Specialist breast care nurses for supportive care of women with breast cancer

In the United States and in other high-income countries, women diagnosed with breast cancer are commonly matched with a specialist cancer nurse who provides care, support and information.

However, a new review of randomized controlled trials reveals that research on the subject is slim and the ability to assess the contribution of specialist nurses is, so far, elusive.

Lead review author Susanne Cruickshank and her team set out to determine if specialist cancer care nurses improve the well-being and quality of life of women with breast cancer.

“We couldn't come to any firm conclusions just by looking at randomized controlled trials,” she said. “There is limited evidence from RCTs. I think, in this type of field, we need a combination of methods really to answer this question. The next stage is to look at the qualitative studies,” said Cruickshank, a lecturer in the School of Acute and Continuing Care Nursing at Napier University in Edinburgh, Scotland.

Cruickshank said the wide use and acceptance of specialist cancer care nurses and evidence from qualitative research suggest that specialist nurses do help women navigate the many life and social adjustments that come with a breast cancer diagnosis.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The reviewers analyzed five randomized controlled studies involving more than 1,050 breast cancer patients. The interventions provided by the specialist cancer care nurses varied from simple bedside conversations to managing after-treatment care for women.

The researchers analyzed quality of life measures including anxiety and depression; sexual, physical and functional well-being; and coping and fatigue.

Specialist cancer care nurses are often members of multidisciplinary health care teams that provide care for women with breast cancer in high-resource countries. Cruickshank said specialist cancer care nurses complement the team, but existing research cannot single out the nurse contributions that improve patient well-being and quality of life.

“It's hard to see a benefit and say that one person did that alone,” Cruickshank said.

The reviewers could not combine the study results because the five trials were too different. Nevertheless, one study found that breast cancer patients were equally satisfied to have a nurse take care of them following treatment versus medical staff.

“Another study showed that specific breast care nurse interventions can alleviate perceived distress for women undergoing radiotherapy treatment; however, this did not have any impact on coping skills, mood or overall quality of life,” the review found.

It is not clear from the review what proportion of the studied interventions were delivered by breast care nurses with master's level training — or if that distinction matters in health outcomes.

Esther Green, board member for the International Society of Nurses in Cancer Care, said that is information she would like to have in order to analyze future research on breast cancer care nurses.

“Nurses prepared at the graduate level have specialized cancer care knowledge, clinical skills and clinical decision-making skills,” Green said.

“I think that we need to take from this [review] that there is a need for advance practice nurses to work with some of these complex-need populations,” Green said.

She said breast cancer patients often have long-term side effects that require monitoring. “These nurses were introduced to the health care team because, in the past, the oncologist or family doctor was overloaded — not as oriented, to support or care for those needs,” Green said.

Cruickshank, who worked as a breast care nurse specialist for seven years, said breast cancer patients face a string of treatment choices and decisions after diagnosis.

“In my role as a breast care nurse, [patients] literally met me at diagnosis. It enabled you to build up a relationship with that individual,” Cruickshank said. “It meant that some of them saw me every week for a year. The women often have the focus of this nurse as a person to touch base with.”

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

Cruickshank S, et al. Specialist breast care nurses for supportive care of women with breast cancer. (Review). The Cochrane Database of Systematic Reviews 2008, Issue 1.