Training breast care nurses throughout Europe: the EONS postbasic curriculum for breast cancer nursing

BackgroundThe European Parliamentary Group on Breast Cancer and the European Society of Breast Cancer Specialists state that there is a need for EU agreed guidelines on breast care nursing and training. Therefore the European Oncology Nursing Society (EONS) commissioned the development of a post-basic curriculum for breast cancer nursing.PurposeThe goal was to define a European curriculum for the training of breast care nurses.MethodsThe curriculum was developed using a variety of sources, including guidelines from a number of European and other countries world wide, relevant literature and input from an expert panel of senior European nurses with expertise in breast care nursing.ResultsAn English language, European curriculum of breast care nursing was developed at a postbasic level to provide guidance for the training of breast care nurses throughout Europe. Definitions for breast care nurse roles and activities and levels of practice, as well as indicative content are provided.ConclusionsThe training of nurses in breast cancer care should be mandatory and common practice for European countries. To enhance comparability and standard development, the indicative content should be applied in all future post-basic education.     

The use of hospital beds for terminally ill cancer patients

A study to identify reasons for admitting terminally ill cancer patients to hospital is reported together with recommendations for the future. Forty per cent of patients were so seriously ill with pain, medical or nursing problems that their carers could not manage satisfactorily at home and hospitalisation was necessary and appropriate. In addition 27% of patients admitted had no family or carers to nurse them at home. In the remaining 33% of patients it may have been possible with planned admissions and better supportive communications to allow some patients to die at home. Analysis of the data would suggest that there are three principal reasons for continuing to provide hospital beds for the terminally ill cancer patient: 1. Special medical and nursing care. 2. To provide care for some patients with no family or friend carer support. 3. Teaching of management by senior staff. The unsatisfactory nature of terminally ill patients dying in the centre of acute wards together with inadequate facilities to interview relatives is noted. It is suggested that the provision of well planned hospital beds is more appropriate than providing remote hospice beds for the terminally ill cancer patient.     

Breast biopsy support program: collaboration between the oncology clinical nurse specialist and the ambulatory surgery nurse.

Nurses play a vital role in the care of women admitted to an ambulatory unit for a breast biopsy. This paper offers one aspect of a psychosocial model that the oncology clinical nurse specialist and the ambulatory surgery nurse can use collaboratively to meet each woman's needs during this critical period. Goal-directed communications are the focus of this paper. Five specific techniques are described and can be used before biopsy reports are known, after women are informed that results are either negative or pending, and after reports are confirmed as positive. Psychosocial support is recognized as an important aspect of nursing care provided to women diagnosed with breast cancer. Although only 10% of women undergoing breast biopsies are diagnosed with malignant lesions, nurses must provide optimal support and guidance to every woman admitted for this surgical procedure.     

Variations in treatment and survival in breast cancer

To achieve optimum quality of care for women with breast cancer in the UK, uniformity of care in accordance with consensus guidelines is needed. This review highlights variations in provision of care for women with breast cancer, with particular emphasis on care received in the UK, examines differences in survival, and discusses the factors that may underlie these differences. Strong variation in treatment was identified, which appeared to affect survival significantly. These findings reinforce the need for women with breast cancer to be treated by dedicated specialists working within a multidisciplinary team to provide a high standard of care.     

Multidisciplinary Approach to Breast Cancer： A New Outlook on Nursing Care

The treatment and general care for women diagnosed with breast cancer has made a tremendous change and advance in the last decades. Better methods for early detection and screening of the disease, higher compliance of women to go for screening, an open social and political discourse of women and the health care team and others, are just a few that both enabled and are a result of this change. Nurses have been highly involved in these changes, which resulted in the specialization of nursing in the field of breast cancer. This article will focus on the main four points that influence the nursing specialist care, that is, the tailoring of treatment and the ability to offer women treatment which is more specific to their own cancer; the importance of the multidisciplinary team as providing a State of the Art care; the involvement of women in the decision-making regarding their treatment and the specific developing role of the specialist breast care nurse.     

Cost of managing women presenting with stage IV breast cancer in the United Kingdom

This study estimated lifetime cost of treatment for patients in the United Kingdom (UK) presenting with stage IV breast cancer. To determine patterns of treatment and resource use in the absence of direct observational data, a cancer physician panel was surveyed. The survey questionnaire described four predefined treatment phases: active treatment; follow-up after active treatment until disease progression; active supportive care after progression; and end-of-life care. Physicians were asked their major treatment strategies for each phase. Monthly cost and average lifetime cost per patient were calculated. Only five cancer registries in the UK document the proportion of breast cancer patients diagnosed with stage IV disease. Their data was used to estimate the incidence of metastatic breast cancer at presentation throughout the UK. This value, together with lifetime cost per patient and projected survival time, allowed approximation of the overall cost for this population of cancer patients in the UK. Annual incidence of stage IV breast cancer at presentation in the UK is approximately 2100; according to treatment practice in 2002, lifetime cost per patient is pound 12 500 and total population cost is approximately pound 26 million. The substantial economic burden associated with patients diagnosed with metastatic breast cancer should be considered when developing strategies for reducing its incidence such as increased awareness, screening and preventative measures.     

Information provision for patients by breast cancer teams about the side-effects of hormone treatments

The choice of adjuvant hormone treatments in post-menopausal women with breast cancer increasingly includes anastrozole as an alternative to tamoxifen. Clearly there may be overlapping side-effects, but other important differences may have serious implications for health and quality of life. Patients consequently require information regarding the side-effects of recommended treatments and their comparisons. This study evaluates the extent of information provision about the side-effects of adjuvant anastrozole and tamoxifen by respective breast cancer professionals within 16 different breast care teams in the United Kingdom (UK). The study used interviews with individual members of breast cancer multidisciplinary teams (surgeons, oncologists and breast care nurses) from 11 cancer centres and 3 district general hospitals, to examine the information they give to patients relating to the side-effects of tamoxifen and anastrozole. The results show that vasomotor symptoms were the most frequently mentioned side-effect for both treatments. All teams, in large part addressed the adverse effects of both treatments (endometrial cancer and thrombo-embolic events for tamoxifen and anastrozole-associated loss of bone density). There was variation between the different professionals as to how frequently side-effects were mentioned. The greatest discrepancies occurred between the information given by team members and that included in patient information leaflets. In some cases, important information pertaining to side-effects was omitted from leaflets. This study suggests the need to standardise information-provision nationally in the UK and within breast cancer teams regarding the evidence-based side-effects of tamoxifen and anastrozole.     

Breast und Cancer Care Nurse

Recent changes in the health care provision for women with breast and gynaecological cancer have induced changes in nursing. Well-established in the Anglo-Saxon and Scandinavian countries, breast and cancer care nurses are currently taking roots in the German-speaking parts of Europe. This article describes the specific concept and practice of Breast and Cancer Care Nurses, Inselspital (BCNI), at the University Hospital in Berne. In particular, an integrated process plan illustrates the integration of the BCNI function in a multidisciplinary team. The article discusses potential responsibilities of specialised nurses. To provide an insight into the services offered by the BCNI some details of specific counselling concepts are outlined. Finally, the article discusses preliminary results of a satisfaction survey.     

Oncology Nurses' Obstacles and Supportive Behaviors in End-of-Life Care: Providing Vital Family Care

Purpose/Objectives: To determine the impact of obstacles and supportive behaviors in end-of-life (EOL) care as perceived by hospital-based oncology nurses.Design: A 69-item mailed survey.Setting: National random sample.Sample: 1,005 nurse members of the Oncology Nursing Society who had provided EOL care for patients with cancer.Methods: Three mailings yielded 380 usable responses from 912 eligible respondents, resulting in a 42% return rate.Main Research Variables: Size and frequency of EOL care obstacles and supportive behaviors for patients with cancer in a hospital setting.Findings: Results of this research demonstrate the need for more EOL education and help in forming teams of nurses, social and palliative care workers, and physicians to support high-quality care. Another finding was the need for other nurses at a facility to give the nurse caring for the dying patient more time to support the patient and family.Conclusions: Dealing with the family is vital in providing optimal EOL care to patients dying from cancer. By carefully listening to the experience, concerns, and recommendations of hospital-based oncology nurses, compassionate EOL care can be provided to these patients and their families.Implications for Nursing: Oncology nurses are dedicated to providing the best EOL care to their patients and patients' families. This study helped to identify research-based obstacles and supportive behaviors regarding the provision of high-quality EOL care.     

Do Saudi Nurses in Primary Health Care Centres have Breast Cancer Knowledge to Promote Breast Cancer Awareness?

Background: Breast cancer is one of the leading causes of death among cancer patients in Saudi Arabia. It isknown that nurses play a key role in promoting breast cancer awareness among women in any society. Nursesin primary health care centres (PHCC) have more direct contact with general population. This study aimed toinvestigate nurse knowledge of breast cancer and practice of early screening in PHCC in Jeddah city. Methods:A cross-sectional study was conducted using a self-administered questionnaire to assess the general knowledge ofbreast cancer, risk factors, and practice of 210 PHCC nurses. Data were analysed using SPSS v.16. Results: Themean age of the PHCC Nurses was 36.9 (SD ±8.6). Only 11% percent scored <50% of the total score for generalepidemiological knowledge on breast cancer, about 35% scored <50% of the total score for breast cancer riskfactors. Sixty seven percent scored >75% of the total score on breast cancer signs. Majority of nurses 62.8%practiced BSE, but only 4% practiced regularly every month. Some 28% practiced once per year. About 81%of the nurses had not had a clinical breast examination and only 14% had had a mammography. The results ofthe study failed to show any correlation between the knowledge scores with age, education, year of experience,family history of BC and marital status of the nurses. Conclusion:The results from the study reflect that thereis a need to provide continuing nursing education programmes for PHCC nurses to improve their breast cancerknowledge and practice.     

Multidisciplinary Approach to Breast Cancer: A New Outlook on Nursing Care

The treatment and general care for women diagnosed with breast cancer has made a tremendous change and advance in the last decades. Better methods for early detection and screening of the disease, higher compliance of women to go for screening, an open social and political discourse of women and the health care team and others, are just a few that both enabled and are a result of this change. Nurses have been highly involved in these changes, which resulted in the specialization of nursing in the field of breast cancer. This article will focus on the main four points that influence the nursing specialist care, that is, the tailoring of treatment and the ability to offer women treatment which is more specific to their own cancer; the importance of the multidisciplinary team as providing a State of the Art care; the involvement of women in the decision-making regarding their treatment and the specific developing role of the specialist breast care nurse.     

Lapatinib and breast cancer: current indications and outlook for the future

Lapatinib is an oral dual erbB 1/2 tyrosine kinase inhibitor that inhibits human EGF receptor 2 (HER2) and blocks the EGF receptor. Studies have shown that in patients with metastatic HER2-positive breast cancer that is resistant to trastuzumab, the addition of lapatinib to capecitabine improves progression-free survival and appears to lengthen overall survival. Furthermore, lapatinib has been studied in patients with involvement of the CNS and has been associated with stable disease and some responses. Its combination with letrozole provided an improvement in progression-free survival compared with single-agent letrozole in women with hormone receptor-positive, HER2-positive metastatic breast cancer. More recently, data suggested that the combination of lapatinib with trastuzumab significantly improves overall survival in women with metastatic breast cancer compared with single-agent lapatinib. Current indications in the USA for the use of lapatinib are for the treatment of metastatic HER2-positive breast cancer, both in combination with capecitabine in patients who have received taxane, anthracycline and traztuzumab, and in combination with letrozole for postmenopausal patients with hormone receptor- and HER2-overexpressing breast cancer. Common side effects of lapatinib include diarrhea and rash. Studies to date have found a less than 2% risk for cardiotoxicity, although most cardiac events that occurred during the studies were not attributed to lapatinib. It is important to consider that most of the patients in existing studies had already been treated with trastuzumab with no significant cardiotoxicity; therefore, future studies will show how trastuzumab-naive patients tolerate lapatinib. Ongoing research is evaluating the role of lapatinib in the adjuvant setting as a single agent or in combination with trastuzumab.     

‘Being there' for women with metastatic breast cancer: a pan-European patient survey

Background:

Understanding their experiences of diagnosis is integral to improving the quality of care for women living with advanced/metastatic breast cancer.

Methods:

A survey, initiated in March 2011, was conducted in two stages. First, the views of 47 breast cancer-related patient groups in eight European countries were sought on standards of breast cancer care and unmet needs of patients. Findings were used to develop a patient-centric survey to capture personal experiences of advanced breast cancer to determine insights into the ‘trade-off'' between extending overall survival and side effects associated with its treatment. The second online survey was open to women with locally advanced or metastatic breast cancer, or their carers, and responders were recruited through local patient groups. Data were collected via anonymous local language questionnaires.

Results:

The online stage II survey received a total of 230 responses from 17 European countries: 94% of respondents had locally advanced or metastatic breast cancer and 6% were adult carers. Although the overall experience of care was generally good/excellent (77%), gaps were still perceived in terms of treatment choice and information provision. Treatment choice for patients was felt to be lacking by 32% of responders. In addition, 68% of those who responded would have liked more information about future medical treatments and research, with 57% wishing to receive this information from their oncologist. Two-thirds (66%) of women with advanced breast cancer, or their carers, believed life-extending treatment to be important so that they can spend more time with family and friends, and 67% said that the treatment was worthwhile, despite potential associated side effects.

Conclusion:

These findings show a continuing need to provide women with advanced breast cancer with better information and emphasise the importance that these patients often place on prolonging survival.     

Ways to make cooperation between hospital nurse and home visiting nurse in treating a final stage cancer patient at home

Due to a payment system based on Comprehensive Medical Evaluation has been adopted, both a shorter hospitalization and the use of home nursing care have been increasing. A good cooperation between hospital and home visiting nurses is desired in order to transfer continued nursing. Regarding a home nursing care service for the most terminal cancer patients, we conducted a survey of 459 home visiting nurses with twelve questions in five categories: (1) Before transferring to home care, (2) Right after the transfer to home care, (3) Patient in a stable period, (4) Time of near death and (5) Other (Requests to hospital nurses). The following issues became clearer in terms of how hospital and home visiting nurses should be cooperating with the handling of last stage terminal cancer patients: (1) A home visiting nurse should have a coordinating role with a hospital nurse when the patient is discharged from the hospital. (2) A participation of home visiting nurses on the coordination guidance at the time of a patient discharge is influenced by a manpower of the nursing station. (3) Even though home visiting nurses found a discrepancy between the hospital information and what patients and their families were getting from the hospital, home visiting nurses have learned through the job to clarify what patient and family needs were, and they responded accordingly. (4) A coordination between hospital and home visiting nurses was needed quite often when the patient's time has come to die at home.     

Survivorship care after breast cancer: Follow‐up practices of Australian health professionals and attitudes to a survivorship care plan

Objective: The increasing number of breast cancer survivors and the complexity of follow‐up care make the provision of high‐quality survivorship care a challenge. This study explored the follow‐up practices of health professionals and their attitudes to alternative models such as shared care and the use of a survivorship care plan. Methods: Specialist oncologists (surgeons, medical and radiation oncologists) breast physicians and breast‐care nurses completed an online survey. Results: A total of 217 practitioners completed the survey, which was estimated to include 42.8% of oncologists treating breast cancer in Australia. One‐third of responding specialists reported spending more than 25% of their clinical time providing follow‐up care. They reported many positive aspects to follow‐up consultations and viewed follow‐up care as an important part of their clinical role but expressed concern about the sustainability of follow‐up care in their practices. The follow‐up intervals and recommendations were in line with national guidelines. The specialists were supportive of sharing follow‐up care with primary‐care physicians, breast physicians and breast‐care nurses. Most professionals felt that a survivorship care plan would improve care and said they would use a proforma. Conclusion: The oncologists felt that follow‐up care was an important part of their role and they were supportive of the concepts of shared care programs and a survivorship care plan. Input from consumers is required to evaluate the acceptability of these alternative models and to assess ways of implementing these changes to work towards a more comprehensive and sustainable method of delivering survivorship care.     

Fertility preservation in women undergoing treatment for breast cancer in the UK: a questionnaire study

Objective.

Fertility preservation is an important survivorship issue for women treated for breast cancer. The aim of this work was to examine the referral practices of health care professionals who treat women with breast cancer in the United Kingdom, and to investigate their understanding and knowledge of the fertility preservation options available.

Method.

An invitation to participate in a confidential, online questionnaire was e-mailed to surgeons, oncologists, and clinical nurse specialists who manage patients with breast cancer in the United Kingdom.

Results.

n = 306 respondents. Factors which influenced whether fertility preservation options were discussed with a patient included the following: patient''s age (78%), final tumor/nodes/metastasis status (37.9%); concern that fertility preservation would delay chemotherapy (37.3%); whether the patient had children (33.5%) or a partner (24.7%); estrogen receptor expression (22.6%), lack of knowledge regarding the available options (20.9%); and concern that fertility preservation would compromise the success of cancer treatment (19.8%). Twenty-seven percent did not know whether fertility preservation was available for their patients on the National Health Service. Nearly half (49.4%) of respondents said that gonadotropin-releasing hormone agonists were used for fertility preservation outside the setting of a clinical trial. Knowledge regarding the available options varied according to different members of the multidisciplinary team, with consultant oncologists better informed than consultant surgeons or clinical nurse specialists (p < .05).

Conclusions.

Many health care professionals have incomplete knowledge regarding the local arrangements for fertility preservation for patients with breast cancer. This may result in patients receiving inadequate or conflicting information regarding fertility preservation.     

HER2 overexpressing metastatic breast cancer

Opinion statement More than 40,000 women in the United States die each year from metastatic breast cancer. Elucidation of HER2 and its role in malignant transformation has helped define a subset of aggressive breast cancer that may be relatively resistant to non-anthracycline-based therapies and hormonal agents, but responds to targeted molecular therapy. Trastuzumab, an antibody against HER2, has proven effective as single agent therapy in women with HER2 overexpressed metastatic breast cancer. Moreover, in combination with chemotherapy, trastuzumab has been shown to delay disease progression and improve overall survival for women with HER2-positive advanced breast cancer. The combination of chemotherapy and trastuzumab is emerging as a standard of care in women with HER2 overexpressed metastatic breast cancer. Several combination regimens using trastuzumab with taxanes, vinca alkaloids, or platinum compounds have demonstrated efficacy in first- and second-line treatment settings. However, the development of anthracycline-based combinations has been limited by concerns of related cardiotoxicity. Newer multi-agent regimens are in development. The optimal combination, duration, and sequence of trastuzumab therapy remain unknown in patients with HER2-positive metastatic disease. The role of continuing treatment after disease progression is also unclear. Evidence from some retrospective analyses suggest HER2-positive tumors are relatively resistant to tamoxifen and perhaps more responsive to aromatase inhibitors, although such data are inconclusive. HER2 status should not be used routinely for clinical decision making regarding hormonal therapy options. Several ongoing trials are attempting to address these and other issues related to HER2 testing to select the most appropriate candidates for these emerging therapies. While many questions remain, the treatment of HER2 overexpressing metastatic breast cancer is rapidly evolving, and represents a new approach to treatment in oncology.     

Supportive care of rural women with breast cancer in Tasmania, Australia: changing needs over time

Providing for patients' psychosocial needs is a potential means of minimising cancer morbidity. Needs assessments can guide responsive patient-centred care. A longitudinal survey of women with early breast cancer consulting a breast nurse in a primarily rural state of Australia was undertaken to measure unmet supportive care needs, identify changes in unmet needs across time and compare results with previous studies. Needs assessments were completed with the Supportive Care Needs Survey (SCNS) at 1 month (n = 74) and 3 months (n = 83) post-diagnosis. Access to services was also examined. High levels of psychological and health system and information needs were identified at 1 month post-diagnosis, but these decreased significantly at 3 months post-diagnosis. Sexuality domain needs increased significantly during the same time. Compared to a previous SCNS study of rural women with breast cancer, unmet supportive care needs in this study were significantly lower than previously reported, although assistance with energy levels (i.e. fatigue) continues to be an unmet need for women with breast cancer. Results suggest there have been positive cultural changes within healthcare systems, specifically in better informing patients and providing support. Although services appear to be more responsive to breast cancer patients, significant unmet needs still exist.     

Hereditary breast cancer

An overview is provided of the genetics of hereditary breast cancer, as well as the clinical aspects and the management of this disease. In September 1994 a new breast cancer gene, BRCA 2 , was located and BRCA 1 , discovered in 1990, was sequenced (Miki et al, 1994; Wooster et al., 1994). The implications of these discoveries are immense. Tests are now available to women who have a family history of breast cancer that can determine if they carry one of these defective genes. The genetic nurse specialist can play a huge role in counselling women who wish to have predictive testing and in advising them about screening and risk.