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This is an exciting and challenging time in which to care for women at risk for, with a diagnosis of, or a history of breast cancer. Scientific advances in cancer genetics and immunology have resulted in dramatic increases in the number and complexity of treatment options available to these women, and these treatment options have led to significant improvements in survival rates and length of survival. Advances in the state of multidisciplinary science, including nursing research, have informed the management of critical aspects of patient care along the illness continuum. The authors of the articles in this In Focus series highlight three of these areas: genetic predisposition to breast cancer, pregnancy and fertility concerns of breast cancer survivors, and late/long-term effects from breast cancer therapies and disease surveillance.

The breast cancer trajectory begins before and continues long after the patient is seen by an oncologist. Indeed, women diagnosed with breast cancer usually receive the majority of their care from primary health care providers or women's health clinicians, many who may not be aware of the latest oncologic advances. Conversely, many of the needs of patients with breast cancer during and after cancer directed therapy typically are not adequately met by the oncologist and require the expert knowledge and skills of a women's health care provider. Consequently, the purpose of this In Focus series is to address two major challenges associated with these advances: to disseminate contemporary knowledge about breast cancer to women's health care clinicians and to explore opportunities for multidisciplinary collaboration between women's health providers and oncology clinicians.

In the first article in this series, Powers and Stopfer present an overview of various heritable genetic syndromes that are associated with a markedly increased risk for developing breast cancer. This is a highly specialized, nuanced, and evolving area of practice that has become more complicated with the emergence of next-generation DNA sequencing technologies. The accurate identification and appropriate management of individuals with heritable cancer risk can provide these individuals and their families with potentially life-saving information and interventions. Nononcology providers, including women's health clinicians, commonly initiate this process. The authors provide assessment strategies for identifying at-risk individuals, guidance in counseling individuals who are affected and unaffected, including referral to a qualified cancer genetic program, and information regarding potential risk reduction strategies.

A frequent misconception is that breast cancer is only a disease of older women, when in fact a significant percentage of patients are younger with childbearing potential. With advances in cancer-directed therapies, many if not most of these women will survive cancer. Unfortunately, as noted by Menses and Holland, cancer therapies can result in permanent changes in gonadal function and limit the reproductive abilities of these patients. Despite advances in assisted reproductive technology (ART) and the availability of relevant national guidelines, fertility preservation options are grossly underutilized in this population. Menses and Holland emphasize the importance of initiating ART before starting cancer-directed therapies when desired and medically feasible. They also review contraceptive methods to use while patients are actively receiving cancer therapies and following treatment. The concerns and needs of patients with breast cancer who are able to conceive after completing cancer treatment are also discussed.

Breast cancer–directed therapies can cause a wide range of late- and long-term changes in physical and psychosocial functioning that negatively affect quality of life. The assessment and management of these late effects are commonly unaddressed. Primary care providers, including women's health clinicians, have the most long-term contact with survivors and face several barriers to providing the requisite care. Kenyon, Mayer, and Owens provide a comprehensive review of the most significant late- and long-term effects of breast cancer therapies, their impact on other medical problems, management strategies, and signs of disease recurrence. They discuss the use of tools such as survivorship care plans to facilitate collaboration and communication between the oncologist, primary care provider, and patient regarding follow-up care.

The commitment of nurses to patient advocacy, education, and health promotion make them integral members of any multidisciplinary team that cares for patients with breast cancer. The articles in this series will expand the knowledge of women's health nurses and other clinicians regarding the unique and nuanced needs of the nation's millions of individuals who have or are at risk for breast cancer. This knowledge will equip nurses to provide high-quality, evidence-based care across the care continuum and to lead the development of effective multidisciplinary teams that will optimize quality of care for this growing population of individuals and their families.

Biographies

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  2. Biographies
  • Genevieve Hollis, MRN, CRNP, ANP-BC, AOCN, is the lead nurse practitioner in the Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, and an advanced senior lecturer at the University of Pennsylvania, School of Nursing, Philadelphia, PA.

  • Carrie Tompkins Stricker, PhD, RN, AOCN, is an oncology nurse practitioner in the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, and the Chief Clinical Officer and cofounder of On Q Health, Inc., Miami, FL.