title: "An addendum to breast cancer": the triple negative experience.
abstract: The triple negative breast cancer (TNBC) subtype, known to be aggressive with high recurrence and mortality rates, disproportionately affects African-Americans, young women, and BRCA1 carriers. TNBC does not respond to hormonal or biologic agents, limiting treatment options. The unique characteristics of the disease and the populations disproportionately affected indicate a need to examine the responses of this group. No known studies describe the psychosocial experiences of women with TNBC. The purpose of this study is to begin to fill that gap and to explore participants' psychosocial needs.
  
  
  
  An interpretive descriptive qualitative approach was used with in-depth interviews. A purposive sample of adult women with TNBC was recruited. Dominant themes were extracted through iterative and constant comparative analysis.
  
  
  
  Of the 22 participants, nearly half were women of color, and the majority was under the age of 60 years and within 5 years of diagnosis. The central theme was a perception of TNBC as "an addendum" to breast cancer. There were four subthemes: TNBC is Different: "Bottom line, it's not good"; Feeling Insecure: "Flying without a net"; Decision-Making and Understanding: "A steep learning curve"; and Looking Back: "Coulda, shoulda, woulda." Participants expressed a need for support in managing intense uncertainty with a TNBC diagnosis and in decision-making.
  
  
  
  Women with all subtypes of breast cancer have typically been studied together. This is the first study on the psychosocial needs specifically of women with TNBC. The findings suggest that women with TNBC may have unique experiences and unmet psychosocial needs.
authors.affiliation: University of Virginia School of Nursing, 202 Lancaster Way, Charlottesville, VA, 22903, USA. turkman@virginia.edu.
authors.forename: Yasemin E
authors.initials: YE
authors.lastname: Turkman
authors.affiliation: Yale School of Nursing in West Haven, West Haven, CT, USA.
authors.forename: Holly Powell
authors.initials: HP
authors.lastname: Kennedy
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Case Western University Medical School, Cleveland, OH, 44106, USA.
authors.forename: Lyndsay N
authors.initials: LN
authors.lastname: Harris
authors.affiliation: Yale School of Nursing in West Haven, West Haven, CT, USA.
authors.forename: M Tish
authors.initials: MT
authors.lastname: Knobf
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D036301:Qualitative Research; D064726:Triple Negative Breast Neoplasms / Q000401:mortality / Q000503:physiopathology* / Q000523:psychology*
keywords: Coping; Interpretive description; Oncology; Psychosocial; Qualitative; Triple negative breast cancer