Not taking symptoms seriously
One informant put off seeing a doctor for a long time despite
suspecting testicular cancer: “And then I felt, well, a year
or so ago, that something happened. And of course I didn’t go
see the doctor all that fast, you know. I just sort of thought that
this will probably pass.”
Another informant did not at first think that the symptoms were
signs of anything serious, while others found that their doctor did
not take the symptoms seriously: “And then when I got to the
doctor he said he didn’t think it was anything to worry
about.” This resulted in it taking a bit longer before the
diagnosis could be confirmed.
Confirmation of the diagnosis
Having a cancer diagnosis confirmed was a great shock:
“Right away when he said you have cancer. Then I got …
just like they had hit me with a shovel. Even if I knew it …
it was like … well, then I it was confirmed.”
The time from confirmation of the diagnosis till information
and treatment – information
The time between confirmation of diagnosis till information on
treatment was the most challenging.
But when the informants received adequate information from a
doctor they had come to trust, anxiety was replaced by calm and a
belief that all would be well: “And then I was given the
prognosis, and I calmed down quite a bit … if you are going
to have cancer it is pretty nice to have a kind they have control
It also emerged that medical information, given in a proper
manner, should not be underrated: “It was pretty good to get
information about … You do wonder how the rest of your body
will work after something like that. When you have lost a testicle
I mean. How your sex life will work and all that, afterwards,
but all that has been just normal.” “They said it was
more or less a 50-50 … could become sterile too, and
don’t really know that yet. So you froze … had an
offer of that. So I did that before starting on the
The information is related to knowledge and safety and is
important for trust in the health services. Informants who
experienced a shortage of information or who had to keep asking for
such information related that to the hospital not having enough
knowledge on diagnosis and treatment.
Chemotherapy was an ordeal – physically and
All informants found the surgery uncomplicated and simple.
Undergoing chemotherapy on the other hand was a great strain both
physically and psychologically. The informants had felt fairly
healthy until the chemotherapy, but the moment they were given
chemotherapy, they had issues that made them feel really ill.
Nausea and vomiting and a feeling of physical and mental fatigue
were challenging: “Was totally in the basement after these
treatments.” Those who had the most cycles emphasised this
strain the most, but also those who had only one cycle of
chemotherapy experienced it as a physical and psychological ordeal.
The informant who did not undergo chemotherapy, found the thought
of doing so very frightening.
Coping resources that contributed to coping – social
It emerged in the analysis that a spouse or partner was the most
important support during the period of illness, and this was seen
as a determining factor for getting through the challenges in an
adequate way. Also own parents, adult children and understanding
from employer and colleagues were emphasised. The informants
described it as an advantage to not have to work and to be on sick
leave with a good conscience. Also feeling safe and cared for in
the health services was central to coping with the challenges
throughout the cancer treatment: “A pure success story I
think. Impressed by the control the regional hospital
All informants had been open about their disease and had had
positive experiences with being so. They emphasised that in being
open it was easier to get support. Openness would also hinder
speculation and get the patient help to work through his own
thoughts and feelings: “It is better to be able to talk about
it than have people just sit and wonder, and then make up their own
thoughts and opinions. Being open has been a help. The more people
who know what you suffer from, the greater is the chance of getting
the help you need.”
Coping resources that contributed to coping – physical
Several informants emphasised that physical activity was
important for coping. Doing something physical signalled that the
body functioned, and one could think of other things. Through
physical activity they saw progress, and they felt that they did
something to move forward: “The best way to get on was when I
started to exercise. That felt good, I felt things were
Coping resources that contributed to coping – hope
The informants further emphasised the importance of being
positive and have hope that all would be well. The informants gave
the doctor and nurses at the regional hospital much of the credit
for this hope: “I guess I hoped I would be among those
percentages, I don’t remember, it was some 95 percent or
whatever she said. Then I thought, oh well, I do think this is
going to go well … and then I did relax a bit more.”
“When I heard the possibilities or prognoses then I thought
that this, this is probably going to turn out really well.”
Believing that it would be all right made it easier to grit your
teeth and go through the treatment. In addition professionalism,
care and cheerfulness from the health personnel were emphasised as
This study shows that the men find it demanding to be a patient,
receive the testicular cancer diagnosis and go through the
treatment. Various coping resources such as social support,
physical activity and hope may help patients cope with the
difficult life situation.
The findings show that some do not see a doctor despite
suspecting that they may have cancer. Some put off seeing a doctor
because they do not think the symptoms signal anything serious.
Earlier studies show that putting off seeing a doctor in the case
of cancer may be due to uncertainty regarding whether the symptoms
are serious enough. Some also deny the fact that the symptoms may
signal a serious disease (4, 6, 7, 16).
To many the diagnosis comes as a shock.
The informants emphasised how difficult the time was before they
received proper information on the diagnosis. The difficulty of
going through a time of medical assessment has also emerged in
other studies (4, 10, 16). This points to the importance of
attending to the patients when they have received the diagnosis. A
study on patients with breast cancer shows that early information
on a specific treatment plan gives them a feeling of control. They
also feel they belong to a trustworthy health service (10). It is
important that patients experience predictability and knowledge so
that they may more easily manage the challenges the disease brings
(5, 10, 11) and feel that the treatment is meaningful, something
necessary for full recovery (5, 10, 11). The informants also
pointed out that having hope is important for coping during the
difficult time that accompanies confirmation of diagnosis and
treatment. Hope may give a feeling that there is a way out or the
difficulties and that challenges can be managed (10, 17).
The doctor's communication is significant
Several informants emphasised the first doctor who gave them
faith that the treatments would succeed. The informants had a clear
memory of this conversation, both regarding the words used by the
doctor and the emotions they induced. Studies show that the
personal interest a doctor shows when communicating a diagnosis is
a factor that determines whether the patient will trust or mistrust
the doctor (4, 8, 18). Earlier studies also point out how
significant trust is, as the disease strengthens the need to trust
others (4, 5, 19, 20, 21, 22).
A central finding is that some informants found the information
they received in the local hospital to be out-dated. Such incidents
weaken the trust in the health services. When the informants felt
their lives were under threat when they developed cancer, it became
even harder when they experienced that some health professionals
did not merit their trust. Earlier studies also show that some
health personnel may greatly influence how the patients cope with
challenges when ill (4, 8, 10, 23). Health personnel must be aware
of this when encountering patients with testicular cancer.
Support from close ones is important for coping
The informants felt that support from family, friends,
colleagues and health services was the most important reason for
their ability to cope with the illness. This is also in line with
earlier studies of patients with testicular cancer (4, 5, 6, 7,
24). The positive effect of social support on health is relatively
well documented (25) and that help and support from health
personnel is invaluable (10, 19). Having at least one confidant
enables resistance and strength and helps give meaning to life
(26). This is important for the ability to cope and for the
improvement of health and wellbeing (11).
In addition to support from family and health personnel there is
much one can do to regain health, according to the informants.
Health is not what we are subjected to in life, but our ability to
use our coping resources in such a way that one copes with the
challenges (11). Focusing on the patients’ coping resources,
such as social support, knowledge and hope, thus becomes important.
The patient thus gets help to keep his or her place along the
continuum between health and non-health, or to move towards better
health. By supporting the patient and advising him to use his
coping resources, he can more easily manage the situation.
Physical activity yields many benefits
The informants emphasised that how the body functioned was
important for their mental health. By using the body physically
they had a feeling of being in recovery and on the way back to a
better health and existence. The days they felt physically low,
they also became psychologically broken down. This is in line with
an earlier study that shows that physical activity and being
preoccupied with other things may be of help in coping with daily
life (4). An earlier review article on cancer patients also
suggests that physical activity during treatment may lead to a
higher survival rate and an improved quality of life (27).
An interesting finding is that the informants pointed out that
openness was an important help for support and coping. This finding
is not in line with earlier studies that show that a male approach
is to be independent and manage problems alone (6, 7). They also
show that it is difficult to talk about one’s own illness (5,
6), and that silence keeps any difficult emotions at bay (28). Our
findings are thus an important contribution to research, as they
show that openness may lead to more support from others. Such
support may also contribute to increased understanding and
manageability. According to Antonovsky, comprehensibility and
manageability are important in strengthening SOC, which again will
improve coping, health and wellbeing (11).
The study's strength
Interviewer had long clinical experience with cancer patients,
both from hospital and municipal health services. This experience
provides a solid basis for understanding the challenges the
informants have had in connection with cancer diagnosis and
treatment. Interviewer can ask informed follow-up questions, and
the men feel safe when speaking openly of their experiences in the
difficult situation (12).
The study's weakness
The study has a small number of informants, and all participants
emphasised being open about their illness. It is possible that some
of those who did not participate would not have been equally open.
Interviewer’s preunderstanding may result in preconceived
notions, which may influence the questions asked in the interview
and the result of the analysis (14). Interviewer was aware of these
issues and attempted to make sure that her own knowledge,
experiences and events should not influence the result.
Receiving the testicular cancer diagnosis and chemotherapy was a
physical and psychological ordeal for the informants. The stages
from suspecting testicular cancer to seeing a doctor, receiving the
diagnosis and the treatment were marked by challenges that put life
at risk and tested the ability to cope with the challenges. The
analysis shows that support, physical activity and hope contribute
to improved coping, health and wellbeing. It is also important to
be open about the disease so that the network may give support.
Early and up to date information was also important, as having
one’s life threatened feels even harder when the trust in
health personnel is weakened.
1. Frøen H, Brennhovd B, Abeler VM, Lehne G. Ung mann med sterke
ryggsmerter. Tidsskrift for Den norske legeforening
2. Helsedirektoratet (2015). Nasjonalt handlingsprogram med
retningslinjer for diagnostikk, behandling og oppfølging for
testikkelkreft. Available at:
3. Berg A, Fosså SD. Kreft i mannlige kjønnsorgan. In: Reitan
AM, Schjølberg TK (ed). Kreftsykepleie.
Pasient-utfordring-handling. Akribe forlag, Oslo. 2010.
4. Kristjanson LJ, Ng C, Oldham L, Wilkes L, White K, Maher L.
The impact and responses of men who have experienced testicular
cancer. Australian Journal of Cancer Nursing,
5. Saab M, Noureddine S, Abu-Saad H, DeJoung J. Surviving
testicular cancer: The Lebanese lived experience. Nursing Research
6. Brodsky MS. The young male experience with treatment for
nonseminomatous testicular cancer. Sexuality and Disability
7. Mason OJ, Strauss K. Testicular cancer: Passage through the
help-seeking process for a cohort of U.K. men (part 1).
International Journal of Men’s Health 2004;
8. Johansson S, Steineck G, Hursti T, Fredrikson M, Furst CJ,
Peterson C. Aspects of patient care: interviews with relapse-free
testicular cancer patients in Stockholm. Cancer Nursing 1992;
9. Dahl O, Lehne G. Cancer testis. In: Dahl O, Lehne G, Baksaas
I, Kvaløy S, Christoffersen T (ed.). Medikamentell kreftbehandling.
Cytostatikaboken. Haukeland universitetssykehus, Bergen. 1995.
10. Drageset S, Lindstrøm TC, Underlid K. Coping with breast
cancer: between diagnosis and surgery. Journal of Advanced Nursing
11. Antonovsky A. Helsens mysterium. Gyldendal Norsk Forlag,
12. Kvale S, Brinckmann S. Det kvalitative forskningsintervju.
Gyldendal Akademisk, Oslo. 2012.
13. Jacobsen DI. Forståelse, beskrivelse og forklaring.
Innføring i metode for helse- og sosialfagene. Høyskoleforlaget,
14. Malterud K. Kvalitative metoder i medisinsk forskning.
Universitetsforlaget, Oslo. 2011.
15. Malterud M. Systematic text condensation: A strategy for
qualitative analysis. Scandinavian Journal of Public Health
16. Sandén I, Larsson US, Eriksson C. An interview study of men
discovering testicular cancer. Cancer Nursing
17. Rustøen T. Håp og livskvalitet – en utfordring i
sykepleien? Gyldendal Akademisk, Oslo. 2001.
18. Myskja A. Leve med kreft. Hvordan styrke håp og livsmot.
Cappelens forlag, Oslo. 2005.
19. Giske T. Sårbarheit, makt og tillit: Tillit – den gode
bru mellom sårbarheit og makt, eksemplifisert med pasientar
innlagde på sjukehus til utgreiing. Michael
20. Fugelli P. Tillit. Tidsskrift for Den norske legeforening
21. Giddens A. Modernitetens konsekvenser. Pax forlag, Oslo.
22. Grimen H. Tillit og makt – tre sammenhenger.
Tidsskrift for Den norske Legeforening,
23. Ekeland T-J. Kommunikasjon som helseressurs. In: Heggen K,
Ekeland T-J. (ed). Meistring og myndiggjering – reform eller
retorikk. Gyldendal Akademisk, Oslo. 2008.
24. Fleer J, Sleijfer D, Hoekstra H, Tuinman M, Klip E,
Hoekstra-Weebers J. Objective and subjective predictors of
cancer-related stress symptoms in testicular cancer survivors.
Patient Education & Counceling 2006;64:142–50.
25. Dalgard OS, Ystgaard M, Brevik JI. Sosiale miljøfaktorer og
psykisk helse. I: Dalgard OS, Døhlie E, Ystgaard M (red.). Sosialt
nettverk – helse & samfunn. Universitetsforlaget, Oslo.
26. Reitan AM. Krise og mestring. In: Reitan AM, Schjølberg T.K.
(ed.). Kreftsykepleie – pasient, utfordring, handling. Akribe
forlag, Oslo. 2010.
27. Galvâo DA, Newton RU. Review of exercise intervention
studies in cancer patients. Journal of Clinical Oncology
28. Lien MI. Syke menn skyr moderlig omsorg. Available at: