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Many patients undergoing cancer treatment experience alopecia. To support patients, scalp cooling programs can be coordinated and implemented to educate patients and their caregivers on the benefits of and best practices for using cold caps to limit the extent of hair loss. In addition, fundraising events can alleviate the cost of cold caps and ensure that the treatment is more widely available to qualified patients. This article reviews the implementation of a cold cap program at a community breast health center. The results of the program indicate that patients who receive detailed education on scalp cooling with a cold cap, as well as have a trained cold capper to assist them with using the device, have an increased chance of limiting alopecia and retaining the majority of their hair.

Background: Mammography is the optimal tool to mitigate breast cancer morbidity and mortality; however, in many healthcare settings, mammography adherence rates are decreasing., Objectives: This nurse-led quality improvement project was conducted to improve patient adherence to annual mammography screening., Methods: Data collection included clinical information from the electronic health record, chart reviews, tracking documentation used by the clinic's social worker, interviews with staff, observation of the clinical setting, creation of a process flow map to identify barriers, and identification of internal and external resources. Strategies to reduce barriers included communication with staff about problems, a streamlined referral process, a scripted message about mammography, an up-front assessment of financial and social barriers to adherence, and an early referral to resources., Findings: A pre-process change chart audit showed a 22% mammography adherence rate. The post-process change rate was 51%, representing a statistically significant difference in adherence.

Various breast cancer risk prediction models (BCRPMs) exist to assess an individual's risk of developing malignancy and risk of having a mutation associated with hereditary risk of developing cancer. This article provides oncology nurses with current information on the available BCRPMs and highlights nursing implications. Oncology nurses' understanding of BCRPMs can help to ensure that patients are receiving accurate and useful information related to their risks.

Background: Nurse navigators play a major role in the care provided to patients with cancer within the healthcare system., Objectives: This study aims describe the outcomes of a pioneering nurse navigation program established in a breast cancer center in a private, nonprofit hospital in Porto Alegre, Brazil., Methods: This is a cross-sectional, retrospective, descriptive study based on electronic health records. Descriptive statistics were used for data analysis., Findings: Data from 263 patients participating in the navigation program and hospital quality indicators showed a reduction in the time elapsed from diagnosis to the start of treatment from 24 days in 2014 to 18 days in 2017. Of 153 patients who responded to a patient satisfaction survey, 97% were satisfied or very satisfied with the care provided by the nurse navigator.

The Edinburgh Malawi Breast Cancer Project, a collaborative partnership project between the Queen Elizabeth Central Hospital (QECH) Oncology Unit, Blantyre, Malawi and the Edinburgh Cancer Centre, UK, was established in 2015. The principal objective of the project is to help to develop high quality multi-disciplinary breast cancer care in Malawi. A needs assessment identified three priority areas for further improvement of breast cancer services: multi-disciplinary working, development of oestrogen receptor (ER) testing and management of clinical data. A 3-year project plan was implemented which has been conducted through a series of reciprocal training visits. Key achievements to date have been: (1) Development of a new specialist breast care nursing role; (2) Development of multi-disciplinary meetings; (3) Completion of a programme of oncology nursing education; (4) Development of a clinical database that enables prospective collection of data of all new patients with breast cancer; (5) Training of local staff in molecular and conventional approaches to ER testing. The Edinburgh Malawi Breast Cancer Project is supporting nursing education, data use and cross-specialty collaboration that we are confident will improve cancer care in Malawi. Future work will include the development of a breast cancer diagnostic clinic and a breast cancer registry., (© 2017 John Wiley & Sons Ltd.)

Objectives: To review the current state of breast cancer prevention from primary prevention through survivorship, highlight cross-cutting issues, and discuss strategies for clinical integration and future research., Data Sources: Published articles between 1985 and 2015 and original research., Conclusion: Cancer risk persists across the lifespan. Interprofessional strategies to reduce morbidity and mortality from cancer include primary, secondary, and tertiary prevention (survivorship). Prevention strategies across the cancer care continuum are cross-cutting and focus on measures to: prevent the onset of disease, identify and treat asymptomatic persons who have already developed risk factors or preclinical disease, and restore function, minimize the negative effects of disease, and prevent disease-related complications., Implications for Nursing Practice: Oncology nurses and advanced practice nurses are vital in the delivery of breast cancer prevention strategies., (Published by Elsevier Inc.)

Purpose/objectives: To evaluate an oncology rehabilitation program over time., Design: A cross-sectional, retrospective program evaluation using a mixed-methods approach., Setting: An outpatient oncology rehabilitation program housed in an urban, hospital-based comprehensive cancer center in Alaska., Sample: 102 cancer survivors who had completed a 10-week oncology rehabilitation program (mean time since completion was 2.5 years)., Methods: Participants completed a mailed, 28-item retrospective survey to collect perceived activity level recalled at various points in time as well as program perceptions. Open-ended questions elicited narrative comments about motivators and barriers. The Medical Outcomes Study (MOS) SF-36® was completed before and after the program., Main Research Variables: Health-related quality of life, perceived health status, activity level, motivators, barriers, and program perceptions., Findings: A small increase in level of activity from precancer to the current time (postrehabilitation) (z = -3.1, p < 0.01) was reported. Most and least helpful motivators emerged from the narrative data, resulting in the shared interpretation of "I have my life back.", Conclusions: Program motivators were effective in helping cancer survivors maintain some increased activity and retain positive perceptions well after the completion of the program., Implications for Nursing: Survivors who complete a rehabilitation program retain a sense of restoration and caring, and some engage in physical activity over time. Adapting the program based on insights into the survivor perspective may assist oncology rehabilitation clinicians to promote optimum physical activity and sustain healthful change.

Objectives: To review the development of a navigation program in a major US academic health care institution, and provide guidance for navigation programmatic development in other settings., Data Sources: The Johns Hopkins Breast Center Steering Committee minutes, Hospital Cancer Registry; administrative data, and literature., Conclusion: Incorporating navigation services throughout the cancer continuum, from diagnosis to survivorship, provides guidance for patients with cancer. Navigation processes and programs must remain dynamic, reflecting patient and community needs., Implications for Nursing Practice: Oncology nurses have traditionally performed many tasks associated with navigation, including patient education, psychosocial support, and addressing barriers to care. This article provides an exemplar for nurses developing or enhancing comprehensive breast programs., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose/objectives: To test the effectiveness of a bilingual education intervention to improve the quality of life (QOL) of Latina breast cancer survivors (BCSs) after completing primary treatment for breast cancer., Design: A two-group prospective, longitudinal, randomized, controlled trial., Setting: An ambulatory-care setting of a designated comprehensive cancer center in southern California., Sample: 52 English- and Spanish-speaking Latina BCSs., Methods: Women were randomly assigned to the experimental or attention control group and completed measures of QOL, uncertainty, distress, and acculturation at baseline, and at three and six months postintervention., Main Research Variables: QOL, uncertainty, and distress., Findings: After controlling for acculturation, the four dimensions of QOL increased slightly in the groups or remained unchanged without significant group-by-time interaction. The social and psychological well-being subscales had the lowest scores, followed by physical and spiritual well-being. Although the group-by-time interaction was not statistically significant, the post-hoc difference for total QOL between time 2 and time 3 in the experimental group approached significance, with a slight increase in total QOL., Conclusions: Latina BCSs have multiple survivorship and QOL concerns that might put them at risk for poor QOL., Implications for Nursing: More culturally congruent intervention studies are needed to address the paucity of intervention research with Latina BCS., Knowledge Translation: Core values must be incorporated in the development of health education programs. Those programs also should be linguistically appropriate and available to non-English-speaking Latinas. In this way, the informational and supportive needs of all BCSs can be met.

The uniform European structure and professional standards for high quality breast cancer care were established in conjunction with the European Organisation for Research and Treatment, the European Society of Mastology and the European Breast Cancer Coalition with the support of the European Parliament. Well-prepared professional teams including a new member called the breast care nurse serve as ground for special breast cancer centers with international accreditation that provide modern, evidence based, patient centered multidisciplinary oncological care. The responsibilities of the new qualified professional staff member include the psycho-social support of the patient and carers from the moment of diagnosis throughout the whole oncological treatment, the fostering of delivering information and communication between patients and specialists. As a result of the curriculum founded by the European Oncology Nursing Society, breast care nurses have become key members of the practice of holistic breast cancer care in countries where the European recommendations have already been implemented. Considering the expected rearrangement of national oncological care, the new sub-specialty is outlined for the first time in the light of the experiences gained at the National Institute of Oncology, Budapest, a comprehensive cancer center.

Purpose/objectives: To explore patient satisfaction among newly diagnosed patients with breast cancer in a rural community setting using a nurse navigation model., Design: Nonexperimental, descriptive study., Setting: Large, multispecialty physician outpatient clinic serving about 150 newly diagnosed patients with breast cancer annually at the time of the study., Sample: 103 patients using nurse navigation services during a two-year period., Methods: A researcher-developed 14-item survey tool using a Likert-type scale was mailed to about 300 navigated patients., Main Research Variables: Nurse navigation and patient satisfaction., Findings: The majority of participants (n = 73, 72%) selected "strongly agree" in each survey statement when questioned about the benefits of nurse navigation., Conclusions: Patients receiving nurse navigation for breast cancer are highly satisfied with the services offered in this setting., Implications for Nursing: Findings from this study offer insight regarding the effectiveness of an individualized supportive care approach to nurses and providers of oncology care. That information can be used to guide the implementation of future nurse navigation programs, determine effective methods of guiding patients through the cancer experience, and aid in promoting the highest standard of oncology care.

Purpose/objectives: To evaluate a mind-body medicine (MBM) program for its impact on persistent fatigue following breast cancer treatment., Design: Quasiexperimental., Setting: An urban community hospital and a health department in a semirural county, both in Maryland., Sample: 68 breast cancer survivors who were at least six months postadjuvant chemotherapy and/or radiation therapy and had a baseline fatigue score of 50 or lower per the vitality subscale of the SF-36® Health Survey., Methods: A 10-week group-based MBM program for breast cancer survivors with persistent fatigue was evaluated using a pretest/post-test study design., Main Research Variables: Sustained change in fatigue severity as measured by the Piper Fatigue Scale (PFS), SF-36 vitality subscale, and 10 cm visual analog scale (VAS)., Findings: Participants were 2.6 years post-treatment, with a mean age of 56.8 years. Overall, fatigue scores improved by 40%. The mean PFS improved from a score of 6 (SD = 1.6) at baseline to 4.2 (SD = 2) at the end of the program (p < 0.001), with additional improvement at two months and sustained at six months (X = 3.6, SD = 2, p < 0.001). Results from the SF-36 and VAS also showed significant improvement in fatigue (p < 0.001)., Conclusions: The findings support the use of a holistic MBM intervention to reduce persistent fatigue in breast cancer survivors. Results should be confirmed with a randomized clinical trial., Implications for Nursing: Nurses and other healthcare team members can effectively impact persistent fatigue in breast cancer survivors through the use of a multipronged MBM program.

Purpose/objectives: To evaluate the efficacy of senior peer counseling by telephone for supplemental psychosocial support of older women after breast cancer surgery., Design: Experimental, randomized block, longitudinal., Setting: A community-based senior service agency and a community hospital-based breast surgical oncology practice in an urban area of California., Sample: 142 women newly diagnosed and scheduled for surgery for stage 0-III breast cancer (X age = 61.8, range = 50-94)., Methods: Participants were stratified by age and randomized to receive telephone calls from a peer counselor (a) once per week for five weeks beginning within 72 hours postsurgery, (b) once weekly for five weeks beginning six weeks postsurgery, and (c) by request. Assessments were conducted before surgery, postintervention, and six months after surgery. Questionnaires included the Hospital Anxiety and Depression Scale, the Interpersonal Relationship Inventory, and the Brief COPE., Main Research Variables: Anxious mood, social support, and coping by seeking instrumental support., Findings: At six months, significant main effects of age were noted for social support, fear of recurrence, and resource use. Significant independent effects of age and intervention were noted for coping by seeking instrumental support. After controlling for age, a significant interaction effect of intervention and time was observed for coping by seeking instrumental support., Conclusions: Peer counseling may affect instrumental support seeking and appears to be differentially received by age group. Additional study is needed to better understand who benefits most and how from peer counseling., Implications for Nursing: Trained senior peer counselor volunteers, supervised by a skilled clinical team, may be a useful adjunct in addressing psychosocial needs of women after breast cancer surgery.

Purpose/objectives: To evaluate the effectiveness of using an educational program based on self-efficacy to increase knowledge and create behavior change regarding recommended mammography and Papanicolaou (Pap) test screening guidelines., Design: Pretest and post-test, prospective., Setting: An urban county in northern Indiana., Sample: 56 women who attended one of four educational programs and 47 women who responded 15 months later., Methods: The one-hour educational programs based on self-efficacy included vicarious experiences and verbal persuasion regarding breast and cervical screening practices. Two programs were offered to local church groups as part of a health fair, and two were offered through health promotion initiatives sponsored by private businesses., Main Research Variables: Demographics, knowledge of breast and cervical cancer, and screening behaviors., Findings: Knowledge of risk and screening guidelines increased significantly immediately following the educational program (p < 0.001) and did not decrease significantly 15 months later (p = 0.57). Family history and history of human papillomavirus and sexually transmitted diseases were the top known risk factors for breast and cervical cancers, respectively. Participant-reported rates of screening behaviors increased 15 months later for mammography (100%) and Pap test (84%)., Conclusions: Educational interventions based on self-efficacy increased knowledge of breast and cervical health and helped increase the rate of mammography and Pap tests., Implications for Nursing: Preparing women with strategies to complete a mammogram and Pap test is an important approach to enhancing self-efficacy and increasing screening behaviors.

Purpose/objectives: To describe the experiences of older women regarding barriers to care for breast cancer in their prediagnostic period and throughout their diagnoses, treatments, and beyond., Research Approach: Qualitative, descriptive study guided by grounded theory., Setting: Participants' homes or apartments in southern California., Participants: 18 women aged 70 years or older who recently completed treatment for breast cancer., Methodologic Approach: Semistructured, individual interviews. The analytic approach was constructivist grounded theory., Main Research Variables: Gero-oncology perspective of accessing care across the breast cancer trajectory., Findings: Three interconnected, age-related barriers to care were described by the women throughout their cancer trajectories: knowledge deficits, preexisting comorbid diseases, and multiple appointments with healthcare providers. The women navigated beyond the triple barriers to life after cancer. Women described how the services of an oncology nurse navigator facilitated their progress., Conclusions: Despite diverse sociodemographic circumstances and challenges in the healthcare system, all women successfully navigated the triple barriers., Interpretation: Effective age-appropriate care requires sensitivity to the unique needs of older people newly diagnosed with cancer. Awareness of the triple barriers can be a catalyst for nurses to enhance access to care for older adults who fight to overcome a life-threatening disease and move on with their lives. More research is needed that specifically focuses on the role of oncology nurse navigators in older populations.

Purpose/objectives: To provide preliminary data on a diffusion of psychosocial benefit to women diagnosed with breast cancer when only their partners receive a psychoeducational intervention focused on the breast cancer experience., Design: Single-group, pretest/post-test pilot study; participants served as their own controls., Setting: Communities in the Pacific Northwest region of the United States., Sample: 9 women with a first diagnosis of breast cancer within the previous six months whose partners received the Helping Her Heal intervention., Methods: Data were collected from women pre- and postintervention via standardized questionnaires with established reliability and validity. Confidential exit interviews were conducted after postintervention data were returned., Main Research Variables: State anxiety (State-Trait Anxiety Inventory Form Y [STAI-Y]), depression (Center for Epidemiologic Studies-Depression scale [CES-D]), and marital quality (Dyadic Adjustment Scale [DAS]; Mutuality and Interpersonal Sensitivity scale)., Findings: Wilcoxon signed-rank tests showed significant improvements on the CES-D (p = 0.01), STAI-Y (p = 0.01), and DAS affectional expression subscale (p = 0.03) in women from pre- to postintervention. Review of exit interview transcripts indicated that women generally were positive about the impact of the program and viewed their partners' gains in communication skills as the greatest benefit of participating., Conclusions: This study offers preliminary support for a diffusion of psychosocial benefit to women with breast cancer when a psychoeducational intervention is delivered to their partners., Implications for Nursing: Diffusion of benefit should be examined in a large, randomized, clinical trial to provide evidence for focusing some clinical efforts on partners alone, rather than adding to diagnosed women's burden of multiple clinical encounters.

Purpose/objectives: To investigate the feasibility and preliminary effects of a simultaneous stage-matched exercise and diet (SSED) intervention in breast cancer survivors., Design: Randomized, controlled trial., Setting: Oncology outpatient treatment clinics at the National Cancer Center in South Korea., Sample: 45 women with breast cancer who completed their cancer therapy., Methods: Participants were assigned to the SSED intervention group (n = 23) or a control group (n = 22). Participants in the SSED group received a 12-week individualized intervention promoting prescribed exercise and a balanced diet through stage-matched telephone counseling and a workbook., Main Research Variables: Program feasibility, behavioral outcomes (stage of motivational readiness for exercise and diet, physical activity, and diet quality), and quality-of-life (QOL) outcomes (functioning and global QOL, fatigue, anxiety, and depression)., Findings: Participant evaluations of the SSED intervention indicated that it was feasible and acceptable. All women felt that the overall intervention contents were appropriate, and 95% believed that the intervention helped to promote healthy behaviors. Objective data also supported the SSED intervention's feasibility (i.e., 91% completed the trial and 100% of intervention calls were received). When compared to control, the SSED intervention group showed significantly greater improvement in motivational readiness for exercise and diet, emotional functioning, fatigue, and depression., Conclusions: Preliminary results suggest that the SSED intervention delivered via telephone counseling and workbook is feasible and beneficial for positive behavioral and QOL outcomes., Implications for Nursing: Nurse-led lifestyle interventions may improve QOL for cancer survivors.

Aim: The Breast Care Nurse (BCN) supports people with breast cancer, co-ordinating services, and providing information and psychosocial support, yet there is ambiguity surrounding the scope of the role, with implications for both BCNs and service provision. The current studies investigated the scope of practice of BCNs from the perspective of both BCNs and other health professionals., Method: In study 1, semi-structured in-depth interviews were conducted with 11 BCNs and 7 other key health professionals (HPs) involved in the care of those with breast cancer. Participants were questioned about the scope of practice of the BCN role and the challenges facing the role. In Study 2, 27 BCNs and 21 HPs then completed a survey asking about the importance of the different elements of practice identified in Study 1, together with the extent to which each aspect of practice was part of the day to day practice of BCNs., Results and Conclusion: Provision of information and support to people with breast cancer and their families were identified as core to the role. BCNs and other health professionals differed in their perceptions of both the length and breadth of practice of the BCN, with implications for workload and burnout in BCNs, as well as multidisciplinary team functioning and patient care. Scope of practice also differed across practice contexts.

Background: Peer support programs are associated with the provision of emotional, informational, and appraisal support. The benefits of peer support for women with breast cancer include reduced social isolation, enhanced coping, and access to information., Objective: The aim of this study was to conduct a pre- and post-program evaluation of a 7-week facilitated breast cancer peer support program in a cancer support house., Methods: Women with primary breast cancer (n = 8) participated in pre- and post-program focus groups. The interviews were recorded and were transcribed verbatim by the researcher. The data were analyzed using content analysis. Eight themes were identified., Results: The key themes emerging from the pre and post programme focus groups included: The need for mutual identification; Post-treatment isolation; Help with moving on; The impact of hair loss; Consolidation of information; Enablement/empowerment; The importance of the cancer survivor; Mutual sharing., Conclusion: It is essential that facilitated peer support programs are tailored to meet the support needs of women with breast cancer. There is a particular need to facilitate mutual sharing and support for hair loss within these programs., Implications for Practice: Implications for practice emerging from this study include the importance of pre- and post-program evaluations in identifying whether peer support programs meet the expectations of women with breast cancer, the need for peer/professional programs to support women with treatment-induced hair loss, the importance of including cancer survivors in support programs, and the need to allow more informal sharing to occur in facilitated peer support programs.

Purpose/objectives: To describe the development of the Fertility and Cancer Project (FCP), an Internet approach to supplement information about fertility; describe FCP study participants' characteristics, fertility, cancer knowledge, and Internet use; and assess perceived information and support from the oncology team., Design: Descriptive., Setting: Internet, international., Sample: 106 young survivors of breast cancer from eight countries., Methods: FCP content was developed from the literature and interviews with breast cancer survivors, oncology professionals, and young women without cancer who were having fertility problems. Participants learned about the FCP through advocacy groups, cancer care providers, and Web searches. After enrollment, they completed five surveys: sociodemographic, breast cancer and health status, knowledge of fertility, Internet use, and the Medical Outcomes Study-Social Support Survey., Main Research Variables: Sociodemographics, breast cancer, health status, fertility knowledge, Internet use, and social support., Findings: Prior to diagnosis, most survivors had no fertility concerns, but more than 14% reported fertility problems. Following breast cancer diagnosis and treatment, 23 reported fertility problems. About half reported receiving little information about fertility options from the oncology team and were referred to a reproductive endocrinologist. Internet use to obtain support and health information was common. Most reported frequent computer use and Internet access in their homes. Participants were most knowledgeable of the general and treatment-related factors that could affect fertility; they were least knowledgeable of infertility treatment., Conclusions: Results provide preliminary evidence about the demographic, cancer treatment, and support characteristics of young survivors of breast cancer who seek online information about fertility., Implications for Nursing: The Internet is a promising format for engaging young cancer survivors who seek information about fertility and cancer. Future studies can evaluate FCP effectiveness in delivering education and support interventions.

The chemotherapy received by breast cancer patients is complicated by many side effects. At our centre, a health care professional is accessible at all times, yet we hypothesize that most breast cancer patients suffer in silence rather than phone for assistance. This study sought to assess the value of and perceived need for a telephone call to breast cancer patients following the initiation of chemotherapy. The women's side effects were also documented, and the level to which they were educated about symptoms to expect and available assistance was evaluated. Overall, the weekend calls were well received because they provided information and support to the patients. It was determined that further research is required to determine if and how such a call should be best implemented at our cancer centre.

Aim: To examine a model of care for breast cancer patients based on the concept of point of need access and investigate the effectiveness of this model compared to routine 6-monthly clinical reviews., Design: A parallel randomised controlled trial was used to examine point of need access to specialist care via the nurse specialist, compared to routine hospital based 6-monthly clinical review at year two post breast cancer diagnosis. A total of 237 patients were recruited to the study., Methods: Outcome measures at baseline, 9 and 18 months included psychological morbidity using the GHQ12 questionnaire, quality of life using the FACT-B plus endocrine subscale, fear and isolation. An analysis of covariance was used to detect changes over time. Recurrences and methods of detection were recorded as secondary outcome measures., Results: Two hundred and fourteen patients completed the study. Overall patients were not exposed to risks of increased psychological morbidity (p=0.767) or decline of quality of life (p=0.282) when routine review was discontinued and no significant differences were detected during an 18-month period. Patients not receiving regular review did not feel isolated, and at the end of 18 months did not wish to return to 6-monthly clinical reviews. The presentation of recurrences and short symptom history demonstrate that the recurrences observed were unlikely to have been detected at a routine visit., Conclusions: Point of need access is acceptable to the majority of patients. Although a third of patients may wish to maintain a regular review, patient choice is important. Findings suggest that after 2 years following the diagnosis of breast cancer there is no evidence to support the view that regular clinical review improves psychological morbidity or quality of life. Patients do not appear to be compromised in terms of early detection of recurrence. Point of need access can be provided by suitably trained specialist nurses and provides a fast, responsive management system at a time when patients really need it.

Purpose: The purpose of this paper is to present an oncology case study focusing on a woman's journey through breast cancer treatment and survivorship and a nurse's journey to provide wholistic care using standardized nursing languages and Rogers's Science of Unitary Human Beings (SUHB)., Data Sources: Published literature, experience, and expertise of the author were used as data sources., Data Synthesis: The data were clustered to formulate oncology nursing care based on the standardized nursing languages of NANDA International, Nursing Outcomes Classification, and Nursing Interventions Classification (NNN) from the theoretical foundation of Rogers's SUHB., Conclusions: The use of Rogers's SUHB, NNN, and the extant literature provided a theoretical, evidence-based, and practical approach to providing holistic care for a woman journeying through breast cancer treatment and survivorship., Implications for Nursing Practice: Nurses can use standardized nursing languages and Rogers's SUHB to facilitate personal well-being and quality of life for breast cancer survivors.

Purpose/objectives: To examine the impact on continuity of nursing care delivered by a pivot nurse in oncology to improve symptom relief and outcomes for patients with lung or breast cancer., Design: Randomized controlled trial in which participants were randomly assigned to an intervention group (n = 93) with care by a pivot nurse in oncology and usual care by clinic nurses or to a control group (n = 97) with usual care only., Setting: Three outpatient ambulatory oncology clinics in a large university health center in Quebec, Canada., Sample: 113 patients with lung cancer and 77 patients with breast cancer., Methods: Participants in both groups completed the Symptom Distress Scale, Brief Fatigue Inventory, and Functional Assessment of Cancer Therapy Scale-General version 4 at eight intervals over six months. Healthcare usage was evaluated through a review of hospital records., Main Research Variables: Symptom distress, fatigue level, quality of life, and healthcare usage., Findings: Researchers found no significant differences in symptom distress, fatigue, quality of life, and healthcare usage between groups., Conclusions: The new nursing role did not have an impact on the patient outcomes under study., Implications for Nursing: Experienced nurses with specialized knowledge of oncology symptom assessment and management may reduce the symptom burden experienced by ambulatory patients with breast or lung cancer during active treatment.

Hormone receptor-positive breast cancer is increasingly considered a chronic disease, as there remains an ongoing risk of local and distant relapse for years after diagnosis. While early recurrence risk peaks 2-3 years post diagnosis, the majority of breast cancer recurrences and deaths occur following 5 years of adjuvant tamoxifen. Aromatase inhibitors have achieved greater relative reductions in recurrence risk than tamoxifen alone and are now widely recommended as adjuvant therapy for postmenopausal women with hormone-sensitive breast cancer. Although both anastrozole and letrozole have demonstrated superior disease-free survival compared with tamoxifen, letrozole to date offers the greatest significant reduction in the risk of distant metastases in patients with hormone-sensitive breast cancer. Anastrozole and exemestane also reduce local and distant recurrence risk in the "switch setting" following 2-3 years of tamoxifen. Extended adjuvant letrozole, given after 5 years of tamoxifen, significantly reduces local and distant recurrence as well as mortality in patients with node-positive disease. Specialist nurses and nurse practitioners facilitate informed choice for breast cancer patients through explaining treatment options and side effects; they thus need an understanding of which treatment strategies reduce recurrence risk, especially the risk of distant metastases.

The growing number of cancer survivors challenges healthcare organizations to develop programs that support survivors' transition from active treatments to survivorship care. Many individuals and families continue to face complicated care issues resulting from cancer diagnosis and side effects long after completion of their treatments. This article describes a model of a survivorship care plan, Cancer Treatment Summary and Follow-Up Care Plan, piloted in an outpatient clinical setting in a community hospital for patients with breast cancer. The plan can be expanded to include other cancer types. The intent of the survivorship care plan is to strengthen the care connections and coordination of services for survivors of breast cancer to ensure that continuing care needs are met during the survivorship phase of the cancer trajectory. The survivorship care plan is a unique opportunity for oncology nurses to be catalysts for the interdisciplinary interactions that are required to develop survivorship care plans and to implement a change in oncology nursing practice. The intervention shifts the paradigm of cancer survivorship care from an acute care medical model to a wellness model for cancer survivors in the clinical setting.

Many factors may interfere with the ability of women newly diagnosed with breast cancer to cope with treatment. Nurses should be aware of patients' needs during this critical time. The purpose of this study was to identify the educational needs and concerns of newly diagnosed patients with breast cancer after surgery. A phone interview with patients was conducted approximately one week after breast cancer surgery. A convenience sample of 200 patients was recruited from four hospitals within a large midwestern healthcare system. The subjects were interviewed by breast health specialists and navigators involved in their education and support and were asked to participate in a short interview during a surgical follow-up phone call. Study results indicate that fear of recurrence and anxiety regarding postoperative treatments accounted for more than 65% of the responses to the question "What concerns you most about your new diagnosis?" Emotional, social, and physical limitations were identified as most important in dealing with a breast cancer diagnosis. As breast health specialists and navigators, nurses can improve the quality of care for women with breast cancer and their families by providing additional support services and post-treatment information during the initial education and follow-up call.

This study aimed to identify the best strategies for dissemination of information about breast cancer In November 2004, 28 breast cancer survivors were interviewed. Three themes emerged from these discussions: the shock of diagnosis; the onus being on the patient to search for information; and the different types of information that breast cancer survivors want. To learn multiple viewpoints, 12 focus groups were held with breast cancer survivors (n = 127) and three focus groups were conducted with information providers (n = 25) in the spring of 2005. Participants validated the themes and identified two programs using "best practices" to provide information for women dealing with breast cancer. This article highlights the study findings, including implications for practice, education, and research.

This paper presents a review of the evidence for long-term breast cancer follow up to determine if routine clinical review post treatment for breast cancer has benefits for patients. There is little evidence that clinical review of patients beyond 3 years post-diagnosis leads to improved patient survival. Separate to survival there is a dearth of inquiry relating to the value of long-term clinical review of patient in terms of psychological outcomes, quality of life, patient satisfaction, access to specialist advice regarding management of symptoms, and reassurance. Regardless of supporting evidence, most breast units in the UK continue to undertake routine six monthly clinical reviews of patients up to a minimum of 5 years. A literature search for the period 1989 to January 2006 was undertaken using the CINAHL, MEDLINE, and PsychINFO databases. Keywords such as 'cancer follow-up', 'cancer survivorship', and 'psychological outcomes of cancer' were utilised. Hand searching was also undertaken. Overall a paucity of evidence was found in relation to the long-term needs of breast cancer survivors. Alternatives to hospital-based follow-up are reported such as GP or nurse-led follow-up, but the fundamental question of the importance of follow-up in relation to psychological morbidity and quality of life still remains unanswered. Further research is needed to investigate the importance of follow-up to patient survivorship. Research to explore the concept of point of need access, as well as the qualitative experiences of patients post-discharge, informational needs at discharge and on-going psychosocial support is suggested. Ultimately this paper argues for a greater choice and involvement of patients in determining their future follow up needs, providing the patient with a personalised package of care based on risk assessment and subsequent education programmes to empower patients towards self-management following discharge.

Aromatase inhibitors are recommended for use by postmenopausal women who have estrogen receptor-positive early-stage breast cancer. They reduce local and distant recurrence more effectively than tamoxifen. Anastrozole (Arimidex, AstraZeneca Pharmaceuticals LP), letrozole (Femara, Novartis Pharmaceuticals Corporation), and exemestane (Aromasin, Pfizer Inc.) inhibit aromatase activity, thus significantly decreasing estrogen production in tissues such as liver, muscle, and fat. Very low levels of estrogen may be one cause of musculoskeletal pain, a common side effect associated with the drugs. In the major adjuvant aromatase inhibitor clinical trials, 25%-30% of the patients enrolled experienced musculoskeletal pain. Although quality-of-life studies demonstrate that aromatase inhibitors are well tolerated overall, some women discontinue this treatment because of musculoskeletal pain. Little is known about how to predict, measure, or manage musculoskeletal pain caused by aromatase inhibition. Oncology nurses play an important role in the assessment and management of side effects related to cancer. This article provides an overview of the current knowledge about musculoskeletal pain in patients with breast cancer receiving aromatase inhibitor therapy.

Breast cancer is a common form of cancer in women of varying age. Due to the relationship between breasts, sexuality and reproduction, this form of cancer has an interconnected psychological and psychosocial influence on the well-being of women. Current understanding of the aetiology and pathogenesis of the disease has evolved as evidence supporting a role for genes such as the HER2 gene has emerged. HER2-positive breast cancer is a particularly progressive form of the disease as a result of its ability to differentiate and spread. Trastuzumab (Herceptin) forms part of the current treatment for this form of breast cancer; albeit costly, it has been shown to improve survival rates in women. For this reason it is now a recommended treatment for early-stage breast cancer. During and after treatment cycles, the breast cancer nurse and medical practitioners should be available to provide emotional support and advice on the manifestations of the disease, coping strategies and how breast cancer patients manage close family relatives.

There is substantial evidence that Specialist Breast Nurses (SBNs) make an important contribution to improved outcomes for women with breast cancer, by providing information and support and promoting continuity of care. However, a recent study has identified significant variation in how the role functions across individual nurses and settings, which is likely to contribute to varied outcomes for women with breast cancer. The project reported in this paper illustrates how a set of competency standards for SBNs were developed by the National Breast Cancer Centre. The competency standards were developed through a review of published literature and consultation with key stakeholders. The resulting SBN Competency Standards reflect the core domains and elements of SBN practice seen as integral to achieving optimal outcomes for women with breast cancer. This project identifies the SBN as a registered nurse who applies advanced knowledge of the health needs, preferences and circumstances of women with breast cancer to optimise the individual's health and well-being at various phases across the continuum of care, including diagnosis, treatment, rehabilitation, follow-up and palliative care. The five core domains of practice identified are: Supportive care; Collaborative care; Coordinated care; Information provision and education; and Clinical leadership. A variety of education programs are currently available for nurses who wish to learn about breast cancer nursing. The majority of stakeholders consulted in this project agreed that a Graduate Diploma level of education is required at minimum in order for an SBN to develop the minimum level of competence required to perform the role. The evidence supports the view that as an advanced role, nurses practising as SBNs require high-quality programs of sufficient depth and scope to achieve the required level of competence.

Introduction: Women who are diagnosed with breast cancer require the support of a range of people during their treatment. Although the role of the breast care nurse in providing support has recently been investigated in several Australian studies the patients' perspective on the role of the breast care nurse in Australian hospitals has not previously been described in detail. The aim of this paper is to explore patients' perspectives on the role of the breast care nurse., Methods: In-depth interviews were conducted with 18 women who had completed treatment for early breast cancer. The women were asked to describe their experiences from the time of diagnosis through to treatment completion. Thematic analysis was used to analyse the data., Findings: Breast cancer patients repeatedly emphasised the importance of the role of their breast care nurses throughout their experience of breast cancer. The support that breast care nurses provided incorporated the following components: communication, rapport and an awareness of the women's needs, availability, reassurance and practical information., Conclusion: This study provides an understanding of women's perspectives on the role of breast care nurses and confirms that breast care nurses play an important support role during the experience of early breast cancer. Oncology clinics should focus on ensuring that all women who are diagnosed with breast cancer have adequate access to the support that breast care nurses are able to provide.

Objective: In a prospective, randomised study, individual psychosocial support performed by: (1) specially trained oncology nurses (INS) or (2) psychologists (IPS) were compared with respect to utilisation, satisfaction and perceived benefit., Methods: Between December 1997 and December 1999, consecutive breast cancer patients (n=120) were included at start of adjuvant therapy (chemo-, endocrine and/or loco-regional radiotherapy). Data were collected by an extended version of the 'IPS-patient satisfaction questionnaire' within 1 week after termination of the support intervention. Questionnaires were also mailed to all patients 6, 12 and 18-24 months after inclusion. Levels of distress were collected with the Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale (IES) questionnaires., Results: The patients were highly satisfied with the individual psychosocial support intervention they received, irrespective of which profession provided the support. However, the patients in the INS group reported higher levels of benefit regarding disease-related problems, regardless if the patients at baseline reported low or high levels of distress., Conclusions: Patients were highly satisfied with an individual psychosocial support intervention. In areas dealing with somatic aspects, the group intervened by nurses were more satisfied than the one by psychologists., Practice Implications: Individual psychosocial support by specially trained nurses is a realistic alternative in routine cancer care.

Lymphoedema is recognised as a significant management problem for both patients and clinicians. Around 25% of those undergoing axillary intervention as treatment for breast cancer will go on to develop some degree of lymphoedema, which will impact their everyday life and wellbeing [Moffatt et al., 2003. Quarterly Journal of Medicine 96, 731-738; Mortimer et al., 1996. Quarterly Journal of Medicine 89, 377-380; Tobin et al., 1993. Cancer 72, 3248-3252]. This paper outlines an audit of the presenting characteristics of all 263 patients seen in The London Haven Lymphoedema Service (TLHLS) between 10th February 2000 and 4th June 2003 for treatment of breast cancer-related lymphoedema and reports outcomes of treatment: Results highlight the key issues around current practice at the London Haven and the need for further research in promising areas in lymphoedema management.

Despite evidence of benefit, little is know about Australian women's access to and perceptions of specialist breast nurse (SBN) care. The aims of this study were to: explore access to SBNs by Australian women with breast cancer; identify factors associated with receiving systematic SBN care (at least 3 SBN contacts including preoperatively and postoperatively and at follow-up); and explore the impact of systematic SBN care on women's perceptions of treatment and support. A population-based sample of 544 women with early breast cancer was randomly selected through state and territory cancer registries. Participants completed a structured telephone interview. Over half (52%) of the women had no SBN contact and only 11% received systematic SBN care. Factors associated with systematic SBN care were being treated in a public hospital and receiving systemic adjuvant therapy. Women who received systematic SBN care were more likely to report receiving enough support for themselves and their families, and enough information about where to get more support or counseling and the costs of treatment. In conclusion, systematic SBN contact was uncommon in this population-based sample but positively influenced women's perceptions of care, particularly in relation to the provision of support.