Specialist breast care nurses for supportive care of women with breast cancer

 

Abstract

Background

Breast Care Nurses (BCNs) are now established internationally, predominantly in well resourced healthcare systems. The role of BCNs has expanded to reflect the diversity of the population in which they work, and the improvements in survival of women with breast cancer. Interventions by BCNs aim to support women and help them cope with the impact of the disease on their quality of life.

Objectives

To assess the effectiveness of individual interventions carried out by BCN's on quality of life outcomes for women with breast cancer.

Search methods

We searched the Cochrane Breast Cancer Group Specialised Register and the Cochrane Central Register of Controlled Trials (15 January 2007). We also searched MEDLINE (1966 to September 2006), CINAHL (1982 to September 2006), EMBASE (1980 to September 2006), British Nursing Index (1984 to September 2006), CancerLit (1961 to September 2006), PsycInfo (1967 to September 2006), Library and Info Science Abstracts (LISA) (1969 to September 2006), Dissertation Abstracts International (only available 2005 to September 2006). We contacted authors as appropriate.

Selection criteria

Randomised controlled trials assessing the effects of interventions carried out by BCN's on quality of life outcomes, for women with breast cancer.

Data collection and analysis

Two authors independently assessed relevant studies for inclusion and undertook data extraction and quality assessment of included studies.

Main results

We included five studies, categorised into three groups. Three studies assessing psychosocial nursing interventions around diagnosis and early treatment found that the BCN could affect some components of quality of life, such as anxiety and early recognition of depressive symptoms. However, their impact on social and functional aspects of the disease trajectory was inconclusive. Supportive care interventions during radiotherapy was assessed by one study which showed that specific BCN interventions can alleviate perceived distress during radiotherapy treatment, but did not improve coping skills, mood or overall quality of life. One study assessed nurse-led follow-up interventions in which no statistically significant difference was identified for main demographic variables, satisfaction with care, access to medical care or anxiety and depression.

Authors' conclusions

There is limited evidence at this time to support the contention that interventions by BCNs assist in the short-term with the recognition and management of psychological distress for women with breast cancer. Further research is required before the impact of BCNs on aspects of quality of life for women with breast cancer can be known.

 

Plain language summary

Specialist breast care nurses for supportive care of women with breast cancer

Breast cancer is a complex disease which has seen survival for women improve over the last 20 years. Many of these improvements are linked to treatment advances, improved screening and a multiprofessional approach to its management. Breast Care Nurses (BCNs) work within this multiprofessional environment providing a range of interventions including support, information, patient advocacy and general liaison among the various members of the healthcare team. The objective of this review was to assess the effectiveness of individual interventions carried out by BCNs on quality of life outcomes for women with a diagnosis of breast cancer. We reviewed five studies which met the criteria for this systematic review. These involved a range of interventions and outcome measurements, and included women of various ages and in various stages of breast cancer assessment and treatment. These studies also used many different methods of reporting statistical findings and for this reason, the results of the studies could not be combined. Despite limited evidence to support their BCN role, one study which looked at follow up by the BCN compared to a doctor concluded that there were no differences for either group in terms of satisfaction with care or the ability of the healthcare provider to identify anxiety and depression. Another study showed that specific BCN interventions can alleviate perceived distress for women undergoing radiotherapy treatment however this did not have any impact on coping skills, mood or overall quality of life.

Generally speaking, this review found limited evidence to identify the components of the BCNs role which impact on a woman's quality of life but acknowledge that the nature of their work, provided within a multiprofessional team, serves to complement the team as a whole rather than highlighting the impact of the BCN alone. Further research is, however, needed which addresses the impact that BCNs may have on aspects of quality of life for women with breast cancer.

 

摘要

背景

乳房護理師對乳癌女性患者的支持療法

目前在國際上，乳房護理師 (BCNs)主要建立在具有良好資源的健康照護體系之下。這個角色反映了工作對象的多樣性及乳癌女性患者存活率的改善。BCNs的介入目的在支持這些女性並幫助她們面對疾病造成生活品質的影響。

目標

評估乳房護理師對乳癌女性患者個別的效果

搜尋策略

我們搜尋了Cochrane Breast Cancer Group Specialised Register及Controlled Trials (15 January 2007)，也搜尋了MEDLINE (1966 to September 2006)、CINAHL (1982 to September 2006)、EMBASE (1980 to September 2006)、British Nursing Index (1984 to September 2006)、CancerLit (1961 to September 2006)、PsycInfo (1967 to September 2006)、Library and Info Science Abstracts (LISA) (1969 to Septembe 006)、Dissertation Abstracts International (only available 2005 to September 2006 我們已與作者做適當的聯繫

選擇標準

以隨機對照試驗來評估，當乳房護理師的介入後，對罹患乳癌女性生活品質的影響。

資料收集與分析

由兩位作者分別獨立評估各層面相關的研究以及處理資料擷取和品質的評估。

主要結論

我們整合五個研究，分為三部份討論。三個研究，評估診斷與早期治療期間 的心理照護介入生活品質，比如：焦慮和早期認知憂鬱症狀。不過，他們對病程中的社會性和功能性層面則沒有影響。一個研究則在評估放射治療中的支持性照護，發現乳房護理師可以減輕放射治療的痛苦，但沒有改善適應能力，情緒或整體生活品質。一個研究顯示出經由護理師的照護而得到的改善，在主要人口變數、護理滿意度、醫療保健、焦慮和憂鬱症狀，無顯著性統計差異。

作者結論

現階段來說，並無足夠的證據來證實BCNs的介入能改善罹患乳癌女性身心方面憂慮的症狀。BCNs對於罹患乳癌女性其生活品質的影響需要進一步的研究才能了解。

翻譯人

本摘要由中山醫學大學附設醫院蔡敏鈴翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

乳癌是一種複雜的疾病。在過去20年，乳癌婦女的生存率已經顯著改善，像是治療方式的進步、篩選的改良，以及複合式相關專業管理。乳房護理師在這種複合式專業管理的環境提供一系列的措施，包括支持、提供資訊、耐心的宣導以及在醫療團隊中各種成員的連繫。 回顧五個研究的目的在於評估個人化專業乳房護理師對患有乳癌女性其生活品質改善的效果。這五項研究包括了不同年齡和不同階段乳癌女性的診斷和治療。這些研究用了不同的統計方法，因此其結果無法有效的連結在一起。雖然缺乏證據去支持乳房護理師的角色，但是其中一個研究，顯示乳癌女性對於乳房護理師或醫師所提供的照顧滿意度或是辨識患者焦慮和憂鬱症狀的能力並無差異。而另一個研究，顯示專業的乳房護理師介入可以減緩接受放射治療婦女可被偵測到的痛苦。然而，在適應能力、情緒或者是整體生活品質，並未有任何影響。 一般來說，極微少的證據顯示乳房護理師對婦女的生活品質有所影響，相較於乳房護理師對乳癌女性的影響，由多方面專業人員團隊所提供的照護工作是被認可的。截至目前為止，仍需更多研究來證實乳房護理師對乳癌女性的生活品質有一定的影響力。