Patients' sensations after breast cancer surgery. A pilot study.

PURPOSE: The purpose of this study was to obtain information about the prevalence and characteristics of breast sensations after breast cancer surgery, the impact they had on patients, and aggravating and relieving factors. DESCRIPTION OF STUDY: Within 1 month after the date of their surgery, 132 patients with breast cancer completed an instrument rating the prevalence, severity, and level of distress of breast sensations. Information also was obtained on the impact that those sensations had on activities of daily living and factors that triggered and provided relief from sensations. RESULTS: Certain sensations remain prevalent (numb, tender), severe (burning, sharp), and distressing (cramping, painful). Overall these sensations significantly interfered with patients' activities of daily living. Certain activities (movement, position change) triggered sensations, while others (position change, medication) provided relief. CLINICAL IMPLICATIONS: Healthcare professionals can use the information learned from this pilot study to educate patients both preoperatively and postoperatively about prevalent breast sensations after surgery for breast cancer and about the types of activities that may aggravate or relieve these sensations. As patient educators and advocates, oncology professionals must continue to explore the long-term effects and treatment options to provide optimal care and support to patients who have or are likely to have post-surgical breast sensations. More studies are needed to explore long-term effects and treatment options.

A flowsheet for documenting independent nursing visits after breast surgery.

PURPOSE/OBJECTIVES: To redesign a postoperative flowsheet already used in clinical practice with patients who have undergone breast surgery to reflect documentation of assessments and interventions noted on each nursing visit. DATA SOURCES: Memorial Sloan-Kettering Cancer Center Standards of Practice for Ambulatory Care, clinical experience, and published articles. DATA SYNTHESIS: A comprehensive flowsheet was redesigned to provide consistency in documentation and reflect current needs of patients who have undergone breast surgery who are in ambulatory care. CONCLUSIONS: Implementation of the new flowsheet has decreased staff documentation time during busy office practices and accurately reflects the nursing care provided to patients after breast surgery. IMPLICATIONS FOR NURSING PRACTICE: Consistency in patient care can be maintained and efficiency can be increased with use of a comprehensive flowsheet.

Sentinel lymph node biopsy in breast cancer and the role of the oncology nurse.

The pathological status of axillary lymph nodes remains the most important prognostic indicator in the management of invasive breast cancer. Axillary lymph node dissection removes histologically negative nodes in more than 70% of stage I breast cancers with no obvious benefit to the patient. Moreover, the procedure is associated with well-described morbidity. Sentinel lymph node biopsy is a new procedure that shows promise in reducing the number of unnecessary lymph node dissections. This article describes the procedure, pertinent issues surrounding it, and nursing implications.

Sensory alterations after breast cancer surgery.

Many patients experience a variety of sensory alterations at and around the site of their breast cancer surgery, which they often report as severe and distressing. Prevalence, characteristics, and treatment options associated with these sensory alterations remain understudied, as does the effect they have on patients. This article will review important studies that address these issues and discuss treatment options and nursing implications. With this knowledge, nurses can play an important role in helping patients to understand and manage these sensations.

Genetic susceptibility for breast cancer: testing and primary prevention options.

PURPOSE/OBJECTIVES: To provide an update on the breast cancer genes BRCA1 and BRCA2 and to review available primary preventive options. DATA SOURCES: Published articles, abstracts, and clinical experience. DATA SYNTHESIS: While genetic testing will help identify a cadre of women at high risk for breast cancer development, it also will raise many psychosocial and ethical issues, including if and when to be tested and what patients and healthcare professional should do with the information. CONCLUSIONS: The only currently available putative form of primary prevention is prophylactic mastectomy. Diet and the use of tamoxifen remain areas for future research. IMPLICATIONS FOR NURSING PRACTICE: Nurses can play an important role in educating patients who face difficult decisions surrounding genetic testing and primary prevention modalities. Nurses also can design and conduct much needed research in these areas.

Dispelling the myths of pregnancy-associated breast cancer.

PURPOSE/OBJECTIVES: To examine some of the common beliefs about pregnancy-associated breast cancer. DATA SOURCES: Published articles, book chapters, and colleague experience. DATA SYNTHESIS: Eight myths regarding pregnancy-associated breast cancer are identified and contrasted with published data. Current recommendations are provided regarding prognosis, diagnostic and staging procedures, general anesthesia, breast conservation, chemotherapy, pregnancy termination, risk of fetal metastasis, and subsequent pregnancy. CONCLUSIONS: Most common beliefs about pregnancy-associated breast cancer are not supported by available evidence. IMPLICATIONS FOR NURSING PRACTICE: Emphasizing the importance of screening during pregnancy and of educating women and their partners so that they can make informed decisions following diagnosis.