Breast Cancer Awareness: An APN on Personalized Care and Survivorship

Breast Cancer Awareness Month should spotlight not only the disease but also how individualized breast cancer treatment has become, according to Marieta Branis, APN, an oncology nurse practitioner at Hackensack Meridian Health (HMH) John Theurer Cancer Center in Hackensack, New Jersey.

Branis, who has worked in oncology for more than 25 years, told Oncology Nursing News in a recent interview that this shift is expanding the nursing role across oral therapies, antibody-drug conjugates (ADCs), younger patients, and survivorship.

What should the public understand about breast cancer care today?

"It's not only about awareness of the disease, but also awareness how individualized and personalized the cancer treatments have become," Branis said.

She emphasized that breast cancer is not a single diagnosis. "Under the umbrella of breast cancer, there are different subtypes. Each subtype is connected to a specific therapy," she said, adding that one patient's diagnosis "doesn't mean the same treatment or even outcome for another patient."

"We are treating the whole person," Branis said, describing care that weighs comorbidities, cardiovascular health, finances, and family dynamics.

Early detection still "remains one of the most important aspects," she said, urging age-appropriate screening. For those already diagnosed: "Be an active participant in your treatment and make sure you understand why a specific regimen was recommended for you."

How is the nursing role changing with oral therapies and ADCs?

"As the treatment becomes more complex, so is the role of the oncology nurse," Branis said.

With oral agents taken at home, she explained, the patient becomes "a partner in administration of medicine," and nursing work moves beyond education to ongoing surveillance of dosing, follow-up laboratory work, and supplement use. "We want to make sure that the patients are not taking any over-the-counter supplements. There are so many out there," she said, noting that some "can actually interfere with the effectiveness of the medicine and they can potentially cause harm."

Even with assistance programs, "sometimes there is still a significant out of pocket pay, some of the patients do not have that capability. And that becomes a big financial strain on the patient and their families," Branis said.

ADCs require different vigilance because adverse effects can be subtle. "A patient could have a simple cough or a new onset shortness of breath. With some of these newer therapies that we are administering, that can be an emergency trigger sign," she said.

With one therapy used at her center, a cough can signal interstitial lung disease (ILD), "which is a very serious condition. And often it just manifests with a slight cough." Nurses must recognize and report these signs, which may lead to treatment being held or discontinued. Oncology Nursing News has covered ILD risk with trastuzumab deruxtecan (Enhertu) and ADC toxicity management in triple-negative disease.

What do younger women with breast cancer need from their care team?

Breast cancer incidence increased by 1% per year from 2012 to 2021, with a steeper rise of 1.4% per year among women younger than 50 years. For these patients, a diagnosis can be devastating, Branis said, arriving as they start careers or families.

Fertility preservation is the first priority, and "this discussion has to occur before any oncology treatment starts," she said, with referrals made before therapy that may compromise ovarian function. Genetic assessment is also essential, because "the result can influence either their surgical decision, the treatment, and maybe counselling for other family members." Psychosocial support should be introduced early.

How do nurses support patients through survivorship?

"The breast cancer care does not stop once you finish your treatment," Branis said. At her center, patients typically transition to survivorship within 3 months of their last treatment. As visits become less frequent, fears of recurrence can surface, making this "a very critical time for our patients."

Monitoring covers recurrence, fatigue, lymphedema, bone and cardiovascular health, early menopausal symptoms, sexual health, and body image. Fatigue in survivors has tracked with baseline stress and depressive symptoms rather than cardiac measures in the UPBEAT trial. Patients are referred to nutrition services and encouraged to get 150 minutes of exercise per week, consistent with American Cancer Society guidance for survivors.

"Survival is our first goal. We want them to reach survivorship, but also living well after the diagnosis and returning to a normal life and functioning to the fullest," she said.

What are the key takeaways for oncology nurses?

• Explain how tumor subtype drives each patient's regimen.
• Check oral therapy adherence, laboratory follow-up, and supplement use at every contact.
• Screen for financial strain early.
• Report new cough or shortness of breath on an ADC promptly as a potential ILD signal.
• Refer younger patients for fertility preservation and genetic assessment before treatment.
• Prepare patients for the survivorship transition, including recurrence anxiety.

References

1. Benyon B. Nurses, talk AEs, interstitial lung disease, before treating with T-DXd. Oncology Nursing News. September 28, 2024. Accessed October 8, 2026. https://www.oncnursingnews.com/view/nurses-talk-aes-interstitial-lung-disease-before-treating-with-t-dxd
2. Biese A. Navigating TNBC: nurse-led insights on ADCs and toxicity management. Oncology Nursing News. August 27, 2026. Accessed October 8, 2026. https://www.oncnursingnews.com/view/navigating-tnbc-nurse-led-insights-on-adcs-and-toxicity-management
3. Giaquinto AN, Sung H, Newman LA, et al. Breast cancer statistics 2024. CA Cancer J Clin. 2024;74(6):477-495. doi:10.3322/caac.21863
4. Depression, stress, may drive breast cancer survivor fatigue. Oncology Nursing News. September 2, 2026. Accessed October 8, 2026. https://www.oncnursingnews.com/view/depression-stress-may-drive-breast-cancer-survivor-fatigue
5. Rock CL, Thomson CA, Sullivan KR, et al. American Cancer Society nutrition and physical activity guideline for cancer survivors. CA Cancer J Clin. 2022;72(3):230-262. doi:10.3322/caac.21719