Supporting Patients with Recurrent Breast Cancer

August 15, 2018
Debi Fischer, MSW, BSN, BA, LCSW, RN
Debi Fischer, MSW, BSN, BA, LCSW, RN

Debi Fischer is a nurse at the University of Miami surgical oncology step down unit. Prior to that she worked in orthopedics and neurology for many years. In addition to her nursing experience, she has earned a master’s degree in social work. Becoming a Licensed Clinical Social Worker was a lon-sought-after goal which she finally attained. She is a caregiver for her family and her dogs as well.

What can we, as oncology nurses, offer to patients who face a recurrence?

The risk of breast cancer recurring is real, and when cancer spreads to the bone, the pain can be unrelenting.

One of the most recent, notable examples is singer/actress Olivia Newton-John, whose breast cancer recurred after 25 years, after she was initially diagnosed with breast cancer in 1992 and successfully treated. In 2017, Newton-John started having severe lower back pain and attributed it to sciatica, but it was actually metastatic breast cancer that had spread to her bones.1

My own aunt died of metastatic breast cancer at 55 in 1973. There was very little in the way of treatment then, and when she went back to the doctor for a checkup a year after being treated for an initial lump, the cancer had spread to her bones.

What can we, as oncology nurses, offer to patients who face a recurrence? What can we say to them as they go on this journey once again? In some cases, breast cancer can recur several times.

Entering the realm of cancer treatment is not an easy feat, physically or mentally, and entering it a second time can be devastating.

Nurses can recommend that patients seek support from a variety of avenues; for example, family, spiritual leaders, and mental health providers can all play a part in supporting patients with cancer who are facing a recurrence. Sometimes patients decide to tap into their spiritual side and connect or reconnect with their priest, minister, or rabbi. In patient admission assessments, we always ask the question, “Do you want to have a spiritual referral?”

Sometimes, oncology nurses are so busy, we can’t sit down, and are rushing to put out one fire after another depending on the acuity of the patient census for that day or night. If your instinct tells you a patient needs additional support, referrals to help with mental health, such as social work or psychiatry, are probably indicated. A social worker can interview the patient and assess their level of depression, if any. They can also suggest interventions such as talk therapy, to give the patient control over the situation and provide them with a sense of closure if necessary. If a patient seems very depressed, the oncology nurse can also contact the attending physician and suggest a psych consult. The physician may also order an antidepressant.

At the end of the day, however, it is the oncology nurse who is there 24/7, giving the patient pain medication and coordinating the chemo, x-rays, CT scans, PET scans, and radiation. Just thinking about this can be exhausting for the patient and the nurse. Reminding the patient that they are strong, and they can continue to fight this battle with the help of others including yours is a good place to start.