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\begin{document}


\def\RunningAuthor{Monisha R and Ganapathy Sankar U}
\firstPage{6564}
\articleType{Original Article}
\receivedDate{23 Apr 2020}
\acceptedDate{23 May 2020}
\revisedDate{20 May 2020}
\journalVolume{2020, 11}
\journalIssue{4}
\journalDoi{ijrps.v11i4.3550}
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\title{\textbf{Evaluation of self abilities among people with advanced cancer}}
\author{Ganapathy~Sankar~U, 
            Monisha~R\textsuperscript{*}~\\[5pt]{SRM College of Occupational therapy, SRM Institute of Science and technology, SRM Nagar, Kattankulathur, Kanchipuram-603203, Chennai, Tamil Nadu, India}}

\begin{abstract}
Living with cancer can have adverse effects on the self. Various factors affect the person self in daily life. It is well documented that encouragement can provide hope and engagement for a person with cancer to engage in his activities of daily living. The support of family and friends helps the persons to lead his life along with the illness. Cancer rehabilitation is a rapidly evolving field all over the world, in large part because of increases in the number of cancer survivors. Everybody wishes to restore the function as resume their lives as usual. Few argue with the rehabilitation experts that treatment options differ from country to country, and does it affect the survival rate? Little research is done to explore how the self of the person suffering in advanced stages of cancer, and we aim to evaluate how people with cancer experience their sense of self. Thirty interviews were conducted with ten patients with advanced cancer, and grounded theory approach was used for statistical evaluation of data. Accepting self and reassessing self was the result of engaging the person in a specific occupation, which is considered to have a core in rehabilitating the person with advanced cancer. Engagement towards occupation influence the self of a person with advanced cancer.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Daily Living Skills,\newline ADL,\newline Cancer,\newline Life-Threatening Illness
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Monisha~R~\\ Phone:\ 99940228679~\\  Email:\ dreamsfuture000@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
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\section{Introduction}
In India, there is an emerging sum of peoples affected by cancer. The demographic profile and the number of the person affected will increase in the years to come. Advanced cancer is considered to have no cure, and living with advanced cancer is life-threatening, and these people will have a poor sleep and low quality of life. Few patients will found to have depression and anxiety disorders\unskip~\citep{897253:20447054}. 

Living with cancer will have a poor perception of self, and they tend to deteriorate themselves under the disease process and consider themselves as inadequate and not fit to live further. Thus, they fail to cooperate for the rehabilitation. Living with cancer is considered as a symbolic battle, where the determination and will of the individual stand against the body's disease status. Where the battle happens between individuals perception of abilities and the disease process, day to day change in the perception of self will reappraise the abilities of the person living with an advanced stage of cancer\unskip~\citep{897253:20447060}. 

During palliative care, how the person considers, their perception of self will influence the disease progress and their quality of life in the time remaining. Engaging the person with cancer in the specific occupation will boost their quality of life, and they consider themselves as not week and fragile\unskip~\citep{897253:20447055}. They perceive themselves as adequate to perform the task that benefits others. Engaging the patients with advanced cancer in simplified tasks will bring a sense of involvement, choice and commitment. People will get an understanding of self only after a good self-reflection. Since 20 years, in numerous definitions have been quoted for self, which had given an understanding of the concept of self. Identity is also part of a personal self. Knowledge concerning the processes of identifying self is useful to support patients in palliative care\unskip~\citep{897253:20447052}.
    
\section{Materials and Methods}
Participants were recruited from a nurse who works in the center for cancer in and around Chennai. If the participants were willing to participate in the study, the contact information was circulated to the first author. Data was collected and evaluated after conducting a depth interview in patients homes. To develop interview questions, previous literature evidence was collected to understand the concept of self and perception of self. Then the questionnaire was focused on describing the patient's daily life situations. For examples, "How do you feel about yourself, when you can't accomplish the simple daily living task, you desire to perform?''.

As the analysis progressed with interviewing patients, new questions were framed. The caregivers or spouse were invited to participate in the study, as patients with long term cancer can be motivated because of their presence. Follow up sessions were planned with the patients when they experience any change with the activity of daily living. In total, ten patients participated in follow up intervention{\textemdash}a collection of data ended, when the secondary researcher analytical ideas seemed to be exhausted. The study was authorized by SRM College of Occupational therapy, SRM University and the participants gave written consent, and they can withdraw from the study at any time each interview session occupied 50 minutes in total and conducted 30 interviews in total. Each patient's interview was recorded and transcribed verbatim.
    
\section{Results and Discussion}
The component expressed in the result of the study is ``Occupation is the real marker of self''. But engagement in occupation is impossible to maintain due to pain, fatigue and loss of strength.

The purpose of the study was to explore how patients in palliative care experience a sense of self. The study aims to predict how the patients in palliative care predict their maximum state\unskip~\citep{897253:20447057}. The current study leads the way to grow the body of research, how a patient in palliative care considers self. When individuals at their end of life, if engaged in any occupation they like, people can strengthen their self. Accepting self and reassessing self was the result of engaging the person in a specific occupation, which is considered to have a core in rehabilitating the person with advanced cancer\unskip~\citep{897253:20447056}. 

By concluding, it has been explored that engagement in occupation is a crucial step to perceive self and to gain the confidence to build up self and to reshape it. It has been clear from the interview sessions that, if the patient fails to perform the activities of daily living skills and when they experience difficulty in participating in the occupation, it has been proved that they experience depression and frustration\unskip~\citep{897253:20447059}. 

It has been proved that the consequences of the disease did not lie in the biological nature of the disease, but the perception of self- worth\unskip~\citep{897253:20447051}. The results from this study were about the previous research on how the stroke survivors measure their capacities to perform activities of daily living skills\unskip~\citep{897253:20447053}. Similarly, the study that examines the ways the people in the end stage of cancer measure their health status and self\unskip~\citep{897253:20447058}. 

The interview results with the participants had shown that few patients with end-stage of life reported that after successfully engaged in an occupation, their abilities enhanced.
    
\section{Conclusions}
Engagement towards occupation influence the self of a person with advanced cancer. The therapist should contribute their involvement in planning new strategies and action plans to enhance or to maintain the self-esteem of patients undergoing chemotherapy.
\section*{Acknowledgement}We thank the participants for their cooperation to continue with the research.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest}

The authors declare that they have no conflict of interest for this study.
    

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