Uncertainty, lack of control and emotional functioning in women with metastatic breast cancer: a review and secondary analysis of the literature using the critical appraisal technique.

A diagnosis of metastatic (or secondary) breast cancer is frequently more distressing than the diagnosis of a primary tumour since it indicates that the cancer is no longer curable. Relatively little is known, however, about women's experiences of this condition in comparison with those diagnosed with primary breast cancer. This paper therefore reports findings from a secondary analysis of the published literature on the topic using tools from the critical appraisal skills programme to identify and analyse appropriate papers, and the constant comparative method as a means of identifying any overarching or dominant themes emerging from the literature. Uncertainty, lack of control and poor emotional functioning emerged as the main themes affecting women with metastatic breast cancer. These are discussed in relation to their antecedents in the original studies and their implications for nursing care. The themes demonstrate that living with metastatic (or secondary) breast cancer is a multifaceted experience that is influenced by a large number of factors, many of which are under-researched in comparison with those affecting women diagnosed with primary disease. It is clear, however, that women affected by the condition need a great deal more support than they currently receive, and new services may be required to meet these needs.