9 Advances in Breast Cancer Treatment
This Breast Cancer Awareness Month, in October 2021, the country celebrates the decline in breast cancer deaths due to earlier diagnoses and advances in breast cancer treatments.
The American Cancer Society reports a 41 percent decline in breast cancer deaths from 1989 to 2018 or about 403,200 fewer breast cancer deaths. The five-year survival rate for women with invasive breast cancer stands at 90 percent.
“Almost 12.9 percent of women will be diagnosed with breast cancer in their lifetimes,” said Kathleen Heneghan, PhD, MSN, RN, FAACE, assistant director of patient education at the American College of Surgeons. “Women are living longer with breast cancer.”
Oncology nurses play a huge role in helping patients understand their diagnosis and navigate the healthcare system to achieve the best outcome.
“It’s been amazing to watch [care] change over the years,” said Angela Hammack, RN, BSN, OCN, clinical educator, Jackson Oncology Associates in Terry, Mississippi, and program chair and past president of the Central Mississippi Chapter of the Oncology Nursing Society (ONS). “It has come so far, and it’s a rewarding gift to have the honor to take care of breast cancer patients.”
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9 advances in breast cancer diagnosis and treatment
1. Combining chemotherapy and immunotherapy
“A big breakthrough was adding immunotherapy to chemotherapy for triple-negative breast cancer,” Hammack said. “We are seeing patients with advanced cancer getting multiple lines of therapy.” Antibody-drug conjugates combine a cytotoxic drug with a monoclonal antibody.“ The chemotherapy is directed right to the cancer cells,” Heneghan said.
2. Using neoadjuvant treatment
Patients often now receive medical treatment to reduce tumor size before having surgery and drugs post-operatively to manage the residual disease, Hammack said.
For women with HER2+ breast cancer that is usually the monoclonal antibody treatment Herceptin. Different monoclonal antibodies target specific receptors.
3. Better educating patients
The American College of Surgeons (ACS) has developed an evidence-based breast cancer skills kit, with videos and images to simplify complex information, in collaboration with other organizations, including the National Accreditation Program for Breast Centers with ONS representatives. Patients, caregivers and nurses can use the online kit to educate patients about all aspects of breast cancer, including treatments and expectations.
“We go into detail about how to manage [post-operatively],” Heneghan said.
Home health nurses and patients can reference the skills kit after discharge. ACS is interested in working with nurses using the kit as a quality improvement initiative.
4. Undergoing same-day surgeries
Instead of enduring a hospital stay, seventy-five percent of breast cancer patients go home the same day of their surgery. Patients undergoing a lumpectomy or a partial mastectomy, typically, go home the same day, reported Heneghan.
5. Better managing treatment side effects
Cooling caps, mittens and boots, which help prevent hair loss and peripheral neuropathy, have reduced those chemotherapy side effects. Better treatment for nausea aids in improving patients’ appetites, so they can keep up their nutritional status.
“We have to be cheerleaders to help patients get through [treatment],” Hammack said.
6. Genetic testing to assess for hereditary disease
Genetic testing can help patients understand the genetic connections for risks of breast cancer. For instance, BRCA genetic mutations increase a patient’s risk of breast cancer and other cancers.
7. Genomic testing
Treatment is determined with genomic testing to determine risk and if chemotherapy is needed or not, Hammack said.
Genomic testing can determine the patient’s gene expression pattern and help the physician determine the best breast cancer treatment plan.
8. Identifying clean margins during surgery
Currently, about 25 percent of women undergoing breast cancer surgery require a second surgery, because the clean border was not achieved.
“I wanted to slow or eliminate that second surgery,” said Rachel Wellner, MD, MPH, a breast cancer surgeon and founder and CEO of Caelum Diagnostic Solutions in Los Angeles. She has used existing technology, fluorescence lifetime imaging microscopy, to identify cancer edges intraoperatively. “This is the wave of the future. We want no cancer left behind.”
9. Using hormone therapy as a prevention tool
In April 2021, the results of a nine-years-long retrospective study were published in the peer-reviewed European Journal of Breast Health revealing that testosterone pellet therapy reduced breast cancer incidence in women by 35.5 percent.
Study co-author Gary Donovitz, MD, a board certified obstetrician-gynecologist and founder of Biote in Irving, Texas, said, “This is the second, and largest, long-term study to demonstrate the relationship of testosterone pellet therapy to invasive breast cancer incidence in women. Although treatment protocols have improved survival over the past decade, successful prevention trials have been few and far between, leaving the preventive potential of hormone therapy tragically understudied.”
Breast care and oncology nurses
In addition to certifying oncology nurses, the Oncology Nursing Certification Corp. offers the Certified Breast Care Nurse credential to nurses actively caring for and experienced in working with patients with breast cancer.
“They can address specific needs of breast cancer patients,” Hammack said. “Breast cancer nurses can handle many different aspects and have different roles from educator to helping with navigation and treatment.”
Hammack finds working as an oncology nurse rewarding, including getting to know the patients, even when helping those patients at end of life.
“You are able to help people navigate through their lives,” Hammack said. “It’s rewarding to see them continue with their lives.”
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