Western Health, Australia
Title: Identifying physical and psycho-social issues facing breast cancer survivors after definitive treatment for early breast cancer: a nurse-led clinic model
Anastasia Dean completed her medical degree and post-graduate study at the University of Melbourne, Australia. She is currently working with Western Health in the Department of Surgery. Her research into breast cancer management is mentored by Prof Bruce Mann and Ms Meron Pitcher, respective heads of the Breast Surgery Unit at Royal Melbourne Hospital and Western Health.
Purpose: Breast cancer survivors are at risk of specific physical and psycho-social issues, such as arm swelling, fatigue and depression. Firstly, we investigate the symptoms reported by Australia breast cancer survivors upon completion of definitive treatment. Secondly, we evaluate the appropriateness and effectiveness of a multi-centre pilot program nurse-led clinic to identify these issues and make timely referrals to available services.
Methods: Patients post-definitive treatment (excluding ongoing hormonal therapy) for early breast cancer or ductal carcinoma in situ (DCIS) were invited to participate. An hour long appointment with a breast care nurse (BCN) was scheduled. In preparation, patients completed validated quality-of-life surveys (FACT-B, Menopause Rating Scale and Distress Thermometer). During the appointment, issues identified in the surveys were addressed and referrals to appropriate services arranged.
Results: 183 of 274 (67%) eligible patients attended a nurse-led clinic. Mean age 56.8 years (range 29-87 years), 181/183 women, 105/183 post-menopausal. 96 (55%) participants reported significant level of distress; 31 (18%) participants reported extreme distress or depression. Distress stemmed from a lack of energy (56/175); poor quality of sleep (50/176); inability to work or participate in household activities (35/172) and problems with sex life (28/89). 166 referrals were offered; 94% of patients accepted the referrals. 65% responded to a follow-up survey: the majority of women either strongly agreed or agreed that the BCN was overwhelmingly supportive, helpful in making referrals, and compassionate towards them. 39% reported making lifestyle changes as a result of the BCN.
Conclusion: Breast cancer survivors experience a unique set of challenges, including low mood, difficulty sleeping, problems with sex life and fear of disease recurrence. The nurse-led clinic model is an appropriate and effective method to ensure physical and psycho-social issues are identified and managed in a timely manner. This model also empowers breast cancer survivors with information about their diagnosis and available services.
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