EduCare Announces the Release of the Breast Cancer Survivorship Handbook

EduCare is excited to announce the release of the Breast Cancer Survivorship Handbook. This new book was built around a quote from the author, Judy Kneece, RN, OCN, “Survivorship is the challenge to no longer focus on cancer, but to focus on the gift of life after cancer.” This book is designed to empower breast cancer patients to build a better life for themselves when treatment is complete.

The Breast Cancer Survivorship Handbook addresses the next challenge for a breast cancer patient—managing her survivorship. Just like a breast cancer diagnosis, survivorship brings its own set of challenges and adaptations. Survivorship also requires managing psychological and social issues along with physical changes and follow-up care.

The Breast Cancer Survivorship Handbook empowers a patient to thrive by explaining lingering breast cancer treatment side effects and how to manage them. The book addresses the seldom-discussed issues of sexuality and the management of lingering depression and anxiety and, most importantly, what to do about them. Throughout the book are quotes from patients, inspirational thoughts to encourage and “how to” tips.

Topics Included in the Book:

  • Managing the Fear of Recurrence
  • Understanding Family Cancer Risk
  • How to Communicate With Healthcare Providers
  • Follow-up Care After Breast Cancer
  • Potential Side Effects After Breast Cancer Treatment
  • Caring for the Surgical Arm
  • Managing Fatigue After Cancer Treatment
  • Managing Menopausal Side Effects
  • Dealing With Memory Changes
  • Dealing With Body Image Issues
  • Fertility After Treatment
  • Dealing with Numbness in Your Hands and Feet
  • Managing Chronic Anxiety and Depression
  • Understanding Hormonal Medications
  • Making Personal and Legal Decisions
  • Spirituality’s Role in Recovery
  • Evaluating Different Cancer Treatments
  • Planning for a Healthy Lifestyle
  • Patient Resources
  • Tear-Out Work Sheets
  • Healthcare Symptoms Record

Included with the Breast Cancer Survivorship Handbook, is a Breast Cancer Treatment Summary, a Breast Cancer Treatment Summary Quick Reference Card and a Survivorship Care Plan folder.

Orders for the book may be made through the company website at www.EduCareInc.com or by phone at 843-760-6064.

I’ve Found a Lump In My Breast….What Do I Do?

Finding a lump in your breast is a frightening experience. Most women immediately think of breast cancer.  The good news is that most lumps women find are not cancerous. However, because most cancers women discover themselves do have a lump present, it is important to have a healthcare provider evaluate any lumps or changes.

After finding a lump, call and make an appointment with a physician or nurse to have the area evaluated.

Having the answers to the following questions will allow your healthcare provider to effectively evaluate your breast lump or change. 

  • How old are you?
  • Are you still having menstrual periods?
  • Are you on Estrogen therapy or birth control pill?
  • When did you find the lump?  (date)
  • What size is the lump?  (size of a pea, penny, quarter)
  • Describe the lump.  Is it soft or hard?  Is it movable or non-movable in the breast?
  • Do you have a discharge in the same breast?
  • At what time in your menstrual period did you find the lump?
  • Have you observed it while going through a menstrual cycle?  If yes, did it get softer or smaller during or after your menstrual period? 
  • Have you ever had a mammogram?  If yes, when and what were the results?
  • Have you ever had a breast biopsy?
  • Do you have a family history of breast cancer on either your mother or father’s side of the family?   If yes, who in your family had breast cancer?  How old were they when they were diagnosed?
  • Has anyone in your mother or father’s side had ovarian cancer?  If yes, how old were they when diagnosed?

If you have questions during the time you are waiting for your appointment, call the center where you are scheduled and ask to speak to a nurse.

Remember, no one can diagnose breast cancer with their fingers.  Your healthcare provider will examine your breast by doing a clinical breast exam and will then refer you for an ultrasound or a mammogram to further evaluate the area.

An ultrasound is a painless test that uses sound waves to evaluate the lump to see if it is solid or filled with fluid.  A mammogram compresses your breast between two compression paddles and takes pictures from several angles.  If you have had previous mammograms and are going to a different facility, it will speed up your diagnosis if you take your previous films with you or have them sent to the center you are going to for evaluation.  A physician will read the films and send a report to your referring physician. Your physician will notify you of the results.

How EduCare Taught Me to Start a Breast Center

In late 2010, I was approached about developing, de novo, a NAPBC-accredited breast center at a hospital in downtown San Antonio.  At the time, I had been retired from pathology for eight years and was living on a ranch in the Texas Hill Country.  Understandably, I was reluctant about returning to work (and the big city), particularly since I had only a hazy idea about what a breast center actually was.  Before dismissing the offer out of hand, though, I visited five accredited breast centers—two in Montana and three in Texas.  I was particularly impressed with the breast center at Community Hospital in Missoula, Montana.  The nurse navigator there used the COPE Library as her main source of patient educational material and NurseNav software for tracking patients.  She also showed me the big notebook that she had received during her EduCare training and called it her bible.  I was very impressed with her approach to navigating patients.  In fact, I loved the concept of a breast center with its chief purpose being to assist patients throughout their breast cancer journey.  I decided to accept the job.

In May 2011, I was hired at Metropolitan Methodist Hospital to be the Director of the Breast Center.  On my first day, I was shown to a windowless, closet-sized office on a patient floor.  There were some empty shelves, an empty file cabinet, and sheets of dust on the countertops.  There was no computer; there was no fax machine; there was no printer; there was a phone, but it was not activated.  I was to soon learn that there would be no significant secretarial or marketing support and, most troubling of all, there were no plans to hire a nurse navigator.  What’s more, the person in Administration who had championed the idea of a breast center (and with whom I had interviewed) had just been promoted to CEO at another hospital; the remaining people in Administration had even less knowledge about breast centers than I did—and, as far as I could tell, their other responsibilities were more pressing than the new breast center.

To many people this would have been an unacceptable departure point for establishing a new breast center, and, truth told, a part of me wanted to call it quits right then and there.  But, another part of me was drawn to this seemingly insurmountable challenge.  For starters, no one else in San Antonio had been successful at developing a hospital-based, accredited breast center.  What did I have to lose? Besides, I liked the idea of being my own boss.  That I was the boss of no one in a dusty little room was beside the point—sort of.

Despite my lack of experience, I did have enough sense to know that the glue of any breast center is a nurse navigator.  Soon after I was hired—before there was even an acceptable place to meet with patients—I was able to convince Administration that a nurse navigator was, indeed, essential and began searching for someone who was qualified and might be interested in the position.  At the time, Lorraine Infantino had, among her other duties, the responsibility for administering conscious sedation to patients undergoing stereotactic biopsies.  She seemed like the perfect candidate.  Unlike me (a pathologist who had spent most of her professional career behind a microscope), Lorraine had vast experience with direct patient care.  Much of her career had been as an OR nurse, but she also had past administrative experience, including being the Director of an oncology floor.  Lucky for me, she was interested in the position of nurse navigator but agreed that specialized training was indicated.  Taking at face value the solid recommendation of the nurse navigator in Missoula, we signed up for the August 2011 EduCare training sessions in Atlanta.

That trip to Atlanta turned out to be a watershed event for Lorraine and me.  After just four days with Judy Kneece and her colleagues, we had a much clearer idea about how to proceed with our fledgling breast center—a sharper big picture, you might say.  For me, one of the most important realizations was that no two breast centers are the same.  People involved with developing a new breast center must be creative and resourceful, because what works at one center may not work at the next.  That seemingly self-evident concept gave me the confidence to trust my own instincts and to use old-fashioned common sense when I encountered a problem or identified a need.  Interestingly, this also made me less afraid of making mistakes.  When I was a pathologist, there was zero tolerance for error, but when starting a breast center, trial and error is okay, maybe even essential.  After all, administrative flexibility ultimately furthers the goal of never compromising patient care.

Lorraine came away from her training in Atlanta with a much better grasp of her role as a nurse navigator.  The experience also helped her refine her philosophy for navigating patients:  (1)   while providing emotional support and education, she avoids directly influencing the patient’s treatment decisions or interfering with the recommendations of the patient’s physician(s); (2)   while helping the patient surmount barriers to health care and services, she also attempts to empower the patient during this difficult time by helping her to help herself.  This is done by providing individualized, accurate information and by “greasing the skids” for the patient with phone calls and emails.

So, where are we now?  Well, for one thing, we’ve been out of the closet, so to speak, for nearly a year.  We have a little suite of offices with a patient library and a break room and some nice artwork on our walls.  We have computers and printers and a fax machine.  We hold bimonthly Category 1 CME breast cancer conferences that are well-attended by medical staff and hospital personnel.  Arguably most important, though, is that we now have a champion in Administration.  The significance of this cannot be overemphasized.   And, as a concrete measure of just how much progress we’ve made:  Metropolitan Methodist Breast Center will have an onsite survey for NAPBC accreditation on August 22, 2012.  If successful, ours will become the first hospital-based, accredited breast center in South-Central Texas.  Not bad.  Not bad at all.

Deborah Douglas, M.D. is the Director of Metropolitan Methodist Hospital Breast Center in San Antonio, Texas.  She is an eleven-year survivor of breast cancer, a retired pathologist, and is the author of Foot Soldiers:  Stories from the Breast Cancer 3-Day Walk.     

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

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.