Overcoming Barriers in Breast Cancer Survivorship Care

Long-term adherence to endocrine therapy remains a critical challenge in breast cancer care, where side effects such as hot flashes, weight gain, and sexual dysfunction frequently jeopardize patient compliance. According to Theresa Lynne Harrington Stukus, ANPBC NP, an oncology nurse practitioner at MedStar Georgetown University Hospital’s Lombardi Comprehensive Cancer Center, overcoming these obstacles requires a collaborative, patient-centered approach.

In an interview with Oncology Nursing News, Stukus highlights the multi-faceted barriers patients face, ranging from asymptomatic forgetfulness to severe treatment-induced toxicities caused by ovarian suppression and aromatase inhibitors. She underscores the vital role nurse practitioners play in evaluating individual risk perception, managing screening anxiety, and aligning supportive care strategies — including both pharmacologic and non-pharmacologic interventions — with patient priorities. By fostering open communication and proactively addressing survivorship challenges, clinicians can better support patients transitioning from active treatment to post-treatment survivorship.

With your extensive experience in symptom management, what is the single most common barrier patients face when adhering to long-term endocrine or targeted therapies, and how can oncology NPs proactively address that?

Long-term endocrine therapy, I think, for the most part, is compliance. Sometimes it's just feeling well and forgetting to take it, or maybe perhaps thinking you don't need to take it since you're feeling so well. But certainly, there are significant side effects, particularly if we make young women postmenopausal with ovarian suppression, aromatase inhibitors. So certainly, sexual side effects, vaginal dryness, decline in libido, weight gain, hot flashes — those all contribute to the ability to stay on the medication long term. There are certainly many things that we can do, but they also often involve other medications. Although sometimes non-medication type things like acupuncture can be helpful for certain, it's often not covered by insurance, and it is time-consuming. So there are definitely some limitations. So the patient definitely needs to be motivated to stay on their medication and also work with you to tell you about side effects and then also what they're willing to do to manage those side effects.

Having spent years working with women at high risk for breast cancer, what key clinical or communication strategies do you recommend for helping high-risk patients navigate screening fatigue and anxiety?

For women who've had breast cancer who are at risk for recurrence, I think the first question is, if they haven't asked, trying to assess what they think their risk is. Sometimes someone with not so high risk thinks they're very high risk, and someone who may have higher risk features might not be as worried about risk of recurrence. I think it's important to ask them what their what their top priority is, what's most important to them, so that we can start there and then figure out how to manage expectations, side effects, as well as compliance to therapy.

Transitioning from active treatment to post-treatment survivorship can be emotionally and physically challenging. What does effective whole-person survivorship care look like in daily clinical practice?

That's a lot of times something that a woman who's completing treatment doesn't expect, that when they're actively doing something, they're motivated, they have an end date, they have something to focus on, and then when they're done with systemic treatment it's hard because they still don't feel back to their pre-diagnosis self. Women are often, I think, frustrated with how long it takes to feel back to what they felt like before their cancer diagnosis. It's definitely a transition. We do gradually space out our visits, so every 3 to 4 months for the first 2 years, and every 6 months, and then I still follow women after 5 years, usually to 10, depending on the features of their cancer and their also their individual preference, focusing on things like exercise, which has been shown to reduce the risk of recurrence, and help to empower connecting individuals with some exercise support programs if they're in the area that can also be empowering to women and then also giving them reassurance but also knowing when to call and letting them know that even if they're not coming in as often, that we're still available.

The psychological impact of a breast cancer diagnosis often lingers long after acute treatment ends. How can oncology nurses better integrate mental health and psychosocial support into routine follow-up visits?

The primary thing is to ask the individual how they're doing. Ask what are they struggling with most? What is most important for them? Is there anything you know that’s bothering them? What do they want to talk about for the visit, particularly in a survivorship visit? A lot of times in a survivorship visit, once you've managed the side effects, it is more talking about how to adjust to their new normal, and just asking what they want to focus on. I think that's helpful.

You've spent more than two decades in oncology care, spanning home infusion, high-risk clinics, and medical oncology. What core advice would you give to advanced practice providers entering breast medical oncology today?

It's such an exciting field right now. There are so many advances, but there's also so much to keep up on. We've gotten much better at treating breast cancer, and women are living longer. Quality of life has improved, but the number of treatment options, how to sequence them, the number of different side effects from the number of different drugs, as a practitioner can often be overwhelming, so staying up to date, attending conferences, talking with colleagues, is also very important. Networking, we often don't do that enough in this new virtual world that we live in. But just discussing things, sharing stories, I think, is very important. and knowing that they're not alone, that it's good to ask questions, that everybody starts somewhere, and it's a lot of information to learn because of so many things, we've had so many new drugs, but we still use most of our old drugs too, and that gives us great treatment options — but it's a lot to know.