Although improvements have been made in outcomes for women with early-stage breast cancer, as many as one third of women will develop and, subsequently, die from metastatic breast cancer. Although the prognosis for metastatic breast cancer generally is poor, median survival time from diagnosis of secondary disease is about three years; therefore, survival is highly variable (Johnston, 2010). Some women have rapidly progressive disease, whereas others can live with metastatic disease for as many as 10-15 years (Johnston & Swanton, 2006). A diagnosis of metastatic breast cancer has a profound emotional impact (Beacham, Hill, McDermott, O'Brien, & Turner, 2005), with the majority of women considering the recurrence more distressing than the original diagnosis (Warren, 2010). Some of these women experience clinically significant levels of distress (Caplette-Gingras & Savard, 2008; Turner, Kelly, Swanson, Allison, & Wetzig, 2005).
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