Contents
Cover
Half Title Page
Title Page
Copyright
Preface
Foreword by HRH The Prince of Wales
Words of Encouragement for Nurses
Contributors
Acknowledgements
1: An Overview of the Breast and Breast Cancer
INTRODUCTION
ANATOMY AND PHYSIOLOGY OF THE BREAST
INCIDENCE AND AETIOLOGY OF BREAST CANCER
CONCLUSION
2: The Histopathology of Breast Cancer
INTRODUCTION
TYPES OF BREAST CANCER
UNCOMMON PRESENTATIONS OF BREAST CANCER
CONCLUSION
3: Genetic Factors in Breast Cancer
INTRODUCTION
INHERITED BREAST CANCER: BIOLOGICAL EXPLANATION
FAMILY CONCERN
CONFIRMING A CANCER FAMILY HISTORY
DOMINANTLY INHERITED BREAST CANCER SUSCEPTIBILITY GENES
RISK ASSESSMENT
IN SUMMARY
GENETIC TESTING AND COUNSELLING
OPTIONS AVAILABLE FOR CANCER PATIENTS WITH A MUTATION
ETHICAL ISSUES
VIGNETTES: BREAST CANCER GENETIC COUNSELLING
CONCLUSION
4: Breast Screening
INTRODUCTION
THE EVIDENCE
RECOMMENDATIONS
INTRODUCING THE NHS BREAST SCREENING PROGRAMME
SCREENING IN ACTION
UPDATING THE BREAST-SCREENING PROGRAMME
ANXIETY ASSOCIATED WITH THE SCREENING PROCESS
NURSE'S ROLE
CONCLUSION
5: Surgery for Breast Cancer
INTRODUCTION
NEOADJUVANT CHEMOTHERAPY
NEOADJUVANT ENDOCRINE TREATMENT
BREAST-CONSERVING SURGERY
CONTRAINDICATIONS TO BREAST-CONSERVING SURGERY
MASTECTOMY
THE AXILLA
COMPLICATIONS OF BREAST SURGERY
TIMING OF SURGICAL TREATMENT FOR PRIMARY BREAST CANCER IN RELATION TO THE MENSTRUAL CYCLE
NURSING CARE
AMBULATORY BREAST CANCER SURGERY
BREAST PROSTHESIS
PROSTHETIC NIPPLES
CHOOSING A BRA AFTER BREAST SURGERY
PALLIATIVE SURGERY
PSYCHOLOGICAL ISSUES AND BREAST CANCER SURGERY
CONCLUSION
6: Physiotherapy for Patients with Breast Cancer
INTRODUCTION
PHYSIOTHERAPY AND BREAST SURGERY
AIMS OF PHYSIOTHERAPY FOLLOWING BREAST SURGERY
RECONSTRUCTIVE SURGERY
RADIOTHERAPY CLASS
COMPLICATIONS FOLLOWING SURGERY
CHEMOTHERAPY AND HORMONE THERAPY
PHYSIOTHERAPY AND METASTATIC DISEASE
CONCLUSION
7: Breast Reconstruction
INTRODUCTION
BREAST RECONSTRUCTION
TYPES OF BREAST RECONSTRUCTION
AUTOLOGOUS TISSUE RECONSTRUCTION
SKIN-SPARING MASTECTOMY
RISK-REDUCING MASTECTOMIES
NIPPLE–AREOLA RECONSTRUCTION
REDUCTION MAMMOPLASTY
MASTOPEXY (LIFT)
BREAST AUGMENTATION
TIMING OF BREAST RECONSTRUCTION
PSYCHOLOGICAL BENEFITS OF BREAST RECONSTRUCTION
NURSING CARE
CONCLUSION
8: Chemotherapy as a Treatment for Breast Cancer
INTRODUCTION
HOW CHEMOTHERAPY WORKS
CLASSIFICATION OF CYTOTOXIC DRUGS
COMBINATION CHEMOTHERAPY
SCHEDULING OF CHEMOTHERAPY TREATMENTS
THE ROLE OF CYTOTOXIC CHEMOTHERAPY IN BREAST CANCER
DRUG ADMINISTRATION
CYTOTOXIC DRUGS COMMONLY USED TO TREAT BREAST CANCER
PROFESSIONAL ISSUES
COMMON TOXICITIES OF BREAST CANCER CHEMOTHERAPY
RECENT DEVELOPMENTS IN BREAST CANCER MANAGEMENT
CONCLUSION
9: Radiotherapy as a Treatment for Breast Cancer
INTRODUCTION
RADIOTHERAPY
GENERAL NURSING CARE FOR A PATIENT UNDERGOING RT
TREATMENT OF RECURRENT AND METASTATIC BREAST CANCER
THE FUTURE
CONCLUSION
10: Endocrine Treatment for Breast Cancer
INTRODUCTION
THE ROLE OF HORMONES IN THE EVOLUTION OF BREAST CANCER
HORMONES AND THE RISK OF BREAST CANCER
PRINCIPLES OF HORMONE THERAPY
HORMONE MANIPULATION IN CLINICAL PRACTICE
IMPLICATIONS FOR NURSING PRACTICE
MENOPAUSE IN ASSOCIATION WITH BREAST CANCER
OTHER HORMONAL EFFECTS
CONCLUSION
11: Lymphoedema and Breast Cancer
INTRODUCTION
THE DEVELOPMENT OF LYMPHOEDEMA
INCIDENCE AND PREVALENCE OF LYMPHOEDEMA
RISK FACTORS ASSOCIATED WITH THE DEVELOPMENT OF LYMPHOEDEMA
IDENTIFYING LYMPHOEDEMA
THE PHYSICAL EFFECTS OF LYMPHOEDEMA
THE PSYCHOLOGICAL EFFECTS OF LYMPHOEDEMA
THE PSYCHOSOCIAL EFFECTS OF LYMPHOEDEMA
THE MANAGEMENT OF LYMPHOEDEMA
CONCLUSION
12: Fungating Wounds
INTRODUCTION
DEFINITION OF A FUNGATING WOUND
AETIOLOGY OF FUNGATING WOUNDS
APPEARANCE OF A FUNGATING WOUND
INCIDENCE OF FUNGATING WOUNDS
THE SKIN
NORMAL WOUND HEALING
ASSESSMENT OF PATIENTS WITH A FUNGATING WOUND
MANAGEMENT OF FUNGATING WOUNDS
DRESSINGS
TYPES OF DRESSINGS SUITABLE FOR FUNGATING WOUNDS
MANAGEMENT OF PAIN
MANAGEMENT OF ITCHING AND PRURITUS
ADJUNCTIVE TREATMENT
PSYCHO-SOCIAL ASPECTS OF MANAGING FUNGATING WOUNDS
CONCLUSION
13: Advanced Disease
INTRODUCTION
THE PATTERN OF CLINICAL SPREAD
LOCAL RECURRENCE
SYSTEMIC METASTATIC DISEASE
COMMON SITES OF METASTASES IN BREAST CANCER
COMPLICATIONS OF METASTATIC BREAST CANCER
PALLIATIVE CARE IN ADVANCED BREAST CANCER
SYMPTOM CONTROL IN ADVANCED BREAST CANCER
PAIN CONTROL
PAIN MANAGEMENT AND INTERVENTION
ALTERNATIVE PAIN MANAGEMENT IN ADVANCED BREAST DISEASE
SYMPTOMS
PSYCHOLOGICAL AND EMOTIONAL IMPACT OF METASTATIC BREAST CANCER
THE NURSE'S ROLE
ROLE OF THE PALLIATIVE CARE TEAM
CONCLUSION
14: Complementary and Alternative Therapies
INTRODUCTION
THE RESPONSIBILITY AND ROLE OF NURSES
WHAT IS CAM?
WHAT IS THE DIFFERENCE BETWEEN COMPLEMENTARY AND ALTERNATIVE THERAPIES?
REGULATION AND STANDARDS FOR CAM
THE EVIDENCE BASE AND RESEARCH
HOW TO CHOOSE A THERAPIST
WHERE TO GET MORE INFORMATION
ACUPUNCTURE
AROMATHERAPY MASSAGE
HOMEOPATHY
REFLEXOLOGY
OTHER COMPLEMENTARY THERAPIES – BRIEF OVERVIEW
SOME SUPPLEMENTS/HERBS USED BY WOMEN WITH BREAST CANCER
COMPLEMENTARY THERAPIES AND MENOPAUSAL SYMPTOMS
DIETARY ADVICE AND EXERCISE
WORLD CANCER RESEARCH FUND UK – RECOMMENDATIONS FOR CANCER PREVENTION
FURTHER READING ABOUT CAM
CONCLUSION
15: Psychological Issues for the Patient with Breast Cancer
INTRODUCTION
PSYCHOLOGICAL REACTIONS TO DIAGNOSIS
FACTORS AFFECTING PSYCHOLOGICAL REACTIONS
SURGICAL TREATMENTS
BODY IMAGE AND SEXUALITY
ADJUVANT THERAPIES
BREAST CANCER IN MEN
BREAST CANCER DURING PREGNANCY
LIVING WITH UNCERTAINTY
PARTNER AND FAMILY REACTIONS
NURSING IMPLICATIONS
CONCLUSION
16: Survivorship Issues
INTRODUCTION
BACKGROUND
MEANING OF SURVIVORSHIP
PSYCHOLOGICAL RESPONSES
LONG-TERM TREATMENT EFFECTS
FAMILY RESPONSE
FINANCIAL AND WORK ISSUES
ASSESSING THE OVERALL IMPACT OF DISEASE
CONCLUSION
17: Specialist Nursing Roles: What Are the Challenges?
INTRODUCTION
CLINICAL NURSE SPECIALISTS
NURSE PRACTITIONERS
CNS VERSUS NP
PROVING OUR WORTH
BUILDING AN EVIDENCE BASE
THE IMPLICATIONS OF FAILING TO PROVE OUR WORTH
EDUCATION AND TRAINING
CONCLUDING THOUGHTS
Color Plate
Index
Breast Cancer Nursing Care and Management
This edition first published 2011
© 2003 Whurr Publishers
© 2011 Blackwell Publishing Ltd
Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell's publishing programme has been merged with Wiley's global Scientific, Technical, and Medical business to form Wiley-Blackwell.
First published 2003
Second edition 2011
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Library of Congress Cataloging-in-Publication Data
Breast Cancer Nursing Care and Management / edited by Victoria Harmer. – 2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4051-9866-0 (pbk. : alk. paper) 1. Breast–Cancer. 2. Breast–Diseases–Nursing. 3. Cancer–Nursing. I. Harmer, Victoria.
[DNLM: 1. Breast Neoplasms–nursing. 2. Breast Neoplasms–therapy. 3. Oncologic Nursing–methods. WP 870]
RC280.B8B6728 2011
616.99′449–dc22
2010031133
A catalogue record for this book is available from the British Library.
Preface
Although there is much literature available for people with breast cancer, there are very few books for nurses and other health-care professionals.
Breast cancer is increasing in prevalence as the population ages. One in six women has a first-degree relative with breast cancer. This book aims to provide a well-balanced approach to all aspects of management of this malignancy. Generalities are not enough. Expert nurses in these topics deal with the specific details of special care. However, the importance of writing from a complete nursing perspective is underlined so that the essence of support and bedside care is not missed.
This book teaches us about breast cancer treatments, and how to manage, nurse and empower patients through each modality, as well as how to give sound, evidence-based information on possible side effects and how to combat them.
Nurses need to have the necessary information to enable seamless, individualised treatment for the patient. This book is applicable to any stage of the cancer journey, from the biological aspects of care to the psychological issues for people facing this potentially life-threatening disease.
This comprehensive handbook has been updated to act as a resource for any nurse or health-care professional caring for a person with breast cancer.
Victoria Harmer
Words of Encouragement for Nurses
If it wasn't for your commitment to helping the needy, the world would certainly be a far crueller place. Your role in the fight against breast cancer starts from day one. You have the power to save a person from giving into the disease. It is your encouragement, patience and support which is invaluable…thank you.
Warm regards
Stella
Stella McCartney
Contributors
Chapter 1 An Overview of the Breast and Breast Cancer
Elisabeth Grimsey RN, MSc, Macmillan Consultant Nurse – Breast Care, East Sussex Hospitals NHS Trust
Chapter 2 The Histopathology of Breast Cancer
Helen E. Froyd RGN, BSc (Hons), Dip (Onc), MSc, Advanced Nurse Practitioner – Breast Care, Guy's and St. Thomas' NHS Foundation Trust, London
Victoria Harmer RN, BSc (Hons), Dip (Br Ca), MBA, AKC, Clinical Nurse Specialist – Breast Care, Imperial College Healthcare NHS Trust, London
Chapter 3 Genetic Factors in Breast Cancer
Audrey Ardern-Jones RGN, MSc, Dip (N), Genetics Cert, Nurse Specialist in Cancer, Genetics/Associate Lecturer in Cancer Genetics, The Royal Marsden NHS Foundation Trust, Sutton
Chapter 4 Breast Screening
Ann-Marie Fretwell BHSC, PgA, Lead Mammography Educator, Nottingham Breast Institute, Nottingham
(previous contribution by) Linda Lee DCR Med, Radiographic Services Manager, Breast Directorate, Nottingham City Hospital NHS Trust
Chapter 5 Surgery for Breast Cancer
Victoria Harmer RN, BSc (Hons), Dip (Br Ca), MBA, AKC, Clinical Nurse Specialist – Breast Care, Imperial College Healthcare NHS Trust, London
Chapter 6 Physiotherapy for Patients with Breast Cancer
Helen Macleod MCSP SRP, Senior Physiotherapist, The Royal Marsden NHS Foundation Trust, Sutton
Pauline Koelling MCSP SRP, Formerly Senior Physiotherapist, The Royal Marsden NHS Foundation Trust, London
Chapter 7 Breast Reconstruction
Nicola West RGN, BN, PGFETC(cert ed), MA, Consultant Nurse/Lecturer Practitioner, Cardiff and Vale University Health Board, Wales
Chapter 8 Chemotherapy as a Treatment for Breast Cancer
Dr Elaine Lennan D ClinP RGN Onc Cert BN, MSc, Consultant Nurse, Southampton University Hospitals Trust, Southampton
(previous contribution by) Joan Klein née McCoy RGN Onc Cert, BSc (Hons), PgDip, Consultant Nurse, Imperial College Healthcare NHS Trust, London
Chapter 9 Radiotherapy as a Treatment for Breast Cancer
Karen Burnet MSc, BSc, RGN, CRUK Senior Research Nurse, Cambridge University Hospitals Trust, Cambridge
Chapter 10 Endocrine Treatment for Breast Cancer
Dr Deborah Fenlon RGN, Senior Research Fellow, Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton
Kay Townsend RCN, BSc (hons), Lecturer, School of Health Sciences, University of Southampton, Southampton
Chapter 11 Lymphoedema and Breast Cancer
Mary Woods BSc (Hons), MSc, RGN Onc Cert, Clinical Nurse Specialist – Head of Lymphoedema Services, The Royal Marsden NHS Foundation Trust, Sutton
Chapter 12 Fungating Wounds
Victoria Harmer RN, BSc (Hons), Dip (Br Ca), MBA, AKC, Clinical Nurse Specialist – Breast Care, Imperial College Healthcare NHS Trust, London
(previous contribution by) Rachael King RN, BSc (Hons), Formerly Clinical Nurse Specialist – Tissue Viability, St Mary's Hospital NHS Trust, London
Chapter 13 Advanced Disease
Elizabeth Sumner RN, BA (Hons), Dip (N), Clinical Nurse Specialist – Palliative Care, Watford General Hospital, Watford
Chapter 14 Complementary and Alternative Therapies
Rosemary Lucey RGN, RMN, Head of Centre, Lynda Jackson Macmillan Centre, Mount Vernon Hospital, Middlesex
Chapter 15 Psychological Issues for the Patient with Breast Cancer
Jane Rogers SEN, RN Dip (Onc), MSc, Specialist Breast Care Nurse, Lancashire Teaching Hospitals NHS, Foundation Trust, Lancashire
Dr Mary Turner RGN, BA (Hons), Research Fellow, International Observatory on End of Life Care, Lancaster University, Lancaster
Chapter 16 Survivorship Issues
Dr Carmel Sheppard RGN, BSc (Hons), MSc, Dip (Counselling), DBMS, Consultant Nurse – Breast Care, Portsmouth Hospitals NHS, Trust/University of Southampton
Chapter 17 Specialist Nursing Roles: What Are the Challenges?
Dr Emma Pennery RGN, MSc, Clinical Director, Breast Cancer Care
Acknowledgements
I have been lucky with the calibre of the contributors and would like to thank them for agreeing to be part of this second edition. This book would not be possible without them; they are the prominent names in breast care nursing, and it is their expertise and reputation that makes this book so robust.
I am also grateful for the continued support of His Royal Highness The Prince of Wales and Stella McCartney.
A special mention should go to Mr D.J. Hadjiminas and my colleagues in the breast unit at Imperial College Healthcare NHS Trust, and thanks to my family – my parents, Lola and Rex.
This book is a tribute to the wonderful patients that it has been my privilege to meet.
