Aim of the breast cancer case study
This case study aims to facilitate the development of competencies that reflect the role of the Specialist Cancer Nurse (SCN) in providing supportive care, information, and education to a person diagnosed with breast cancer at various points across the cancer journey.
This case study focuses on issues during and following active treatment, including specific issues associated with diagnosis and treatment of a contralateral second primary breast cancer.
For Australian women, breast cancer was the most commonly diagnosed cancer in 2011, and the second most common cause of cancer-related death.6 While breast cancer may occur in men, it is relatively rare and the focus of this case-based learning resource is on breast cancer in women.
Developments in early diagnosis, treatment and supportive care mean that 89.6% of women will be alive five years after diagnosis of breast cancer.6 However, treatments for breast cancer are complex, given over extended periods of time, and often result in short and longer term effects across a range of domains of health.
A supportive care approach involving multidisciplinary treatment planning and care is recommended to ensure optimal management of people affected by breast cancer during and after treatment.7
There are many points along the cancer journey when the SCN can improve outcomes for people at risk of or affected by breast cancer. This module focuses on support for people during and after treatment for a second primary breast cancer.
Section 1: Reduce risk
- Risk factors for breast cancer include older age, having a strong family history of the disease, being overweight and increased alcohol intake. There are also some factors that may have a protective effect against breast cancer, such as having children at a younger age and breastfeeding.8
- While there is little evidence to support prevention programs in reducing the risk of developing breast cancer, SCNs can play an important role in reducing engagement in behaviours that may increase a person's risk.9
Section 2: Find the condition early
- The benefits of early detection include increased survival, increased treatment options and improved quality of life.10
- Rates of participation in screening programs are lower for some groups, such as Indigenous women and women from non-English speaking backgrounds.11
- SCNs play a major role in promoting breast awareness, encouraging participation in screening programs, as well as in care and support for women participating in screening programs.
Section 3: Have the best treatment and support during active treatment
- The treatment of breast cancer generally involves multimodality therapy that may include surgery, radiotherapy and systemic therapy such as antineoplastic therapy, hormone therapy and targeted therapies.
- People undergoing treatment for breast cancer can experience a range of effects across all domains of health. SCNs act to prevent these effects, identify their occurrence early, and reduce their impact on the person's health and wellbeing.
- The array of treatment options provided over extended periods of time means that people affected by breast cancer face many challenges navigating the health care system. SCNs play an important role in providing information and support relevant to the individual's clinical, personal and social circumstances during this time.
Section 4: Have the best treatment and support between and after active treatment
- Supportive care and information provision is required to address short and longer term sequelae of treatment, including risks for:
- premature menopause
- impaired cardiac function
- bone density
- cognitive impairment
- psychosocial distress, anxiety and/ or depression.
- Women who have had breast cancer have a higher risk than the general population of developing another breast cancer.12 The SCN can assist people who have been treated for breast cancer to follow recommended guidelines for follow up including:13
- clarifying the goals of follow up
- understanding their individual risk of breast cancer recurrence
- assessing new symptoms in light of their risk of recurrence
- seeking appropriate follow up care in line with evidence based protocols.