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JOANNE WOODLANDS November 2017

BREAST CANCER Care in Primary Care. JOANNE WOODLANDS November 2017. Introduction. DIAGNOSIS Role of Breast Cancer Nurse- Local Cancer Care service –referrals and counselling options Breast surgery- post op care Breast cancer treatment :Chemo Radiotherapy  Clinical trials/what’s new

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JOANNE WOODLANDS November 2017

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  1. BREAST CANCER Care in Primary Care JOANNE WOODLANDS November 2017

  2. Introduction DIAGNOSIS Role of Breast Cancer Nurse- Local Cancer Care service –referrals and counselling options Breast surgery- post op care Breast cancer treatment :Chemo Radiotherapy  Clinical trials/what’s new SURVIVORSHIP /Endocrine therapy Targeted therapy

  3. Early Diagnosis STARTS WITH THE WELL WOMENS CHECK ? Encouraging women to be breast aware and to discuss any changes Encourage Breast Screening – Its free! Management of Breast Symptom- Triple test Patient History Image – MMG USS Breast MRI Biopsy – Core FNAB

  4. Awareness of Risk Factors • The main risk factors • being a woman • getting older • having a strong family history of breast cancer inheriting a faulty gene that increases the risk • Other • Being overweight or obese • Alcohol • Smoking • Personal History of Dense breasts DCIS LCIS • Menstrual History • HRT use

  5. DIAGNOSIS Test Results • Biopsy Pathology result • Type- Invasive or Insitu • Endocrine receptor • Grade • Imaging – size Nodes? • Surgical Histology • Type • Receptors • Oestrogen • Progesterone • Her2 • Grade • Imaging Staging

  6. Genomics • Mammoprint • Oncotype DX

  7. Breast Cancer STAGING

  8. Prognosis

  9. Role of Specialist Breast Cancer Nurse AIMS • Provide Support and Information • Local support services • Encourage high standards of patient care • Optimize Health and wellbeing – Across the various phases • i.e. diagnosis, treatment rehabilitation, advanced cancer care and palliative care.

  10. Nursing Role • Registered Nurse – extra study in Cancer care • Initiate contact as soon as possible after diagnosis or when there is a change in cancer • Referrals from Breast screening and Pre-admission clinics. MDT meetings • Recurrence – Med Oncologist or Rad Onc correspondence. • EBC pathway to exit interview usual end of RT • AdBrCa Pathway - initial then as treatment changes - Advanced Breast Cancer (25 women are presently having Treatment at MNCCI, others will be having endocrine therapy (alone) and managed from private Oncologists rooms Oncologist estimate 30 patients)

  11. Distress Screening

  12. Distress Screening

  13. Counselling • Advanced Communication skills in BCN Role so able to provide initial counselling and assessment • Management of Anxiety related to Cancer diagnosis • Assessment of other concerns • Safety • Social workers in Cancer care • GP for Mental Health Care Plan and referral to Psychologist • Beyond blue NewAccess (6 sessions) • Mental Health assessment via PMBH emergency.

  14. Other Supports that may Help • Look Good feel Better • Lymphoedema Nurse • ENCORE Exercise program or the Get Healthy NSW health • Dragon Boating • Cancer Council – Telephone support • BCNA • Local Peer support – Group at Library; Pink Girls • Complementary Therapies • Meditation Yoga Psychologist Physiotherapist Exercise Physiologist

  15. Types of Breast Cancer Surgery • The Breast • Breast conserving Surgery • Mastectomy • The Nodes • Sentinel Node • Axillary Sample • Axillary Clearance

  16. Breast Reconstruction • Implant • FLAPs • TRAM / Latissimus dorsi / • DIEP(Deep inferior epigastric artery perforator flap (like the TRAM but uses only Abdo skin and Fat • Other variations

  17. Radiotherapy • IMRT + Boost • Field Whole Breast; Chest Wall Lymph Nodal areas • Hypo fractionation 4 weeks instead of 7weeks • Deep Inspiration Breath Hold (DIBH) • Left side to protect heart • Prone • Protect the Lungs (pendulous Breasts)

  18. Breast cancer treatmentRadiotherapy  

  19. Radiotherapy DIBH (Deep Inspiration Breath Hold)

  20. Radiotherapy • Skin Care • Eviq • Sorboline • BOZ

  21. Medical Oncology • Chemotherapy • Targeted • Immunotherapy • Endocrine Therapy

  22. Breast cancer treatmentChemotherapy • Triple Negative • Her2 positive • Node positive • High Grade • Neo-adjuvant Vs Adjuvant • Advanced Breast Cancer

  23. Chemotherapy - • Hair loss • Nausea • Hematological- Neutropenic Sepsis • Skin/GIT • Neurological

  24. Breast cancer Treatment Targeted Therapy • Her2 neu receptor positive Breast Cancer • Herceptin (Trastuzumab) • Perjeta (Pertuzumab) with Herceptin • Kadcyla

  25. Clinical trials/what’s new • Keynote  - 355 - Study of Pembrolizumab (MK-3475) Plus Chemotherapy vs. Placebo Plus Chemotherapy for Previously Untreated Locally Recurrent Inoperable or Metastatic Triple Negative Breast Cancer (MK-3475-355) • GSK phase 1A Phase I/II Dose Escalation and Expansion Study to Investigate the Safety, Pharmacokinetics, Pharmacodynamics and Clinical Activity of GSK525762 in Combination With Fulvestrant in Subjects With ER+ Breast Cancer

  26. Clinical Trials- Radiotherapy • ANZ 1601/BIG 16-02 EXPERT EXamining PErsonalised Radiation Therapy • for low-risk early breast cancer (Risk of Recurrence (ROR) score ≤60 characterised using Prosigna (PAM50) Assay) • A randomised phase III trial of adjuvant radiation therapy versus observation following breast conserving surgery and endocrine therapy in patients with molecularly characterized luminal A early breast cancer • Arm A: RT and endocrine therapy; • Arm B: No RT (endocrine therapy only).

  27. SURVIVORSHIP PLAN– life after Cancer • Surveillance / Fear of Recurrence • Long term side effects • Body image • Hair loss • Scar • Mastectomy • Fatigue • Weight / Exercise • Cardiovascular • Peripheral Neuropathy • Menopause

  28. Breast cancer treatment Endocrine therapy • Oestrogen Receptor and Progestrone Receptor positive • Tamoxifen-Selective estrogen-receptor response modulators (SERMs). • Risk of blood clots, especially in the lungs and legs • Stroke • Cataracts • Endometrialand uterine cancers • Bone loss in premenopausal women • Mood swings, depression, and loss of libido • headaches, nausea, vomiting, skin rash, and decreased sexual interest (impotence in Men)

  29. Breast cancer treatment Endocrine therapy • Aromatase Inhibitors • Risk of heart attack, angina, heart failure, and hypercholesterolemia • Bone loss • Joint pain • Mood swings and depression • Afinitor (Everolimus) an mTOR inhibitoradded to Exemestane • Stomatitis (taste changes) • Pneumonitis • Hyperglycemia • Hyperlipidemia • Nausea

  30. Continue Endocrine Therapy • Estrogen-receptor downregulators (ERDs). Fulvestrant injection IM • Pre-Menopausal - Luteinizing hormone-releasing hormone agents (LHRHs). • E.g. Zoladex or • Oophorectomy

  31. THANK YOU Questions?

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