Breast Cancer Research to Improve Odds and Lives
By Debra Wood, RN, contributor
Nurses are on the forefront of finding better ways to help women with breast cancer survive not only the disease but also its aftermath, through nursing research and coordinating clinical trials in collaboration with physicians.
“Women are living a long time with breast cancer and have long-term survival in many instances,” said Betty Ferrell, RN, Ph.D., FAAN, professor, department of nursing research & education at the City of Hope, in Duarte, California. “While that’s wonderful news for breast cancer survivorship, what we also know, and is clear from our research and others, is women living beyond a breast cancer diagnosis are women living with serious quality-of-life concerns.”
Ferrell began studying breast cancer survivors’ quality of life in 1995 with Marcia M. Grant, RN, DNSc, FAAN, the director of the City of Hope nursing research department. They have found many women feel anger and anxiety about their disease, and experience fatigue, menopausal symptoms and chronic pain for years following treatment. Many women also express fears that their daughters will develop breast cancer.
“They need ongoing support to deal with their anxiety [and] depression or how to live with uncertainty,” said Ferrell, who recommends nurses initiate conversations about coping and probe about unreported symptoms. “Our research has documented that women are so glad to be alive, they don’t complain much.”
Karen Hassey Dow, Ph.D., RN, FAAN, a professor in the University of Central Florida School of Nursing, in Orlando, Florida, is conducting a four-year, federally funded study to evaluate quality-of-life interventions for women with early-stage breast cancer. Most of these women chose not to attend support groups.
After the women complete treatment, the study offers survivors three weekly, hour-long support and educational sessions with an advanced practice nurse. The nurses provide basic and in-depth information and answer patients’ questions about side effects, expectations and how to talk to the oncology treatment team. Investigators follow up monthly for six months, asking about quality of life. That data will be compared with a control group. The study is still accruing and analysis incomplete, but unofficially patients seem to appreciate the intervention.
“The heart of this program is nursing,” Dow said. “It focuses on the skills and expertise nurses do best in terms of teaching, educating and communicating with families and patients about how to maintain their life quality.”
Dow also is researching fertility concerns of young women diagnosed with breast cancer, in a study funded by the Susan G. Komen Breast Cancer Foundation. Previous research shows women want to know how treatment will affect their ability to bear children. Dow will evaluate the effectiveness of providing women from around the globe with Internet-based information about chemotherapeutic side effects as they pertain to fertility and about assisted reproduction techniques.
At the University of Wisconsin-Eau Claire School of Nursing, professor Susan Diemert Moch, RN, Ph.D., is working to identify whether an interview intervention will help women in midlife talk about their breast cancer experience. Some women in the intervention group required coaching about how to discuss feelings and concerns with partners and other family members.
Other nurses are conducting research that will help women deal with and manage lymphedema and other side effects. Nurses also play key roles in clinical trials to evaluate new treatments.
Bradford Austin, RN, a research coordinator at the Harold W. and Mary Louise Shaw Regional Cancer Center, in Edwards Colorado, is involved in a study comparing the efficacy of breast brachytherapy to traditional external-beam radiation therapy in women with early-stage breast cancer who have undergone a lumpectomy. Brachytherapy, placing radioactive seeds into the breast, offers the promise of a short treatment period, about one week vs. six weeks with traditional external-beam radiation.
“My interest has always been can we do it better, and the only way to find out is through formal research protocols,” Austin said.
Shaw investigators will follow the women for five years, assessing survival rates, appearance, side effects and quality of life. Austin explains the trial to candidates, obtains consent, and prepares the women for the treatments.
Similarly, Priscilla Kromelis Mates, RN, OCN, a research coordinator for breast cancer studies at US Oncology’s Sammons Cancer Center in Dallas, Texas, cares for patients participating in adjuvant- and metastatic-treatment trials, providing patient education and managing side effects.
“Patients may go from trial to trial with us, and we get to know them really well,” said Mates, who has worked at the center for 16 years. “We really, in a sense, are their primary support.”
Women elect to enter trials for different reasons. Many hope a new treatment may work where others failed. A clinical trial provides an opportunity to try something not otherwise available. Most adjuvant trials include standard of care treatment, plus additional drugs. Almost all studies Mates is involved with include a quality-of-life component.
“I have seen several of the drugs that have been in clinical trials now become the standard of care, and you see patients do well,” Mates said. “It’s extremely rewarding. If we can give someone an additional six months with quality of life, it’s worth it. Every patient I care for has a real desire to live.”
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