EduCare Announces the Release of the Eighth Edition of Breast Cancer Treatment Handbook

EduCare is pleased to announce the release of the eighth edition of the Breast Cancer Treatment Handbook. First published in 1995, this easy-to-use book features the newest treatments, continuing research about survivorship, graphic illustrations and practical tips for helping the patient navigate the cancer journey.

With more than 295,000 copies in use, the Breast Cancer Treatment Handbook is a trusted patient navigation guide for up-to-date clinical information, clear explanations of tests and treatments and recommendation-free guidance. The new edition now offers additional material on emotional recovery, survivorship and healthful living. Eighteen tear-out worksheets help a patient prioritize and organize the questions she must ask her medical team in order to actively participate in her treatment. An expanded glossary, a drug reference section and an updated resource list further empower patients.

“Understanding the disease, treatments, emotions and recovery from breast cancer is just as important as the medical treatment a woman receives,” says Judy Kneece, R.N., OCN, President of EduCare. “We wrote this book for every woman diagnosed with breast cancer to inform and empower them with a complete road map for their journey from diagnosis to recovery.”

EduCare Inc., a dedicated breast health education company, was founded in January 1994 by Judy C. Kneece, RN, OCN. In the past 18 years, Judy has trained over 2,200 breast health navigators to guide patients through their cancer journey.

The eighth edition of Breast Cancer Treatment Handbook is available directly from EduCare. Orders may be made through the company website at www.EduCareInc.com or by phone at 843-760-6064.

Access to Oncofertility Options for Rural Cancer Patients

Cancer Navigators working in smaller rural cancer centers often face a challenge in arranging a timely fertility consult for a newly diagnosed cancer patient. Time constraints due to the need to begin cancer therapy, along with the distance required for the patient to travel for the consult, frequently cause patients to forgo the fertility preservation options discussion before treatment. Following cancer treatment, many patients want to investigate their fertility options.

Cancer Navigators not working in a facility with a fertility specialist, now have access to an online  Fertility Patient Navigator, providing the opportunity to better educate young patients about fertility options.  The new website, hosted by the Department of Obstetrics and Gynecology at Northwestern, has been designed to assist young patients in learning about their reproductive options in the midst of a cancer diagnosis or after treatment for cancer. The website, Patient Navigator for Fertility Preservation, provided by the Oncofertility Consortium of Northwestern University, has a Fertility Patient Navigator, Kristin Smith, available to answer questions about reproduction options surrounding a cancer diagnosis. She is experienced in talking to patients and providers about the best reproductive options for cancer survivors at all stages of treatment.

The web site has an interactive tool to provide information for patients before or after puberty, and before or after cancer treatment.  At his/her convenience, the patient can watch tutorial videos explaining how fertility is impacted by chemotherapy, radiation therapy or surgery.  Personal stories from others who have selected different types of fertility preservation are also available for viewing. This new website should be an excellent resource to help Cancer Navigators educate their patients about fertility options.

Have any of you working in rural areas dealt with this issue? How have you managed it?

Breast Health Navigator Challenge: Overseeing Patient’s Surgical Arm Range of Motion Restoration

One of the major roles of a Breast Health Navigator is to see that each post-operative patient, after undergoing a lumpectomy or mastectomy, has her physical range of motion restored to her surgical arm.  Most often, the patient is given written instructions and instructed to perform a set of recommended range of motion exercises at home until their physical range of motion is restored.  She is then expected to perform the recommended exercises at home under her own initiative.

Some women accept the challenge and perform the exercises as instructed, while some find it difficult to read the instructions and perform the exercises.  Having a coach, either a support partner or a healthcare professional, increases the likelihood the patient will be consistent and achieve full range of motion before they discontinue the program either from boredom or frustration.

Failure to perform the exercises and restore range of motion can result in future limited use of the arm.  This can cause difficulties with everyday tasks, such as zipping a back zipper or combing hair using the surgical arm. Occasionally, failure to exercise can result in a frozen shoulder which extremely limits normal movement and causes stiffness and pain.  Frozen shoulder occurs from scarring, thickening and shrinkage of the capsule that surrounds the normal shoulder joint.

Treatment of a frozen shoulder usually requires an aggressive combination of anti-inflammatory medication, cortisone injections into the shoulder and physical therapy. Without aggressive treatment, a frozen shoulder can be permanent. Physical therapy is often essential for recovery and can include ultrasound, electric stimulation, range of motion exercise maneuvers, stretching, ice packs and eventually strengthening exercises. Physical therapy can take weeks to months for full recovery, depending on the severity of the scarring of the tissues around the shoulder.

It is essential that patients are encouraged to comply with the stretching and range of motion exercises to avoid either limited movement or having a frozen shoulder.

Some large breast centers address the problem of compliance by referring patients to a Physical Therapist or to a post-surgical group exercise program for patients.  Patient compliance increases with increased encouragement from the personal interaction when attending a group or from the personal coaching provided by the Physical Therapist.  But what about the woman who has time and travel constraints and this is not a viable option?  For these women, achieving maximum rehabilitation can be a challenge.

A good solution is a new DVD, the Breast Cancer Survivor’s Guide to Physical Restoration, written and directed by a Dr. Suzanne Martin a Physical Therapist.  It is now available for breast cancer patients for at-home coaching. Dr. Martin’s video provides instruction for a complete physical rehabilitation program through a 30-minute daily workout program. The DVD includes nutritional guidelines along with a daily Pilates workout to increase core stability and strength. The video is designed for post-op rehab from breast cancer related surgeries including lumpectomy, mastectomy and reconstruction. Dr. Martin includes a self-test to measure surgical arm range of motion, a chest wall lymphatic massage demonstration and the foundation for restoring core strength and posture. The video is 108 minutes in length.  The cost is $19.95, making it affordable for most patients.

For Breast Health Navigators, this is an excellent answer to the challenge of surgical arm physical rehab and an excellent tool to recommend to patients. For women who cannot afford to purchase the video, it could be purchased by the facility and loaned out to patients during their arm rehab period after surgery and then returned to the facility. The DVD can be ordered here. Or, you may contact Balanced Body by phone at 1-800-745-2837.

Have any of you used this video yourself or with your patients. What are your thoughts on it?

 

Commission on Cancer Distress Assessment Recommendation Impact on Navigators

The Commission on Cancer (CoC) has recommended regular on-site psychosocial distress screening for all cancer patients outlined in Cancer Program Standards 2012: Ensuring Patient-Centered Care. The CoC emphasizes the importance of screening patients as a critical first step to providing high quality healthcare. According to Institute of Medicine, distress is any psychological, behavioral or social problems of a patient that interferes with their ability to participate fully in their health care and manage their illness and its consequences.

“Distress should be recognized, monitored, documented and treated promptly at all stages of disease,” recommends the CoC. The goal is to identify patients with distress or barriers to care and provide them with resources or referral to healthcare providers prepared to modify their identified problems.

The CoC recommendation is a huge advancement in keeping with up the great strides in medical treatment over the past decade. Now cancer patients can be ensured that their psychosocial needs will also be addressed.

Like any new mandate, the question arises, “Who will be responsible for implementing the standard?”  It seems fairly obvious that the responsibility will fall mainly to nurse navigators because of their continuous relationship with the patient across the continuum of cancer care. Other appropriate caregivers for patient assessment include oncology social worker, clinical psychologist or other mental health professional.

The Nurse Navigator’s role has traditionally included reducing patient barriers and relieving psychosocial stress through education. The major difference with the new recommendations for most Navigators will be that these assessments now have recommended criteria on time of administration, documentation of referral and follow-up.

Implementing Process Requirements:

A distress assessment should be made soon after a patient enters into care to remove any barriers that could prevent them from receiving adequate medical treatment for their disease.

Timing:

  • Recommended distress screening times are at major transitions in care: diagnosis, presurgical and postsurgical visits, first visit with medical oncologist, first visit with radiation oncologist, post chemotherapy or radiation therapy treatments, and any major transitions during and after treatment.
  • The results of the assessment should to be documented and referral to an on-site or outside care facility should be made to address problem.
  • A report on findings and referrals should be made to the cancer committee annually.

Method:

  • The assessment can be a written patient questionnaire or a clinician-administered questionnaire.

Distress Assessment Tool:

  • The distress assessment tool should be a standardized, validated instrument with established clinical cutoffs. Each facility can determine the cutoff score used to identify distressed patients.

Distress Referral:

  • Patients identified with distress (barriers) should be addressed with appropriate interventions by the Navigator or referred to resources either on-site or to community resources.

Documentation of Distress:

  • Screening, referral or provision of care and follow-up should be documented in the patient medical record to facilitate integrated high-quality care.

Facility Guidelines for Meeting Compliance:

  • Cancer committee develops and implements a process to provide assessment and monitor on-site psychosocial distress screening.
  • Conduct a community needs assessment at least once every 3 years.

 

Facility Decisions:

  • Select distress tool*
  • National Comprehensive Cancer Network has a distress assessment tool available free by contacting them and asking for permission to use tool.
  • Determine clinician to administer
  • Determine major care transitions of care to conduct assessments
  • Cancer committee referral for provision of psychosocial care and follow-up
  • Review all barriers to care and establish referral methods
    • Social Work
    • Psychosocial services
      • On-site
  • Outside facility

Documentation:

  • Screening assessment, referral or provision of identified barriers to care and outcomes of referral should be documented in patient record.

 

Facility Decisions:

  • Documentation:
    • Pen/paper/chart
    • Navigation software program

The new CoC accreditation standard for regular distress assessment is a major advancement in providing patient-centered care.  You can download it here. Nurse Navigators will play a major role in facilitation of this new standard. How do you see it impacting your role in caring for your patients?

 

How to Conquer the Fear of Cancer Recurrence

Fear of recurrence is the number one reported fear of cancer survivors. A cancer patient laments, “I thought that once I completed cancer treatment I could go on with my life. Instead, I have found myself hypersensitive to every ache and pain and dreading my follow-up visits to the oncologist.”

This cancer survivor’s confession is all too common. Having escaped a death sentence, many survivors are now serving a new life sentence in a prison of fear. The fear of cancer recurring has robbed them of their joy and energy. To heal completely, survivors often find that they have to relearn how to live. This should be a major goal of a Navigator—helping patients gain a new perspective on life after cancer.

Having cancer is similar in some ways to other traumatic experiences such as the death of a family member or being in a car wreck. Facing the suddenness and severity of life and death issues changes something deep within. One thing that changes is one’s outlook on life. One survivor said it was like “repricing everything around her with new price stickers.”  Surviving cancer makes one conscious of what was almost lost and what can never be regained. This awareness makes some afraid that they may again face the trauma of cancer. Some survivors develop Post Traumatic Stress Disorder (PTSD), a state in which life is significantly altered by these fears.

In the same way, someone does not stop driving after a car wreck or having friends after someone they love dies, a person cannot stop living and working towards a positive life after cancer. A survivor must find ways to overcome their fears and return to a sense of “normalcy.”  However, what one decides is normal will have to be redefined because cancer has changed the way they see things.

Cancer interrupted a life already in progress. Old dreams and goals may have died along the way. It’s important that survivors grieve for those very real losses. Those with a heightened sense of fear may not have sufficiently dealt with the trauma that cancer caused in their lives. Since they are dealing with both present fears and issues from the past, their coping measures may not be sufficient. Identifying their losses and making peace with them will help them live a fear-less life.

Navigator Tips for Helping Patients Overcome Their Recurrence Fears

Challenge Survivors To:

  1. Identify exactly what you fear and do all that you can reasonably do to prevent it. Make a plan to improve your health. Write your planned changes down so you can review them and work your plan.
  2. Schedule and keep regular check-up appointments to monitor your body.
  3. Write a letter to fear. This may sound silly, but it works. Write it with a “revengeful attitude” and tell FEAR that you will no longer listen to its constant taunting. Tell fear how you chose to think, believe and live instead. Without an “instead” plan you will rubber-band right back into fear.
  4. Try an experiment. Write down every little thing you enjoy and are grateful for. See how you feel after five full minutes of writing. Schedule time to be reflective and grateful every day. Develop your attitude of gratitude. Plan to start writing short notes to people who touched your life for the better. Tell them now grateful you are for what they did and for what they mean to you.
  5. Develop an emergency kit. This kit can be a letter to yourself reorienting you on how you want to live and what you will think and believe. Ask a friend to be your emergency kit. Teach them to let you vent and then remind you of your chosen beliefs.
  6. Make a plan for what you will do if cancer does recur and how you will live if it happens. This sounds hard, but when you face this mentally and make plans there is a sense of power knowing you have plans, no matter what happens.
  7. Determine to live a positive, faith-filled life. It is has a positive effect on your immune system. Build, buy or make something that reminds you of your choice to live positively in the present.

Fear paralyzes a person. Conquering the fear of recurrence is essential for a cancer patient to reenter life as a triumphant cancer survivor. Many survivors are living life free of disease, but prisoners of their fears of recurrence. Navigators can be the catalyst to help change her perspective of recurrence into a manageable fear. Navigators can coach the patient on how she can transform her fear into knowledge and empower her to live life as successfully after cancer as she did before cancer.

These are some of our suggestions that our Nurse Navigators and patients alike have found helpful. What other steps have worked for you?

 

 

Can Exercise Reduce Breast Cancer Risk?

We know you’ve heard about the many benefits of exercise to your overall physical and cardiovascular health. But do you know the relationship between exercise and your immune system, and its’ role in minimizing risk of getting certain types of cancer? Today we’ll explore how exercise can help minimize your breast cancer risk.

Exercise increases the body’s ability to provide adequate oxygen to your cells, which is essential for cell metabolism.  Increased oxygenation boosts the immune system, elevates  mood, and helps control obesity.  Evidence continues to mount that exercise later in life may become a factor for reducing breast cancer incidence.

A recent study recruited women with breast cancer from 31 hospitals in or near New York City. These cases were aged from 20 to 98 years old, and were diagnosed with breast cancer between 1996 and 1997. The controls were women who had never been diagnosed with breast cancer, and were matched to cases based on age. This is important, as age is a significant risk factor for breast cancer. The study included 1,508 cases and 1,556 controls to collect data for impact of exercise on breast cancer occurrence.

Study Outcomes:

When adjusting for age, the researchers found that:

  • Regular physical activity during adolescence was not associated with a difference in risk of developing breast cancer.
  • Women who reported engaging in 10 to 19 hours of physical activity during their reproductive (pre-menopausal) years had a 33% reduction in the odds of developing breast cancer after menopause, compared with women who reported no regular activity during these years (odds ratio 0.67, 95% confidence interval 0.48 to 0.94). No significant differences were seen at other activity levels.
  • Women who reported engaging in approximately 9 to 17 hours of physical activity during post-menopausal years had a 30% reduction in the odds of developing breast cancer after the menopause, compared with women who reported no regular physical activity during these years (odds ratio 0.70, 95% confidence interval 0.52 to 0.95).

How did the researchers interpret the results?

The researchers concluded that women can “reduce their breast cancer risk later in life by maintaining their weight and engaging in moderate amounts of physical activity”.

Back to the Basics

With all the vast number of treatments for breast cancer, most having numerous debilitating side effects, it may be time that we go back to the basics of good health and include exercise as a treatment recommendation to reduce breast cancer incidence. Exercise in moderation, based on the individual’s health, comes with many benefits and usually has no cost associated, unless one decides to join a gym or exercise class. Exercise may be the best value in reducing breast cancer incidence.  One thing is certain: Participating in regular exercise later in life will increase one’s overall health, improve mood, and control obesity.

Do you, as a Nurse Navigator, recommend exercise for your breast cancer patients? Does your Breast Center offer any programs to help facilitate patients’ exercise during treatment?

Dr. Ruth O’Regan: Featured Speaker at Educare Training this September

For those of you visiting our Blog for the first time, we want to let you know that we have an exclusive, annual Breast Health Navigator Training at Emory University Conference Center in Atlanta. This year’s training takes place September 17- 20.  EduCare has been training Navigators for 18 years and over 2,200 nurses have attended the training.

This year’s training promises to be our best yet.  We say this because we are very excited to have, Dr. Ruth O’Regan, practicing Oncologist at the prestigious Emory Breast Center, who will teach the oncology treatment modules. Dr. O’Regan currently serves as an Associate Professor of Hematology and Oncology at the Emory Winship Cancer Institute and is the Director of Winship’s Translational Breast Cancer Research Program.

One of the most challenging roles of a Breast Health Navigator is understanding and discussing cancer treatments with a patient after surgery.  Drugs for chemotherapy are constantly changing, as is the delivery of radiation therapy.  New gene testing and targeted drugs are now a mainstay of oncology treatment.  The body of breast cancer treatment information is large, often complicated, and changes rapidly.  For nurses without an oncology background, cancer treatment navigation may be intimidating. Determining what is important to understand among the vast array of options is essential for effective patient navigation.  Because patients look to their Nurse Navigator to help interpret a physician’s treatment decision, a Navigator needs to feel competent to answer basic patient questions about chemotherapy, hormonal therapy, radiation therapy and the management of their side effects.

Dr. O’Regan brings her front-line, hands-on experience, to prepare Breast Health Nurse Navigators for the role of educating, supporting and navigating breast cancer patients through treatment.  She will condense the vast body of breast cancer information into the basic essentials that you, as a Navigator, must know to educate and empower your patients.

Starting with how treatment decisions are determined for a patient, Dr. O’Regan will:

  • Explain the most recent guidelines and treatment essentials a Navigator needs to understand to support a patient throughout chemotherapy, hormonal, and radiation therapy treatment.
  • Discuss the emotionally charged issues of fertility preservation for young women and treating a woman who is pregnant.
  • Teach Navigators the signs and symptoms of recurrence and the latest practice standards for the treatment of recurrent breast cancer.

We know you will benefit greatly from Dr. O’Regan’s expertise on these topics, and we can’t wait to have you join us in Atlanta. You can register for our conference here. We’ll also be glad to answer your questions in our comment section, or if you prefer, call us at (843) 760-6064 or reach out to us online here.

Study Results: Can Metformin Reduce Breast Cancer Incidence?

The diabetes drug, Metformin, commonly prescribed for management of adult onset of diabetes shows promising results in a clinical comparison of postmenopausal women for prevention of breast cancer development.

Study:  68,019 postmenopausal women, including 3,40l with diabetes at entry point, were observed for a mean of 11.8 years. During this time 3,237 invasive breast cancers were diagnosed and were confirmed by pathology reports.

Results Compared with that in women without diabetes, breast cancer incidence in women with diabetes differed by diabetes medication type (P = .04). Women with diabetes receiving medications other than Metformin had a slightly higher incidence of breast cancer (hazard ratio [HR], 1.16; 95% CI, 0.93 to 1.45), and women with diabetes who were given Metformin had lower breast cancer incidence (HR, 0.75; 95% CI, 0.57 to 0.99). The association was observed for cancers positive for both estrogen receptor and progesterone receptor and those that were negative for human epidermal growth factor receptor 2.

This one study presents evidence that Metformin may reduce breast cancer incidence.  Metformin has been used successfully for many years to control blood sugar. Additional studies are needed to confirm this finding in search for a drug that can be used for prevention and management of breast cancer.

Source:  American Society of Clinical Oncology, June 2012

Intra-Operative Pathology Margin and Node Assessment Prevents Additional Patient Surgery

Decreasing breast cancer patient morbidity is of foremost concern for a Breast Health Navigator and their multidisciplinary team.  Having breast cancer surgery is emotionally traumatic for a patient. Finding that a second surgery is needed because of positive margins or positive nodes, increases a patient’s physical morbidity and prolongs their emotional stress. Not only is the patient impacted, the costs associated with a second surgery are higher as shown by a recent study at the University of Michigan Comprehensive Cancer Center.  The study reported on the impact of intraoperative pathology consultation for breast cancer patients.

Methods: The center compared the 8 months before the establishment of a pathology laboratory, when intraoperative pathology consultation was not available, with the 8 months subsequent, when it was routinely performed.

Results:

  • The average number of surgeries per patient decreased from 1.5 to 1.23, and the number of patients requiring one surgery increased from 59% to 80%.
  • Re-excisions decreased from 26% to 9%.
  • Frozen section allowed 93% of node-positive patients to avoid a second surgery for axillary lymph node dissection.
  • A cost analysis showed savings between $400 and $600 per breast cancer patient, even when accounting for fewer axillary lymph node dissections based on the American College of Surgeons Oncology Group 2011 data.

Conclusions:

  • Incorporation of routine intraoperative margin/sentinel lymph node assessment at an outpatient breast surgery center is feasible, and results in significant clinical benefit to the patient.
  • Use of frozen section decreased both the time and cost required to treat patients.

American Journal of Surgery

Original Article Link:

ABSTRACT: Development of an intraoperative pathology consultation service at a free-standing ambulatory surgical center: clinical and economic impact for patients undergoing breast cancer surgery

Nurse Navigators Ease the Journey of Uncertainty

Cancer transforms a person’s life from one of general well-being and confidence to one of enormous anxiety and uncertainty about the future. A pervasive sense of uncertainty characterizes the journey more than anything else.”  Dr. Jimmie Holland

Shocked, helpless, numb, confused, hopeless and seeking direction as to what she needs to do next describes the patient after hearing she has a breast cancer diagnosis. The patient, who most often is feeling physically well, has just heard words that will forever change her life. The diagnosis has just given her an entrance ticket into the world of cancer treatment—a world of unknowns, a scary place filled with many physical and emotional challenges. These challenges create a mental journey that is characterized by an evasive feeling of uncertainty.

Uncertainty is described in the dictionary as: doubt, unpredictability, indeterminacy and indefiniteness. After a cancer diagnosis, most patients feel that their body has betrayed them. Can they dare trust their own body again, or will it betray them again?  This is combined with the uncertainty of treatments. “What is the best treatment?  Will treatment work?  How can I get answers to my questions?  How long will this last? Will my cancer come back? Does anybody care about what happens to me?”

It is at this time of uncertainty that the Cancer Navigator comes into the patient’s life to help them deal with their overwhelming sense of uncertainty. As a trained Cancer Navigator, you can step into their world of fears and act as an anchor to hold on to. You come to their emotional rescue as a knowledgeable person who will navigate them through the unknowns of cancer treatment. You are a trained guide. You know the general direction of their treatment path. You know the various stops along the journey of treatment—surgery, chemotherapy and radiation therapy—and what they require. The overwhelming good news for the patient is that you are committed for the entire journey.

In a sense, you are like a GPS helping to map out their predicted journey. Like a GPS, if they get off course, you are there to help them find their way back or to find a suitable detour that will still get them to their destination. Just as a GPS serves as a sense of direction and safety when we are on a trip, we serve as a prepared guide for their cancer journey ready to offer directions without demands.

As a Navigator, your very presence and commitment for the journey reduces a patient’s uncertainty to a manageable level. You calm their emotional anxiety and reduce their fears with your navigation skills. Your presence is as valuable as any medical intervention to their recovery.