Care and Support for Women with Breast Cancer

Transcription

1 Care and Support for Women with Breast Cancer The Professional s s Perspective Agnes Glaus, RN, PhD

2 Swiss Rhaetian Railway: UNESCO world heritage

3 The Breast Cancer Journey In Need of Supportive Care Pillars

4 Supportive Care Pillars in Breast Cancer Care Dealing with a global disease Prevention, early detection: keys to the future Emotional concerns and physical limitations Cultural meaning of breast and cancer Competent care in breast centres Physical and psychological recovery: survivorship issues

5 Breast Cancer: a Global Disease

6 A Global Change in Life Style Change in reproductive patterns: delayed childbearing, fewer pregnancies, less breastfeeding Western life style, nutrition, overweight, less physical activity, hormone-replacement replacement Environmental factors The best medicine: health promotion and education

7 Prevention and Early Detection: Keys to the Future Increase of breast cancer worldwide requires more resources Increase of aging population leads to more older women with breast cancer Less resources available for expensive treatment, cost explosion Early detection: most promising and cheapest to prevent suffering, reduce costs

8 Identifying Risk: Familial, Genetic and Sporadic Breast Cancer

9 Quality-Assured Mammography- Screening for Women at Average Risk Available in most western countries For women at average risk (no family history of breast cancer) For women between years of age, every 2 years Digital technique offers easy quality assurance, shows breast density

10 Individual Surveillance in high risk women (>( > 20% LifeTimeRisk) Start 10 y. before age of 1.degree relative at diagnoses, or at age 25 Annual mammography and MRI if LT Risk > 15-20% as an adjunct Clinical breast examination 6 monthly Ultrasound, endovaginal 6 monthly to observe ovaries, CA 125

11 Chemoprevention for Healthy Women at High Risk for Breast Cancer ready to go? Chemoprevention with anti-estrogens: the most effective way to reduce breast cancer (appr.. 40%) in healthy women Only very few women have preventative treatment worldwide Concept difficult to implement as associated with chemotherapy and cancer, treatment side effects Preventive therapy a more attractive name

12 Breast Cancer - a Sudden Attack on Life, Femininity and Sexuality The Breast: sensitive, meaningful, vulnerable Symbol of motherhood (mamma), nurturing, comforting, synonym for the heart Symbol of sexuality, attractiveness, love Marketing object, over-emphasised emphasised Feeling as a whole person again, despite physical injuries: a painful process

13 Impact of Treatment after Surgery: Becoming a Patient In need of information, communication Fatigue exhaustion Emotional distress, feeling depressed Social impact, relations, return to work Chemo- and radiotherapy-related related side effects, especially hairloss,, nausea/emesis; MASCC: Menopausal symptoms, sexual problems, negative body image

14 Side-effects effects of Anti-Hormonal Treatment Hot flashes Fatigue Vaginal Dryness Weight Gain Decreased Libido Glaus A et al. Ann Oncol 17: ,2006

15 Adjusting to Breast Cancer Diagnosis and Treatment Chinese women s s experience of adjusting: Facing the reality of cancer diagnosis Taking an active part in treatment Sustaining an optimistic spirit and physically Lessening the impact of cancer on others Reflecting, moving on Trying to make the best of it (Fu MR et al. 2008)

16 Treatment in Multidisciplinary Breast Centres: better outcome possible Professionals with specific experience (e.g. at least 50 operations per year) Scientifically based treatment and care, discussed by interdisciplinary team Individually targeted treatment, according to personal tumour patterns: minimal invasive, less chemotherapy P4P Programme Taiwan Guidelines for screening and diagnosis

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18 Competent Care Provided by Breast Care Nursing Experts Communication, rapport and awareness of womens needs, availability, reassurance and practical information (Halkett 2006) Core curriculum for breast care nursing developed by the European Oncology Nursing Society (2010)

19 Survivorship Care The Term Survivor Survivor (Khan NF et al. 2011) Term first used for advocacy reasons and to promote research and care Reasons for acceptance by patients: Having had cancer and survived Positive connotation of beating cancer Operational descriptions recommended For patients past a cancer diagnoses (ONS)

20 The Term Survivor (Khan NF et al. 2011) Reasons for rejection by patients Implies high risk of death that did not reflect their experience Survival depending on personal characteristics Cured despite possibility of recurrence A label not describing their identity Implying an advocacy role not wanted

21 Survivorship Care: what is it? Life with cancer and it s s treatment Life after cancer Follow-up Care Living with and beyond cancer; physical and psychological rehabilitation, weight control, nutrition, smoking cessation, late treatment effects, reproductive issues or

22 Women conquering Breithorn, Switzerland, 4100 m