Monthly Archives: June 2012

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

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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

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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?

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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

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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