Table 1.

Final category system used for the qualitative and quantitative analysis

Category	Description	Sample characteristic statements by the women
Worst experience
Psychological distress	Anxiety or uncertainty about the course or outcome of the illness.	“uncertainty according to the outcome of surgery”; “uncertainty about the future”; “anxiety”; “fear of recurrence”; “fear of dying”
Chemotherapy	Chemotherapy or related side-effects.	“chemotherapy”; “loss of hair”; “to look at myself due to the loss of hair” “port implantation for chemotherapy”
Cancer diagnosis	The shock of receiving cancer diagnosis and the fact of being a cancer patient.	“communication of the diagnosis by the gynaecologist”; “Cancer itself! I have always lived a healthy life”; “that you have cancer and can’t forget it”
Mastectomy	Removal of the breast and the affected body image.	“removal of the breast, loss of self-esteem regarding sexuality”; “losing my breast or dying”; “disfigurement of the body, considerable restrictions in dressing”
Social burden	Fear of family or other conflicts in partnership or family caused by the illness.	“to have to be strong for my family”; “the fear of my twin sister and my daughter”; “that my husband couldn’t get along with the changes of my body, what I never had expected”; “to see, how my husband was suffering”;
Additional illnesses	Additional diseases like comorbidities or recurrence during or after breast cancer.	“I had a recurrence”; “cancer disease was accompanied by atrial fibrillations – bad health status for a long time”; “arm pain because my right upper arm was disabled by a fracture”
Radiotherapy	Radiotherapy with related side-effects.	“loss of energy because of radiation”; “after radiotherapy I had a pneumonia for nearly five years after treatment with cortisone”
Endocrine therapy	Endocrine therapy with related side-effects.	“endocrine therapy with all side effects”; “the obligation to take pills continuously despite circulatory complaints”; “my bones, probably affected by the intake of medication”
Nothing	No worst experience.
Other		”pain”; “fatigue”; “that life will never be the same!”; “Everything happened at once. Diagnosis, divorce, driving test, moving house”
Positive aspects
Change in life priorities	Change of one’s own priorities in life in terms of living life more consciously and relaxed, or changes in lifestyle.	“I think, you live more intensively and consciously”; “I have reconsidered my life, changed several things”; “I see a lot of things more relaxed”; “I have learnt to take more care of myself, to say ‘no’ more often that makes me proud”
Social support	Support by family, friends, or colleagues as well as unexpected help from others.	“the experience of intensive and also often unexpected support and friendship”; “my friends never abandoned me”; “I experienced a lot of attention, appreciation and support”; “I met wonderful people”
Good course of cancer	The good course and outcome of the illness.	“tumour was very small”; “no metastases”; “disease was early detected because of annual check-up”
Support by physicians/ nurses	The good (medical) treatment by physicians or nurses.	“the experience of caring physicians and nurses”; “advice and reassurance”; “the good medical attendance”
Gratitude	Being grateful to have survived.	“I have developed a profound feeling of gratitude”; “that I’m still alive”; “looking back on my life and thankfulness”; “regarding every day as a gift from God”
Other		“I could manage my disease very well”
Advice
Fighting spirit	Think positive, fight, and never lose hope.	“never give up and think positive all the time”; “always thinking ‘Yes, I can manage that!’”; “Never lose hope!”
Information	Keep calm, get a second opinion, and inform yourself about the illness.	“inform yourself about all treatment options”; “don’t believe just one single physician”; “inform yourself intensively in the internet, get a second opinion”
Confidence in physicians	Trust your physician and follow his/ her instructions.	“do everything the doctor says”; “confidence in physicians”; “adherence to treatment”
Openness	Confide in somebody and talk a lot about the illness.	“positive conversations, share your experiences”; “talking a lot about the illness”; ““don’t hide the disease”
No advice	It is not possible to give any advice for fellow patients.	“I can’t give any advice”; “none, every patient comes to terms with it another way”
Business as usual	Don’t think too much about the illness, live life in a normal way.	“fade out disease of daily life, live for the moment”; “master everyday life as usual, domestic work, sports, friends, theatre”; “don’t think too much about disease, distract yourself, and remain cheerful”
Cancer screening	Have regular cancer screening.	“go to the doctor in time”; “regular cancer screening”; “early detection by screening”
Acceptance	Accept the illness.	“things you can’t change you have to accept”; “accepting disease”
Self-reflection	Reconsider your life.	“consider disease as a touchstone and if applicable as turning point, which is not solely negative but also offers opportunities to find oneself”; “attend to your own soul, find out, what makes you happy”
Belief in God	Strengthening in faith.	“pray a lot”; “don’t lose courage, my trust in God helped me a lot”
Support group	Visit a support group.	“contact other patients or a support group”; “visit a support group as soon as possible”
Secrecy	Keep your illness as a secret.	“Inform as few people as possible! Hardly anybody can help!”
Other		“Go to rehab”; “to undergo surgery immediately”; “no complementary medicine, take part in a trial”; “accept help”