A Narrative Inquiry of the Difficulties by Breast Cancer Survivors in the Sports Participating

Ji Yeon Suh^a; Seami Lim^b^*; Junho Lee^c
^aCouncil Member, Busan Metropolitan Council,^bResearch Fellow, Korea Institute of Sport Science,^cAffiliated Professor, Yungsan University,Correspondence: smlim100@kspo.or.krInternational Journal of Applied Sports Sciences, Vol.34, No.2, pp.203-214, 31 December 2022
https://doi.org/10.24985/ijass.2022.34.2.203

초록

The aim of this study was to analyze the breast cancer survivors’ difficulties in participating in sports as cancer aftercare. This study employed the case study and purposive sampling to obtain the sample from five breast cancer survivors, two surgical oncologists, and a cancer aftercare NGO specialist. This study conducted the participatory observation method and depth interviews to categorize and conceptualize based on transcribed data with selected study participants. The study was to identify the essential themes, and four medical experts addressed within and across cases. Three essential themes were revealed: financial difficulty, severe chronic condition, and social role. Firstly, breast cancer survivors suffer financial difficulty after a cancer diagnosis because of their career breaks or the absence of economic activities. This situation put survivors hard to take part in sports with high expenses or customized personal programs. Secondly, breast cancer survivors suffer experience motor disorders due to low motivation due to poor physical ability. Therefore, follow-up measures for them should be taken at the welfare level. Thirdly, breast cancer survivors continue to shoulder a disproportionate share burden of Balancing work and family obligations. Cancer survivors who are parents or family caregivers have taken on even more during the cancer treatment. They were already shouldering the majority of financial, social, and family care responsibilities. That is wholly inadequate for most cancer survivors to find enough time to work out or do sports regularly but sporadic or never for themselves and their health.

Abstract

keyword: cancer aftercarebreast cancer survivorssports participatingcontinuing or returning to sports

Introduction

According to the national cancer statistics, the cumulative population of cancer patients in Korea is about 2,147,000, which means that 1 out of 25 people in Korea is currently in cancer treatment or is a cancer survivor (National Cancer Center, 2021, p. 42). The number of cancer survivors continues to increase in Korea due to the advances in early detection and treatment. The 5-year relative survival rate of South Korea for all cancers increased to 70.7% as of 2019 (National Cancer Center, 2021, p. 24). In particular, breast cancer survivors whose 5-year relative survival rate is as high as 93.6% and appear mainly women are continuously increasing. The standard for breast cancer diagnosis patients, which was only 33.4 per 100,000 people in 2012, has increased significantly to a level approaching 48.6 in 2019. As cancer survival rates increase, the 5-year survival milestone is often a cause for celebration. Still, survivors need ongoing support, and survivorship or cancer aftercare becomes an issue to highlight at the personal and social level in Korea to promote good Quality of Life (QoL), Return to Work (RTW), and family care. To promote cancer aftercare in Korea, the National Assembly of the Republic of Korea passed an amendment to the Cancer Control Act initiated by ten members of Congress (The National Assembly of the Republic of Korea, 2021) at the 4th plenary session on May 29th, 2022, which Suh Jiyeon, the chair of NGO SWIMPYO, initially proposed in 2021. An amendment to the Cancer Control Act aimed at understanding the number of cancer survivors continues to grow in Korea primarily as a result of the combined effects and needs of cancer aftercare or survivorship at the government and local level to expand the welfare scope restricted from diagnosis and treatment to aftercare. This act was purposed to establish the legal basis for social support and cancer aftercare system in sustainable health care, return to school, return to work, balance the family and treatment, etc. In Korea, “cancer survivor” is used as a direct translation of patients after cancer treatment by cancer survivorship, but this may be limited to patients who survived only, not including the undergoing patients. For this purpose, the term a person who experienced cancer was also used in this study in Korean version (Shin et al., 2015, p. 217).

Cancer survivors are stigmatized and elicit persistently in physical activities even after intensive treatment. Cancer treatment modalities reported are surgery, radiation therapy, and systemic therapy, including chemotherapy, targeted therapy, hormonal therapy, and immunotherapy for five years or more upon individual symptoms and diagnosis. Especially, Breast cancer survivors with lymphedema often experience multiple symptoms, such as swelling, pain, tenderness, soreness, aching, etc (Hwang, 2020; Kim, 2019; Kim, 2022; Park, 2006). Not only breast cancer-related lymphedema but cancer survivors also express the distress or fear of cancer recurring and the possibility of getting a second primary cancer or multiple primary cancer.

The benefits of physical activity as cancer aftercare for cancer survivors have been well-reported in the health and medical community(Kim, 2014; Min et al., 2011; Park & Jung, 2019; Park et al., 2015). However, most cancer survivors in Korea have not established an optimal exercise prescription or sports participation after cancer. However, most cancer survivors in Korea have not established an optimal exercise prescription or sports participation after cancer. According to the National Health and Nutrition Survey (2018), the rate of cancer survivors’ return to sports is only 31.6%. Only a few survivors can participate in sports or hobbies, but majorities depend only on passive care or medical care, such as taking medications or drug adjuvants after the treatment.

According to diverse research, susceptibility genes, obesity, Westernized diet patterns, pollution, physical inactivity, and other lifestyle changes have been proposed as the main contributing factors for cancer. (Danaei et al., 2005; McPherson et al., 2000; Møller et al., 1994). Especially, aging, late age at menopause, and late age at first full-term pregnancy, and lifestyle changes (Early age at menarche, Marriage pattern, Breastfeeding, estrogen-exposed) are also linked to a modest increase in the risk of breast cancer.

A study by Kim & Kim (2009) showed physical functional improvement and benefits by prescribing a complex exercise program to breast cancer survivors with mastectomy. Stan et al. (2012) research also reported that sports positively affect breast cancer survivors with mastectomy in body balance. Cancer aftercare cannot define except for Sports, or Physical activity, which is closely related to cancer survivors’ quality of life (QOL) and survival rate (Min et al., 2011). The study by Young & Sexton determined that Breast cancer survivors who exercise experience a higher quality of life (QOL) than breast cancer survivors who do not exercise(Young-McCaughan & Sexton, 1991).

Various studies revealed physical activity’s benefits, including American College of Sports Medicine. Physical activity supports sustaining and improving overall health and fitness. Doing physical activity is essential for reducing the risk of chronic diseases (Booth et al., 2002). In particular, the research results on exercise and cancer by Cho Eun-Hyo, Jeon Tae-won, and Kim Jun-hong (2010), exercise had a positive effect on cancer management, especially in the prevention and treatment of breast cancer.

Recent studies about relationship between cancer and exercises (An et al., 2018; Chae et al., 2012; Cho, 2016; Eun & Baek, 2021; Han & Song, 2017; Kang & Yoon, 2021; Kim, 2009; Kim, 2013; Kim & Park, 2018; Kim et al., 2009; Kim et al., 2016; Lee, 2018; Lee, 2020; Lee et al., 2009; Wang, 2022; Yeon, 2020) have suggested that training highly supports cancer aftercare. Other researchers had focused on physical activity and cancer survivors and exercise in relation to the quality of life using quantitative approaches rather than focusing specifically on the cancer survivors’ physical activity frequency and the impediment factors to returning or continuing to sports. However, cancer survivors’ physical activity frequency is considered very low. Few studies have been done to examine the impediments to continuing or returning to sports or training as cancer survivors, even though survivors feel hopeless and distressed about returning to sports. The study through a medical approach or may encounter difficulties finding help and receiving an optimal physical activity or sports prescription from health care professionals is inadequate.

This study aims to promote physical activities which positively affect cancer aftercare and eliminate the impediments to continuing or returning to sports by analyzing and identifying the factors that negatively affect cancer survivors. Previous studies about cancer survivors’ exercise, physical activity, and sports were focused only on improving bodily function but lack of the difficulty and needs of cancer patients, including sympathy. From the perspective of knowledge development, Narrative inquiry methods enable researchers to explore the experiences of cancer survivors after cancer treatment life.

Therefore, it was essential to explore and describe cancer survivors’ experiences through narrative inquiry, one of the Qualitative studies, to explore the difficulties of continuing or returning to sports after cancer treatment deeply. This study aimed to lead the discussion and cast the new sight to approach cancer survivors and investigate the hindrance factor of cancer survivors’ physical activities.

Methods

Recruitment of Participants

After employing Purposeful sampling, one of the Non-participant observations in Qualitative studies, six breast cancer survivors were invited to participate. Table 1 presents the characteristics of the Participants (Table 1).

This study was employed to enroll cancer survivors who met the eligibility criteria: (a) sports experience before cancer diagnosis, (b) completed surgical treatment for breast cancer before enrolling in the study and employed auxiliary participants to represent the cancer experience and physical activity.: (a) two surgical oncologists from A and B hospital; (B) a specialist of Cancer Aftercare NGO SWIMPYO.

Dept Interviews

A narrative inquiry method with intuitive reflections was employed to present specific experiences of breast cancer survivors’ impediments to continuing and returning to sports after cancer. Each participant had three in-depth interviews: on January 7th and February 7th, and February 22nd in 2022, to report their perceptions and significant events related to exercise experience after cancer treatment. During each interview, the participants were asked to answer the broader question for an hour where they wanted to. The in-depth interview data were categorized to analyze the decisive events, similar incidents, and other experiences across cases to confirm the person’s influence and information related to the interview context. In this way, each idea was carefully analyzed in every transcript. Specific data analysis procedures included sensitive, theoretical and practical questions. This study analyzed the impediments to continuing or returning to sports after cancer treatment through a narrative inquiry.

Data Collection

The auxiliary data analyzed books about breast cancer and previous research studies on the effect of physical activity and published cancer reports through online research, including Google scholar, Naver, etc.

Data Analysis

The in-depth interviews with each participant were transcribed by computer and categorized by theme with conceptualization. All the interviews were professionally transcribed and checked three times for accuracy by four medical experts. The credibility of findings and quality improvement, in terms of integrity and accuracy, was supported through the investigator’s discussions with participants and self-introspection.

Results and Discussion

Impediments of Doing Sports due to Financial Burden

Continuing or returning to sports as a cancer survivor is found highly important. Continuing or returning to sports as a cancer survivor is found highly important. However, spending on sports encounters difficulties as the expense or financial burden rather the survivor is privately insured or not. Physical activity recommendations for cancer survivors could be practical as many studies have been performed to investigate the effects of exercise improves positively in physical, emotional well-bing, and social impact. However, the data revealed that only 31.6% of cancer survivors participate in physical activity with low frequency after cancer treatment (National Health and Nutrition Survey, 2018). This data casts doubt on the current sports welfare system in Korea.

I am doing Pilates now. Since the swelling in my arm is severe due to the breast cancer surgery, I can’t keep up with the poses requested during the group lesson. I wanted to take a private lesson, but I gave up because of the high cost. (Lee Mi-Hwa, 35, breast cancer survivor).

Pilates is my favorite. Because I had one breast surgery and now suffer a severe body imbalance. So I tried Pilates, but I couldn’t afford it. So now, I walk only. (Choi Eunmi, 35, cancer survivor).

Participants further expressed that the financial burden negatively affects continuing or returning to sports after cancer treatment. It is not easy for them to continue or to return to sports since the unexpected expense but fixed cost for therapy and monitoring during the treatment.

Breast cancer survivors, especially, experience similar side effects like severe swelling by lymphedema (Shin Duksu, 2018), and feel hard to continue or return to sports activity. It is considered another negative experience for survivors after the treatment. Interviews with cancer survivors stated a significant gap in the radius of sports activity with limited physical activity after cancer treatment. Therefore cancer survivors suffer notable challenges before and after treatment to search for appropriate alternatives for their sports activity under personalized circumstances is also revealed.

Before I was diagnosed with cancer, I loved golfing and playing squash. However, I quit my job because of cancer and met career breaks. As a result, no income situation no longer makes me play golf continuously at a relatively high cost.(Park Taeyeon, 36, Cancer survivor).

One of my patients had difficulty paying hospital bills because the company forced her to resign when she was diagnosed with cancer. For this reason, she felt that sports or hobbies become a burden with the extra expense. I felt heartache when she said she could not sustain her workout program because of the financial issue. (Ko Jin-ah, 35, doctor).

While cancer survivors were diagnosed with cancer, they experienced career breaks often in Korea. A study reported that 47% of cancer patients lost their jobs within a year of their cancer diagnosis; after six years, only 30.5% were found to have been re-employed (Park JH, et al, 2008) Cancer survivors from this study also raised relative poverty a lot because of their career breaks, which impedes participation in sports, especially high-expense sports such as golf, squash, and others. The financial burden caused mainly by job loss was the most negatively influential factor in preventing cancer survivors from continuing or returning to sports.

I couldn’t find the balance between work and treatment. So I took a break. At that moment, my treatment and recovery were top priorities, but once I got over it, money became the biggest problem. (Lee Mihwa, 35, Cancer survivor).

When I was diagnosed with cancer, I felt I was at the crossroad of life or death. Work or career was no option to consider. At that time, I only wanted to survive. There was nothing more important than my recovery. (Park Tae-yeon, 36, Cancer survivor).

The work and treatment balance system in this society, especially the private sector, has yet to be ready. Cancer stigma and not fully recovered survivors’ physical and emotional status may reduce the chance of breaking social isolation.

Regardless of the unspecified cancer aftercare system in Cancer Control Act and Labor and Employment Law, advice to resign from the company to an employer diagnosed with cancer is against the law. Cancer survivors lose the chance to do sports or physical activity after treatment by this unprepared aftercare system.

I have heard that people with disabilities or veterans have a welfare policy called a voucher which can replace the rehabilitation or treatment payment. But, I couldn’t find a similar system for cancer survivors even though they also need aftercare continuously. (Son Jungja, 42, doctor)

The treatment of cancer is affordable in Korea, I think. The National Health Insurance Corporation and the national cancer control system work well in Korea. However, even after treatment, I would like the government set up an aftercare system to prevent severe side effects or reoccurrence. (Park Tae-yeon, 36, cancer survivor).

Regardless of the rate of high welfare systems, life after cancer treatment in Korea belongs to the personnel range. At the same time, people with handicapped receive welfare in rehabilitation and treatment through the policy such as workout vouchers which is the preferred system for cancer aftercare.

We, SWIMPYO, also analyze the most significant issue of cancer survivors after treatment: the financial issue. Cancer survivors have already paid the unexpected extra expense for treatment and monitoring while lots of career break cases. Therefore, it is hard to decide whether to start or continue a workout that costs again. That’s why the government needs to have an aftercare system. (Lee Malja,, 32, Specialist of SWIMPYO).

Since I no longer belong to the company, a little support could be big support for me, such as a rehabilitation voucher. (Choi Jiye, 44, Cancer survivor).

The financial issue is clearly defined as an impediment to cancer survivors continuing or returning to sports. The national government and academia are still not taking care of aftercare in sports even though the benefit of physical activity to cancer survivors is well known. Aftercare for cancer survivors in sports should be supported in welfare policies like work out vouchers until the survivors become ready to re-employ and financially prepared.

Impediments of Doing Sports due to Low Motivation from Deterioration Physical Ability

For physiological reasons, the human body degenerates, and physical ability decreases. For the same reasons, even in the case of athletes, they decide to retire when they reach their 30s. Physical ability deterioration links to low motivation and losing hobbies they loved. This symptom is revealed to people with congenital disease, including cancer survivors. The disturbance of body motion comes from physical ability deterioration because of the side effect or treatment. Cancer survivors meet the limitation on sports or hobbies with a financial burden and cause a lack of enthusiasm for physical and emotional well-being.

I am a breast cancer survivor with lymphedema. Because of that, I feel afraid to play racquet sports or golf since I sometimes experience diverse symptoms on my breast and arm, such as swelling and pain. (Park Taeyeon, 36 Cancer survivor.)

I liked the marathon and did a lot till I was diagnosed with cancer. However, it became difficult to do with my low physical condition after chemotherapy. I am willing to run again but challenging. (Lee Mi-hwa, 35, cancer survivor).

These interviews vividly portrayed the situation of no longer continuing sports after cancer with lymphedema. Recently, studies have investigated changes in balance and gait function related to impairment after mastectomy. Cancer survivors from this study described the pain or swelling of the arm a lot through the interviews, which is possibly the hurdle for them to exercise using their hand or arm.

Moreover, deterioration of physical ability from the treatment connects to emotional well-being and motivation to challenge to return to sports.

Most of the cancer survivors of SWIMPYO claim that low physical strength is one of the difficulties of exercising after cancer treatment. Therefore, we also feel the program should be vary on personal symptoms. (Lee Malja,, 32, Specialist of SWIMPYO)

I am just not feeling well inveterately after treatment, like losing control and disturbing the body’s state of equilibrium. I dare not think of doing sports because of my physical condition. (Choi Eun-mi, 46, cancer survivor)

The war on cancer is still going on. It becomes to treat cancer as a chronic, manageable disease with diverse symptoms and side effects. This significant prevalence of multiple ongoing symptoms or impairment impedes cancer survivors’ sports participation.

Many studies have consistently found the risk of breast cancer and estrogen levels. Estrogen hypersecretion is also associated with the deterioration of physical activity. Moreover, cancer survivors considered that exercise might negatively affect fatigue levels.

I encourage patients to exercise after treatment. Nevertheless, there is negative feedback or complaints about doing sports because of their diverse symptoms and side effects like exhaustion or muscle pain. Therefore I suggest simple physical activities such as stretching or walking, so they do not feel challenged to start the exercise. (Son Jungja, 42, Doctor).

My muscles feel too tight after doing sports. Moreover, I have a fear of lymphedema when I overuse my arm. So, I avoid using my arms and rather not do sports. I know exercising is important, but my condition and body still need to be prepared. (Yoon Jungun, 39, cancer survivor)

Of course, immoderate or inappropriate exercise may affect the physical condition disorder of cancer survivors. Therefore, an optimal workout prescription or guide for cancer survivors is essential. Aftercare in sports is needed to develop the guideline about work out for cancer survivors, but not systemized yet. Cancer survivors have no alternative but to visit the gym or other sports center to work out where there are no cancer treatment experts. It is hard to expect to meet a personalized professional program at a gym or sports center since they provide only regular exercise programs. However, cancer survivors need a rehabilitation exercise program, including an analysis of types of exercise, duration, level of workout, and frequency that reflects personal physical status.

It is impossible to receive a customized exercise program for each cancer survivor. Various symptoms and side effects were found from cancer survivors during the interviews. The discussion on cancer survivors’ exercise caring side effects or sequelae of cancer treatment is not still made in Adaptive Physical Activity. The aftercare for cancer survivors, especially for sports, is hard to categorize in a specific field which can be the basis of legal support.

Indeed, survivors can feel big differences in their physical strength before and after the cancer treatment, especially the chemotherapy. A person can feel reduced stamina even if we catch a cold. Maintenance workout is key to increasing strength and physical level, but it will not be easy. (Ko Jinah, 35, Doctor).

Even though we prepared a diverse workout program with different types and levels, many cancer survivors feel too hard to follow. An optimal exercise prescription for cancer survivors is our goal to make (Lee Malja, 32, SWIMPYO specialist).

This is also considered because there are no aftercare measures for exercise physiology related to cancer survivors. As a series of examples, patients who have undergone orthopedic surgery receive welfare benefits under the system, such as manual therapy at a low price due to the subsidy of the National Health Insurance Corporation. However. Cancer survivors have only insured the treatment, but aftercare. Aftercare, as the rehabilitation and continuous health management, the breast cancer survivors’ impairment in body balance and lymphedema need to be taken care of. It was important to build an aftercare system and highlight the importance of cancer survivors’ body management study with policy and legal support.

A Disproportionate Share Burden of Balancing Treatment, Work and Family Obligations

Diverse social roles for one person is expected these days. Not only economic activity for survival, but hobbies, family time, and networking for Quality of Life. Parenting is also included in one’s life. The discomfort from ongoing parenting and other family care triggered give up and apprehensions in the women about sports returning, which made some feel “meaningless” and others concerned that there are “mandatory” roles than taking care of themselves.

The interviews progressed mainly by the 30s to 50s breast cancer survivors, and they had common agonize in family and treatment balance. Family care is almost performed by women and enforced on women so far, which is a chronic issue in Korean society. Even though they were diagnosed with cancer, breast cancer survivors continue to shoulder a disproportionate share burden of Balancing treatment, work, and family obligations.

I had a hard time balancing caring for my child and treatment. There is no time to exercise except for short walks with my child. Since my child needs the mother’s care so far, I have to focus on family care instead of maintaining my career and doing sports. (Yoon Jungun 39, Cancer survivor).

I have to take care of and support my family. My husband expects a promotion at the company, and My child is a test-taker. Finding the time for exercising and my own time with the household is challenging. (Choi Eunmi, 49, Cancer survivor).

Caring for the child was revealed to be the most considered economical and environmental hurdle, among other issues to returning or continuing to sports. Especially a cancer survivor with an infant has no time even to relax. In this situation, Sports with a group or partner for a long duration become more challenging than walking or stretching alone.

The real world is not that warm to cancer survivors. After leaving the hospital, I immediately returned to my role as mother and daughter-in-law. I try to accomplish my role at the house for the family since I hate to have stigma from other people. (Yoon Jungun 39 Cancer survivor).

My family has met a financial crisis since covid-19. My husband’s business has not worked well. At that moment, I was undergoing chemotherapy and losing my job. I tried hard to overcome everything because of my one and only child. (Kim Sunhwa, 42, Cancer survivor).

The case that person is classified as disabled due to an injury, the welfare system provides and supports: a leave of absence from work and receives various social benefits such as discounts on toll gate fees, discounts on the train, domestic flights, communication fees, museums or temples entrance fees, and freezing of insurance premiums. However, cancer survivors with serious side effects have any social benefits except national insurance for treatment.

The number of people with cancer is a national problem (48.6 per 100,000 population as of 2019) for various reasons, such as economic and social issues. Losing jobs and face to financial issues can affect the national GDP in the long term. The challenging balance between the family and treatment puts the child’s rights, birth rate, and QoL low. The reoccurrence risk may negatively affect national health. Aftercare of cancer survivors is no longer individual but social level. The fundamental step to discussing cancer aftercare must start with support to return to sports. Social safety net for cancer survivors can find the time and afford to do sports for their health management after treatment. It leads the virtuous circle from managing health and QoL as fully recovered labor and family member. The aftercare system as the welfare policy is highly recommended since cancer survivors’ life difficulties affect a wide range of social issues. Despite ranking high in advanced medical care and the national insurance system, Korea’s welfare range is evaluated narrowly, with few discussions of cancer aftercare and cancer survivors’ continuing or returning to sport.

I am taking care of my parents, who are also in the hospital. I also need to visit my doctor for monitoring, and there is no time to workout (Park Taeyeon, 36, Cancer survivor).

Patients between 20 to 40s, young cancer survivors, face diverse roles in society and family, making survivors under challenging situations have aftercare.(Son Jungja, 42, Doctor).

Three important conditions need to define for effective exercise: (1) the exercise frequency, (2) intensity, and (3) duration. In particular, physical activity for which the frequency of exercise is not considered has no physical significance. In general, doing exercise about three times a week is appropriate. However, it turns out that cancer survivors cannot participate in continuous exercise for complex reasons, including social roles like mother, wife, employer, and others.

I do exercise ones a week. Since I work late a lot, it is hard to participate in a group lesson on time. (Park Taeyeon, 36, Cancer survivor).

Regularly working out is impossible for me. I must take care of my babies alone when my husband goes to work. I also worried a lot about asking for babysitting if they became sick or hurt. Sometimes my parents-in-law visit us without any notice. (Kim Sunhwa, 42, Cancer survivor).

It is tough to exercise, even a healthy adult, three times a week because of a busy schedule or other reasons. Of course, it is possible for affordable cancer survivors, but periodic exercise is challenging for most cancer survivors who suffer complex social role obligations.

Cancer aftercare is an essential system built by society, not an individual’s responsibility. Regardless cancer survival rate approaching 70.7%, higher and higher annually, the life after the treatment is up to personal. So, cancer survivors should be considered long-term treatment patients to live with their cancer while maintaining a quality of life. Cancer Aftercare should consider the somewhat periodic idea of managing politically and academically.

Conclusion

This study aimed to understand the multidimensional needs of cancer patients, find the social safety net to support cancer aftercare on a legal basis, and activate the social support system. In this study, we aimed to analyze the difficulties of participating in sports of breast cancer survivors for cancer aftercare. This study employed the case study and purposive sampling to obtain the sample from five breast cancer survivors, two surgical oncologists, and a cancer aftercare NGO specialist. This study conducted the participatory observation method and depth interviews to categorize and conceptualize based on transcribed data with selected study participants. The study was to identify the essential themes, and four medical experts addressed within and across cases. Three essential themes were revealed: financial difficulty, severe chronic condition, and social role. Firstly, breast cancer survivors suffer financial difficulty after a cancer diagnosis because of their career breaks or the absence of economic activities. This situation put survivors hard to take part in sports with high expenses or customized personal programs. Secondly, breast cancer survivors suffer experience motor disorders due to low motivation due to poor physical ability. Therefore, follow-up measures for them should be taken at the welfare level.

Thirdly, breast cancer survivors continue to shoulder a disproportionate share burden of Balancing treatment, work and family obligations. Cancer survivors who are parents or family caregivers have taken on even more during the cancer treatment. They were already shouldering the majority of financial, social, and family care responsibilities. That is wholly inadequate for most cancer survivors to find enough time to work out or do sports regularly but sporadic or never for themselves and their health.

In this study, the impediments to breast cancer survivors’ continuing or returning to sports following cancer treatment fell into three leading causes; financial, physical, and social. The in-depth content on difficulties in training and doing sports for breast cancer survivors has been established with the need to broaden the blind spot of welfare and for practical governance building to make information delivery seamless among various provided welfare services in health and sports in South Korea. This study explored the political and social needs for cancer aftercare by analyzing the impediments from low participation in sports after cancer treatment. As the cancer survivor rate in South Korea is increasing, the need for long-term social support after cancer treatment has become highlighted to consider the sustainable quality of life, balancing social roles, and return to work. As the needs of the cancer aftercare system increase, the government’s role also should be broadened in the legal and policy support system with a multidimensional approach, especially for return to sports, including the delicate sympathy of cancer survivors. Therefore, the following study should aim to establish an optimal way for a return to sports after cancer and related policy research.

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Table

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Table 1

Characteristics of Participants

No	Name	Age	Types of Cancer	Occupation	Note
1	Lee Mihwa	35	Breast	Administrator
2	Yun JungUn	39	Breast	Office worker
3	Kim Sunhwa	42	Breast	Marketer
4	Choi Eunmi	49	Breast	Fashion worker
5	Park Taeyeon	36	Breast	Office worker
6	Choi Jiye	44	Breast	Freelancer
7	Son Jungja	42	-	Doctor	Assistant Research participant
8	Ko Jinah	35	-	Doctor	Assistant Research participant
9	Lee Malja	32	-	NGO SWIMPYO specialist	Assistant Research participant

※ Participants’ information is blinded as a request under the privacy act.