title: Defining the illness trajectory of metastatic breast cancer.
abstract: BACKGROUND
  With significant developments in the management of metastatic breast cancer, the trajectory of progressive breast cancer is becoming increasingly complex with little understanding of the illness course experienced by women, or their ongoing problems and needs.
  
  
  OBJECTIVE
  This study set out to systematically explore the illness trajectory of metastatic breast cancer using models from chronic illness as a framework.
  
  
  METHODS
  Longitudinal mixed methods studies detailing each woman's illness trajectory were developed by triangulating of narrative interviews, medical and nursing documentation and an assessment of functional ability using the Karnofsky Scale. The Corbin and Strauss Chronic Illness Trajectory Framework was used as a theoretical framework for the study.
  
  
  METHODS
  Ten women aged between 40 and 78 years, with metastatic breast cancer.
  
  
  RESULTS
  Women's illness trajectories from diagnosis of metastatic disease ranged from 13 months to 5 years and 9 months. Eight of the 10 women died during the study. Chronic illness trajectory phases identified by Corbin and Strauss (pretrajectory, trajectory onset, living with progressive disease, downward phase and dying phase) were experienced by women with metastatic breast cancer. Three typical trajectories of different duration and intensity were identified. Women's lives were dominated by the physical burden of disease and treatment with little evidence of symptom control or support.
  
  
  CONCLUSIONS
  This is the first study to systematically explore the experience of women over time to define the metastatic breast cancer illness trajectory and provides evidence that current care provision is inadequate. Alternative models of care which address women's increasingly complex problems are needed.
authors.affiliation: Research and Evaluation Department, Breast Cancer Care, London, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Reed
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Corner
mesh_terms: D000328:Adult; D000368:Aged; D001293:Attitude to Death; D001943:Breast Neoplasms / Q000523:psychology* / Q000556:secondary* / Q000628:therapy*; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care / Q000592:standards*; D011787:Quality of Health Care; D011788:Quality of Life
keywords: Supportive care