Published: Thursday, May 03, 2007

1. Patient needs during adjuvant breast cancer treatments
2. How nurses can help during active adjuvant treatments

1. Patient needs during adjuvant breast cancer treatment

During adjuvant treatment, patients find it challenging to recover both physically and psychologically from a diagnosis of cancer and surgery, and then have additional physical symptoms from adjuvant treatment. Although most patients view adjuvant therapy as a reasonable “insurance policy” against subsequent breast cancer recurrence, these treatments may significantly decreases quality of life while it is being given. Many women have a love-hate relationship with adjuvant treatment, feeling protected by it and even wanting more intensive therapies, but nevertheless feeling distressed and overwhelmed by some of the physical symptoms that they experience while receiving treatment.²

During active treatment, patients are exposed to media reports about newer treatments that may provide benefit to some breast cancer patients. As well, many breast cancer patients compare notes with other patients, and often learn that their treatments are different from those of the other women in their support group or in the office waiting room. Patients may begin to question the type of treatments they are currently taking or may consider switching to one that is less studied. In the midst of all this, patients are often offered clinical trials and need to make decision about becoming involved.¹

The majority of patients tolerate adjuvant therapies very well and often continue many of their usual activities (childcare, household activities, paid employment) but often on a reduced schedule. For those receiving chemotherapy, hair loss, nausea, and vomiting are among the most distressing side effects, followed by fatigue and changes in body image and weight (Shimozuma et al., 1999). For those receiving radiation therapy, the need to prevent and, in some cases, treat radiation skin reactions is important. Management of adjuvant treatment related side effects is a major need during adjuvant therapy.²

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2. How nurses can help during active adjuvant treatments

• Provide reassurance about the varied prognoses of women with breast cancer and that many different treatment strategies can be used for the same stage of disease
• Clarify treatment recommendations to ensure understanding and enhance compliance
• Encourage patients to review appropriate sections in their "Breast Cancer Information Kit" for further information on adjuvant treatments and their management
• Provide as much information and consultation as needed before starting any adjuvant therapy to enhance understanding and acceptance of the treatment plan
• Provide written information on potential side effects of each treatment and the percentage of people who experience them
• Reassure patients about what is normal in terms of treatment side effects and provide verbal and written information on how to address symptoms should they occur.
• At each appointment, assess the patient's level of distress³ in each of these areas and address issues through appropriate referrals or by addressing symptoms. Remember that not all symptoms are directly related to the treatments themselves:
  • Practical Problems - child care, housing, transportation, work/ school, financial
  • Family Problems - dealing with children, dealing with partner
  • Emotional Problems - depression, fears, nervousness, sadness, worry
  • Spiritual/ Religious Concerns - loss of faith, relating to God
  • Physical Problems - appearance, bathing/ dressing, breathing, changes in urination, constipation, diarrhea, eating, fatigue, feeling swollen, fevers, getting around, indigestion, mouth sores, nausea, nose dry/ congested, pain, sexual, skin dry/ itchy, sleep, tingling in hands/ feet

View a list of Patient Resources.

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References

1. Hewitt M, Herdman, R, Holland, J, editors. Meeting psychosocial peeds of women with breast cancer. Washington, D.C.: The National Academies Press; National Cancer Policy Board; 2004. pg. 25.

2. Hewitt M, Herdman, R, Holland, J, editors. Meeting psychosocial peeds of women with breast cancer. Washington, D.C.: The National Academies Press; National Cancer Policy Board; 2004. pg. 26.

3. Distress Management: Practice Guidelines in Oncology Version 1. 2007, 08-10-06 © 2006 National Comprehensive Cancer Network, Inc.