In honor of Breast Cancer Awareness Month, former NPWH Board of Directors member Carola Bruflat shares her experience with breast cancer and suggestions for WHNPs with breast cancer patients.
After an 18-year career as a women’s health practitioner, I retired from clinical practice in December 2016. Two months later, on Valentine’s Day, I received a breast cancer diagnosis. What I’ve learned since then may be helpful to those in my profession.
My first phone call after being diagnosed was from the nurse navigator at a large medical center where my husband and I had received care for years. The medical center’s Breast Cancer Clinic answered many questions, but I still felt I needed a second opinion. After all, this was life changing. So, I called one of the physicians at my practice, who became my guide through the process. I am eternally grateful to her.
The breast surgeon was my next stop. She made me feel at ease immediately, drawing diagrams to illustrate the entire process. Together, we chose a partial mastectomy, and the surgery went very smoothly. My margins were clear, and I had no lymph node involvement.
For follow-up, I chose aggressive partial breast radiation. My radiation oncologist had helped to develop this technique and offered a lot of data about side- and long-term effects. But I was not ready for the overwhelming fatigue that resulted, and I also developed oral thrush from using Bactrim and Flovent at the same time. That’s my first lesson for my colleagues: always look at that medication list!
The final part of my cancer journey was to the medical oncologist. I wanted to avoid chemotherapy if possible, and the oncologist reassured me that my choice was valid. Together, we decided on aromatase inhibitor (Aromasin) treatment daily for five years with no chemotherapy. It was a great day when I got that news!
Recently, I had my first mammogram (all-clear), and my first survivorship meeting with the oncology office. I hope my experiences will benefit your patients as we observe Breast Cancer Awareness Month 2018!
Here are some other observations from one who’s “been there”:
What WHNP’s Need to Know
Know and follow the current guidelines for breast cancer screening and risk assessment: Work with your patients to develop individualized plans for screening based on their age, health status, risk assessment and personalized values, and encourage them to take active roles in monitoring their own breast health.
Get a thorough genetic history and update at each visit: As nurse practitioners we are ideally placed to identify families that may have an inherited predisposition to cancer. (My sister developed breast cancer around age 60.) Taking a brief family history can easily become a part of routine health assessments.
Get to know your local breast cancer community and refer patients often to them: Local support groups can be a very important live resource, in addition to websites, message boards, education workshops, counseling programs and online communities.
Listen to your patients: Megan Childers, a nurse practitioner from Vanderbilt University, offers valuable tips here on how to talk to patients with a new diagnosis. They include:
- Sitting down when you talk.
- Using simple language.
- Covering the most important information slowly.
- Staying positive, calm, personable and empathetic.
Read what is in the everyday press about cancer treatment and new research: Since your patients will surely do so, it’s important to give them good internet sources—those with informative and factual information and stories of hope and reassurance—to look at. I recommend www.breastcancer.org and www.cancer.gov to both patients and practitioners.
My Best Resources
Practitioners may be interested in the results of the TAILORx trial, released in June 2018, finding that most women with early breast cancer do not benefit from chemotherapy.
Please also take a look at this article from The Journal for Nurse Practitioners, April 2018, on managing cancer survivorship issues.
Another great resource is www.breastcancer.org
My Own Personal Insights
- My mammogram saved my life as I could not feel the lump, nor could anyone else.
- When you get your diagnosis, learn all you can about breast cancer from reliable on-line sources. It helps you formulate your questions for your first visits, including what your wishes for treatment are.
- Find your support system – girl friends, spouse/partner, medical partner (my boss), and the nurse navigators. I did not do this very well. It was so unexpected for me, I found it hard to talk about initially with anyone outside my immediate family.
- Always get a second opinion – this is cancer after all.
- Find a medical team you are comfortable with. One of the benefits of being in health care is that as nurses we have the best contacts for care.
- Choose a healthy lifestyle – be active, eat a healthy/Mediterranean diet, no smoking, limit alcohol, manage stress and other chronic illnesses.
- Utilize your local support systems and health and wellness programs.
Yes, I am a member of the “1 in 8” club, but I am a breast cancer survivor.