This study was performed to explore the illness trajectory of MBC women from breast cancer diagnosis to metastasis. Meanwhile, the perspective of patients toward the future has been evaluated through their narrative in the framework of a qualitative study.
There are several differences between the two phase of breast cancer diagnosis, and incidence of metastasis. Despite the feelings such as shock and denial in the diagnosis phase, the hope and energy are higher rather than the metastasis phase. It addresses the despairing nature of metastasis which resulted in the disappointment of MBC women.
An interesting finding is a variation in perceived social support particularly from the physician. Almost, the metastasis occurrence is accompanied by losing trust in the physician, such as away some of the patients in metastasis onset category, attributed the illness recurrence to the medical malpractice, and they start blaming the doctor. While, simultaneously with treatment resuming, they decide to trust their physician. At this time, they disclose the supportive role of the physician for facilitating the decision making about the future therapeutic attempts and encouraging them to remission. This finding suggests the educational and supportive program for improvement of the relationship between patient and physician, in a different phase of illness and treatment. Being aware of these trajectories may help clinicians plan care to meet their patient’s multidimensional needs better, and help them to cope with their situation .
The diversity and complexity of the problems resulting from the disease and its treatments could affect the physical, emotional, and social domains of MBC patients' life .
According to the study finding, a frequent complaint of MBC especially in the metastasis phase was the physical and emotional pain caused by remembrance of chemotherapy and its side effect. This suffering in some cases can give rise to the avoidance from medical attempts, or treatment postpone. It can be attributed to recent findings emphasizing the physical and cognitive dysfunction caused by chemotherapy which leading to increased psychological distress .
This study revealed that living with MBC as a progressive illness can consist of both positive and negative experiences at intrapersonal and extra personal levels. Positive experiences such as hardiness and resiliency have consisted of previous research and theoretical foundation which referred to the post-traumatic growth , and psychological hardiness theory . These positive psychological changes occur as a result of the struggle with MBC as challenging life circumstances.
On the contrary, some of the adverse consequences of the MBC, such as isolation, rejection, hopelessness, and other experiences due to side effect of treatment (for instance, sexual, hot flashes, and body image problems), can consider as common negative experiences leading to the annoying memories, even after treatment complement. These findings highlight the importance of monitoring MBC challenges during the illness trajectory and reinforce the necessity of management of physical, psychological, social, and spiritual needs of MBC women.
Moreover, patients' narratives about the future of illness, revealed an interesting result. In predicting the future, the spiritual theme is visible. For examination of this finding, this is crucial to highlight the religious and spiritual nature of Iranian culture. Religious beliefs play an important role in coping strategies for the management of illness trajectory. Consistent to McLaughlin et al. deferring control to God leads to lower levels of breast cancer concerns but also more passive coping styles .
Similar to anticipatory narratives, the MBC patients' perspective about death, includes spiritual, as well as religious concepts in terms of revision from illness and attaining to long-time life. This matter is evident in their psychological reactions, especially avoidance from speaking about death, and bargaining with God for a lifetime.
As noted by Lam et al. distress trajectories over the first 8 months post-operatively predicted psychosocial outcomes 6 years later . Then, screening for distress at the initial phase of breast cancer may help to identify patients with more unmet needs, and higher use of maladaptive coping styles who are at risk of experiencing non-resilient trajectories for further management of these symptoms .
This study can be considered with several limitations. Some of the confounding demographic and medical variables such as the age of patients, time since diagnosis, time since metastasis occurrence, stage of illness, and physical condition and mental status of patients at the moment of the interview can be contributed to their narratives. All of the abovementioned factors can tarnish patient’s narratives about past experiences, and/or affected their perspective about living with MBC and their overview about the future. Also, further information about the important others associated with patients, such as caregivers, family members, as well clinician and, medical professionals during illness trajectory, is required to organize the interventions tailored to their actual needs or aimed to prevent later difficulties . Finally, more research is needed to understand the heterogeneity of individual trajectories within these major patterns of variation .