Up to one-third of women with breast cancer experience progression to metastatic disease. To address the unique situation of these patients, a team of nurses at the University of Pittsburgh School of Nursing developed an interdisciplinary support program: the Support, Education, and Advocacy Program of Care for Women with Metastatic Breast Cancer (MBC-SEA). Concentrating on psychosocial and palliative care, the program uses assessment tools to determine patients’ specific needs then connects them to resources that focus on those needs.1
The team was concerned that patients with metastatic breast cancer often feel marginalized. These women have moved past the early stage breast cancer pink ribbon campaigns that are pushing for a cure, corresponding author Victoria Reiser, RN, BSN, BMTCN, OCN, explained to Oncology Nurse Advisor. There is no cure for them; they are now living with a chronic disease and all the stressors that go along with it. They need advocates, just like patients living with diabetes or heart disease have. Patients with metastatic breast cancer are most likely to undergo treatment for a longer time and may have had multiple sequential treatments. They are often on targeted or hormonal treatments for much longer, and their symptoms and financial burdens are much greater than those of patients with early stage breast cancer. Their disease might be stable and under control, but they live in constant fear of it coming back and more aggressively.
Focus on Chronic Status vs Acute Disease
The team of nurses developed the palliative and supportive care intervention for women with metastatic breast cancer to improve support services for these patients. It is implemented by the clinical staff of the University of Pittsburgh’s breast cancer program. The MBC-SEA program evaluation component comprised 118 women ages 50 to 69 years with metastatic breast cancer who visited the outpatient breast cancer clinic once a week in 2016 and 2017. Most of the women had been living with the disease for at least 3 years, and were undergoing hormonal or targeted treatment only for estrogen receptor (ER)-positive breast cancer.
The staff consisted of a nurse navigator, a nurse practitioner, a palliative care provider, a social worker, and the oncology collaborative practice nurses. The nurse navigator had no patient contact; her responsibility was to review the charts for the patients who would be attending the clinic the following week, lead a team meeting to review the patients, and then coordinate support services for the patients based on what was identified in the meeting.