Purpose: This study explored quality of life (QOL) experiences after non-metastatic breast cancer treatment, especially related to mastectomy, among survivors in Botswana.

Methods: We conducted 23 qualitative interviews in Setswana with survivors who were within 1-5 years of having a mastectomy from a nationwide cancer survivorship cohort. Physical and mental QOL, measured by SF-8, were also assessed. We translated, double-coded, and thematically analyzed transcripts according to QOL domains.

Results: Over half of participants were diagnosed with stage III disease; all received chemotherapy and mastectomy. Key aspects of physical, financial, psychological, and social QOL that were influenced by treatment included the following: (1) pain, mobility, and fatigue; (2) reduced work capacity and financial stress; (3) depression, anxiety, and body image; and (4) mixed social support due to stigma. We also identified structural factors that limited access to symptom management and support services, which affected multiple aspects of QOL.

Conclusions: Long-term pain, mobility restrictions, and fatigue affected physical functioning, specifically regarding employment, which had an overall negative impact on household financial status. Though some survivors received informal support through social networks, access to symptom management, support services, and public assistance was limited. Implications for Cancer Survivors This study highlights multi-level challenges that affect QOL after mastectomy in Botswana. Interventions enhancing physical symptom management and improving psychosocial support services may improve QOL of survivors across sub-Saharan Africa.

Keywords: Breast cancer; Mastectomy; Quality of life; Sub-Saharan Africa.