on the "Qualitative Analysis Method of the Situated Phenomenon" (10) , in which four moments are proposed to analyze statements (6,10) .These were strictly followed in the present study.
First, a comprehensive reading of the statements was performed in order to obtain an overall meaning, seeking to capture the meanings that subjects attributed as well as how they attributed those meanings.Next, a new reading of the statements was performed, slower and more carefully, and meaning units were identified.After identifying the meaning units in the statements, they were read once again with the aim of catching the meaning they contained.
Finally, the meaning units were summarized or categorized according to the theme, attempting to reach the structure or essence of the phenomenon.
This synthesis or categorization phase is also understood as thematization, which means to study a subject seriously and systematically (10) .
At each analysis moment, efforts were made to incessantly question the descriptions obtained in the statements regarding existing with cancer, aiming to understand the phenomenon.The comprehensive analysis of the statements made it possible to discover some aspects of being-with-cancer, according to the meanings attributed by oncological patients, which appointed the essence of experiencing this situation.
Phenomenology, as the theoreticalmethodological framework, made it possible to obtain experiences of the Beings with cancer.It was possible to understand them in their existential sense of beingin-the-world-with-others, in order to apprehend the essence of their existence with cancer, with their own experiences, meaning attributions and world perspectives as starting points.
As a philosophical movement, phenomenology is one of the main thought lines in the 20 th century, which appeared from the conceptions of Edmund Husserl (1859-1938) and was developed mainly in France and Germany, by his followers (11) .
Husserl proposed, through phenomenology, the "return to the same things", the analysis of essences, understood as ideal units of meaning, elements that constitute the meaning of their experience (11)   .
In the present study, the statements clearly pointed to the issue of human existence, to further perspectives or life projects, redimensioning existence, and, especially, to the finitude issue.These dimensions recall the philosophical thought of Martin Heidegger, since they incessantly question the issue of the Being and deal, fundamentally, with the issue of human finitude.
Heidegger considers man as being-there or Dasein, which means a being in the world, being with oneself and with others, who search for their own truth through self-interrogation.According to this framework, a Being can only be determined based on its own meaning, that is, it is only possible to understand the Being in the context of its own world, its own experiences (12) .
Besides the characteristic of being-in-theworld, the being-there is a being-toward-death.
Existence is not given to man as a well arranged pathway in which death is at the end.Rather, death, as a possibility, can run across man's existence at any moment.Death is understood as an inalienable possibility of no longer being able to be present, an ontological possibility that Dasein has to assume; with death, the being-there completes its course.Hence, dying is not an event; it is a phenomenon to be understood existentially (12) .

These considerations, understood as
Heidegger's main thoughts, permeated the thought lines followed during the analysis of this study.With phenomenology as the theoretical-methodological framework, the analysis was organized in thematic categories.Some of the revelations identified in this study are presented below, using fictitious names.These changes make the situation lived by

COMPREHENSIVE ANALYSIS
Beings with cancer more difficult, and intensify feelings of anguish and uncertainty regarding their possibilities as Beings.These feelings are associated with the human condition of "being-cast" in the world, a form of being that refers to their own existential possibilities (12)   .
Changes in body image are reported as one of the major difficulties faced by people with cancer.
Patients Cancer has always been perceived as something embarrassing, contagious and incurable; an illness traditionally relegated by society (13) .Cancer can significantly affect one's self-perception, behavior and social relationships.In most cases, people start being treated differently after their diagnosis.
Social life is important for human beings.This evokes the Heideggerian comprehension that the being-there is a being-with, so it is impossible to separate Beings from those with whom they keep social relationships.The being-with is an existential characteristic of the being-there, since it is impossible for man to exist alone in the world and not establish relationships with others (4) .In a capitalist society, the inability to work, provide for one's own needs and keep one's family in good financial conditions makes humans feel disposable, a dependant-being with no autonomy, a body that no longer meets the productive demands of a consumerist society (14) . Existing

Suicide attempts reveal the inability of Beings
to bear the overload of living with such a serious and disabling health problem.Suicide is one of the main causes of death among young adults, and though it is studied all over the world, it still remains a major enigma for sciences that study human behavior.
However, from the Heideggerian perspective, it is Dasein's wish to no longer be there-in-the-world, and this understanding can be a way of rebuilding and redimensioning their existential perspectives (15) .
In While they acknowledge and suffer due to the side effects of treatment, patients emphasize the importance of chemotherapy in their quest to become again a Being without the disease (16) .The following statements express patients' awareness regarding the need for chemotherapy: Many chemotherapeutic agents cause a cytotoxic effect on hair bulb cells, which affects their rapid proliferation and partially or totally inhibits their metabolism and mitotic activity, which weakens and causes hair loss (17)   .
Hair loss was reported as one of the most relevant side effects in terms of the impact of treatment in patients' lives.Their self-perception is that of an ugly person, different from the one that existed before the disease, and one that does not meet social beauty standards, causing significant psychological and social repercussions in the life of beings-with cancer going through chemotherapy: Though it is not a clinically significant side effect, some patients consider chemotherapy-induced hair loss as one of the most devastating side effects of treatment.Alopecia can have negative effects on one's body image, causing much suffering and changing interpersonal relationships and social life as a whole (16)(17) .
The feeling of fear toward death is experienced at the moment of diagnosis and accompanies beings-with-cancer throughout their coping with the disease.Death is the most frightening fact in life, which no one can control or predict (12) .In the present study, the fear of death was reported by people who were unable to make life projects like seeing their children grow, meeting their grandchildren and enjoying their retirement.Some statements explicitly presented the fear of death: From the fundamental constitution of Dasein, the death phenomenon is revealed as a beingtowards-the-end.It is an ontological possibility that Dasein has to assume, configuring it as a possibility of no longer being able to be present (12)   .In this sense, the death phenomenon is no longer seen as a mere end or disappearance; it assumes its human existential characteristics.
Despite the advancements in cancer treatment, patients report that the fear of recurrence is something that worries and causes suffering.
Anguish is associated with the fear of the disease returning and causing death, and is characterized by not knowing what is feared or causes that anguish.
With anguish, what threatens the Dasein or the Being's existence is something that is nowhere, is unfamiliar with their everyday life, and is unexpected (12)   .
The fragility due to the possibility of relapses Important thoughts regarding Being-ill recall that the disease causes an aggression, a solution of continuity between the former and the present living, making the future uncertain (18)   .This uncertainty is part of everyday life and worries especially those who are ill with a serious disease like cancer.There is a present fear of no longer living like they used to or of not overcoming this moment, which causes feelings that reduce the existential quality of Being of people with cancer.
When health professionals live with these people and come closer to these feelings, they should recover the original meaning of health care, a wayof-being with solicitude, which permits sharing experiences and clarifying patients' doubts and uncertainties, when possible.Besides the numerous sufferings caused by the disease, the stigma that still involves cancer is responsible for the continuing prejudice that increases suffering and intensively exhausts humans.

FINAL CONSIDERATIONS
Despite the advancements in cancer treatment, it was observed that the fear of death accompanies patients when coping with the disease.
Moreover, the possibility of recurrences was highlighted in the statements as something that worries and causes suffering.Anguish is associated with the fear of the disease returning and causing death.
Considering the presuppositions regarding human complexity and subjectivity of the diseasehealth process, it is believed that this study made it possible to reveal some aspects of the Beings with cancer, including their fears and existential perspectives.This permitted the development of a reflexive posture in health care professionals.
Moreover, it collaborates with the integrality of care people seek health institutions to treat malign tumors should make researchers reflecting on the quality of health care offered to those people.Despite conceptually aiming at human dignity and integrality, the reality of health institutions reveals that, over time, the health care process has acquired merely technical and reductionist characteristics.Health care professionals often assume an authoritarian and defensive posture.Moreover, health care actions seem to loose their originally interactive character, in which patients are co-responsible for making decisions on their health.Health care should recover its essential meaning, and should be performed multidimensionally and involve the ability to recognize patients as integral beings.Health care should be characterized as an attitude, a way of being, and not only a task that takes place at a certain moment.As a way of being, health care becomes a basic ontological-existential phenomenon and, as a part of the human nature and constitution, it reveals its concrete way of being-in- offered to oncological patients, by recovering the authentic meaning of health care actions.The comprehension of what cancer patientsexperience indicates the need to discuss feelings, share pains, sorrows and preoccupations, relieve tensions caused by a situation filled with uncertainty and fear.Caring for people with cancer implies developing the sensitivity to perceive patients and consider their fragility as people aware of their situation and who need specific care in terms of their existential domain, and not only their physical body.Health care professionals need to take responsibility for care with solicitude, guided by consideration and patience, and founded on these two words' sense of temporality.Consideration refers to the solicit experience looking at the past, at former experiences, and patience is the solicit experience looking towards the future, to what is yet to come.