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.

“Chemo Brain” Validated In New Study

Feeling like you are not “all there” mentally after chemotherapy treatment? Take heart: You’re not alone, and it’s not your imagination.

Breast cancer patients often complain of memory problems and foggy thinking after chemotherapy, often referred to as chemo brain.  Often healthcare providers dismiss their complaints and attribute the change to stress and the acute fatigue caused by chemotherapy treatments.

A recent study from the Netherlands Cancer Institute published online February 27, 2012 in the Journal of Clinical Oncology, shows that women who underwent a once-common chemotherapy regimen known as CMF between 1976 and 1995 score slightly lower on cognitive tests that measure word learning, memory and information processing speed than women without a history of CMF cancer treatment.  This study gives validation to patient complaints that chemotherapy had impaired their memory.

CMF is no longer the standard of care for breast cancer; however, there are many breast cancer survivors alive today who received this regimen 20 or more years ago and who may be experiencing such cognitive difficulties.

Study:

  • 196 women with breast cancer who had received CMF chemotherapy (six cycles following surgery) between 1976 and 1995 were compared to women without cancer.
  • The study was conducted between November 2009 and June 2010.
  • Patients underwent neuropsychological examination and were also assessed for depression and self-perceived memory problems.
  • The control group included 1,509 women who were enrolled in the Rotterdam Study (which is exploring risk factors for disease in the elderly) who underwent the same neuropsychological tests and assessments.
  • All women in the current study were between 50 and 80 years of age when they were first enrolled.

Result:

The investigators found that women who received CMF chemotherapy were more likely than the women in the control group without cancer to have lower scores on test of immediate and delayed verbal memory (ability to recall words), information processing speed, and psychomotor speed (coordination of thinking and hand movement, such as putting pegs in a board). The magnitude of the effects was comparable to approximately six years of age-related decline in cognitive function. The women who had received chemotherapy also had more memory complaints than the control women, but these complaints were not related to objective memory functioning.

The good news is that people with cognitive deficits can learn strategies to improve their daily life functioning which include establishing routines in activities of daily living and using memory aids, check lists and filing systems for organizing activities.

Has “Chemo Brain affected you? If so how did you manage your symptoms?

 

ASCO Comment:

Sylvia Adams, MD, ASCO Cancer Communications Committee member and breast cancer expert summarized, “As the number of long-term breast cancer survivors continues to grow and age, patients and their healthcare providers need to be aware of possible long-term effects of past chemotherapy. While there is currently no intervention to restore lost cognitive function, there are skills people can learn to help them manage their daily routines more easily.”

Study Author: Sanne B. Schagen, PhD, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, the Netherlands 1066

 

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

Vast Differences Found Between BRCA1 ER Positive and ER Negative Breast Cancers

We recently came across this data that we want to share with each of you:

BRCA1 germline mutations are one of the main causes of hereditary early-onset breast and ovarian cancer. Recent analysis of BRCA1 mutations conducted by researchers from the Institute of Cancer Research in London, provide additional insight regarding estrogen receptor status of the breast tumor. When a woman has a genetic confirmation of a positive BRCA1 mutation there is a difference between a diagnosis of an ER positive or an ER negative tumor. In more than 80% of cases, tumors arising in BRCA1 germline mutation carriers are estrogen receptor ER negative; however, up to 15% are ER positive.

Researchers reported a summary of the following characteristics found in the study:

Characteristic BRCA1/ER Negative BRCA1/ER Positive
 
Age  participants 54 52
Sex Female Female
Histological grade 3 2
Mitoses/10 HPF 81 15
ER Negative Positive
PR Negative Negative
HER2 Negative Negative
BRCA1 mutation c.124delA/p.Ile42TyrfsX8 c.4485-?_4986 + ?del/p.Ser1496CysfsX14
Somatic BRCA1 wild-type allele* Loss Loss
TP53 mutation c.927_928delTA c.951C > T
Molecular subtype Basal-like Luminal B
Tumor cell content GAP* (H&E) 71% (70%) 42% (60%)

This study confirms for Breast Health Navigators that a diagnosis of breast cancer, even when we have a confirmation that the tumor is BRCA1 positive, may vary in characteristics of the tumor.

The Journal of Pathology (2012); Pathological Society of Great Britain and Ireland

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.

Navigator Challenge: Ask, Hear, Respond

How do you approach the psychological and emotional healthcare experience of your patients?  Do you consider them an expert in the process?

We do. In fact, one of our guiding principles is that the patient is the first expert on managing their care experience. They know what they need, what works, and what doesn’t work, in their care. Thus, we believe that your crucial first step as a nurse navigator is to ask, hear and respond to to the needs of your patient.

Why do we feel this way? As healthcare providers, we specialize in training Nurse Navigators to guide patients through the journey of breast cancer, with all its twists and turns of diagnosis, treatment options, life changes and adjustments, and the myriad of emotions they and everyone affected around them encounter along the way. Yes, we as navigators know much about breast cancer: its causes, diagnosis, treatment and recovery.  What we don’t know is the individual needs of each patient who sits in front of us with a new diagnosis; these needs are a secret to be uncovered to ensure a successful psychological recovery.  Taking the time to ask and hear before we respond can be  a challenge in the face of the many tasks we have to perform daily, yet it is the most important component to our patient’s psychological safety.

One of the mental tools you can employ to stay grounded and remind yourself of the importance of taking the time to discover a new patient’s unique needs is to think, each time you pick up a new patient’s chart: “This could be my Mom or daughter, how would I want someone to treat them?”  It works! This technique taps into your empathy and reminds you of this person’s relationships and important life roles she has, much like your own. It reinforces her uniqueness and the fact that she is a special person who needs your undivided search for her needs. Finally, it also helps you remember not to impose any preconceived ideas of “what’s best” on her treatment journey.

It is only when we slow down at the beginning of the journey to discover this valuable information by asking questions and listening for her reply that we uncover what she needs.  Her needs, added to our medical interventions help make this unexpected, unwanted journey into the scary world of cancer treatment more bearable.  As Breast Health Navigators, we are the members of the interdisciplinary team that serve as her voice.  These needs and desires are only revealed to us when the patient views us as a trusted member of her healthcare team who cares about her personal needs.  So, slow down, take the time to tap into her heart to discover her recovery needs and them give voice to them as treatment decisions are made.  Navigation at its best is to ask, hear and respond.

What insights have you gleaned from your patients with an “Ask, hear, and respond” approach? How have these insights helped you become an even better advocate for your patients?