NUR342 Evidence Based Health Research And Practice

Introduction:

Breast cancer is defined as one of the major catagory of cancer that developed in breast tissues. The symptoms of breast cancer include the lump observed in the breast, swelling observed in nipples, laceration in nipples. Breasts of the individuals might change shape due to breast cancer. In Australia, it is the leading cancer that experienced by majority of the women in Australia. Hence, this paper will focus on background of the breast cancer, importance to nursing, personal reflection, aim of the study, search strategy and findings in following paragraphs.

Background

Breast cancer is described as the second leading category of cancer that Australian female are facing. Breast cancer is defined as the abnormal growth of cell line that is observed in breast ducts in women. These cells have the potential to spread in different parts of the body (Welch, Prorok, O’Malley & Kramer, 2016). Both the genders can develop breast cancer although it is more predominant in the case of the female population. However, the survival rate for breast cancer is higher than any other disease. In Australia, the report of the five-year survey suggested that approximately 90% of the individual in population survived. 96% of the individual in the community survived where the cancer was limited did not spread to other parts (Harris, Ismaila, McShane & Hayes,2016). Some people do not show any symptoms of breast cancer, but some individuals show signs after screening with the mammogram. Breast cancer is genetic and inherited to the next generation.

Importance to Nursing

Breast cancer is one of the major category of cancer that predominant in female. However, it is the preventable disease if appropriate precautions along with the care are provided to the patient. Nurses play an essential role in curing breast cancer (Welch, Prorok, O’Malley & Kramer, 2016). By understanding the fundamental principles of radiotherapy, nurses generally provide two kinds of care to the patient. One care is supportive care where nurses identify, validate the physical and social and psychological problem associated to the breast cancer (Grantzau & Overgaard, 2015). Moreover, nurses demonstrate the therapeutic advantage of curing breast cancer by effective communication with family members of the patient. Nurses collaborate with the multidisciplinary team for providing care that is best for the patient. Another type of the care nurses contribute to the patient is informative provision and education. In this  type of care, nurses demonstrate the advantage of the importance of self-care and significance of healthy lifestyle, how to reduce distress and make informed decision about different option of treatment procedure (DragesetLindstrøm, Giske & Underlid, 2016)

Personal Reflection

Reporting

When I was posted in emergency department of oncology of Royal prince Alfred hospital, a 65 years old woman was admitted to the hospital at evening 6:30pm. Her family was waiting outside of the hospital.

Responding

She had severe pain in breast and her nipples were swollen. She had discomfort in her face and she was continuously saying that she had severe pain in every portion of breast and her breast was heavy. I noticed that her nipples were abnormal. Moreover, she had a huge lump in her breasts.

Relating I immediately carried out the screening of the breasts by using mammograms. I took the sample of the abnormal breast with a needle for core biopsy of the breast and sent it to the pathological lab. I was providing her mental support to ease her discomfort.

Reasoning After analysing her biopsy report I understood that she had breast cancer. After analysis, I talk to multidisciplinary team for providing her chemotherapy. Moreover, I demonstrated her family members the advantage of chemotherapy and side effects of chemotherapy. It was also suggested to use the adjuvant therapy as optional therapy to the multidisciplinary team for the sake of the patient (Gnant et al., 2015).

Reconstructing Thus, it can be concluded that she was admitted to the hospital due to severe breast pain and after mammogram, biopsy it was confirmed that she had breast cancer. Chemotherapy, proper life style and self care are the important factors in order to prevent breast cancer (Pavone et al., 2017).

Aim

Breast cancer is considered as one of the leading cancer around the globe that affects the pregnancy of women. Majority of the women diagnosed with breast cancer before they complete their reproductive plan. Although the survival rate improved over the year, due to chemotherapy, a significant number of females are experiencing the issues related to the fertility. Therefore, many women were advised against pregnancy for avoiding such complication due to chemotherapy. Thus, the aim of this study is to preserve fertility by using modified chemotherapy for the sake of the patient with breast cancer.

PICO (Quantitative)

Population Female with breast cancer that suffering from the fertility issues due to chemotherapy

Intervention Chemotherapy with adjuvant therapy

Control/ comparison Adjuvant and chemotherapy combination is more effective than traditional  chemotherapy

Outcome Fertility preservation by preventing loss of  ovarian reserve

Research Question

Is adjuvant therapy with combination with chemotherapy is efficient than tradition chemotherapy in females with breast cancer?

Search Strategy

In order to get the best evidence for research, Key words were used such as breast cancer, fertility issues, how adjuvant therapy helped to preserve fertility. The databases used for research are pub med, Medline, Google scholar, CINAHL. The methods used for search strategy are both qualitative and quantitative. To strengthen the research, accumulated evidences and best practice has been searched for accurate information. Moreover, the research information mainly based on the population who were going through the therapy or already survived the therapy.

Best Evidence

Best Practice Level of Evidence Study Design In-text Citation in CDU APA 6^th Format

Breast cancer survival Level iv quantitative Dieci et al., 2018

Pregnancy after breast cancer Level iv Survey and quantitative Dabrosin ,2015

Hormonal receptor positive breast cancer Level v Quantitative study with primary analysis Sparano et al., 2018

Findings

Fertility preservation becomes increasingly important for women who survived cancer along with women who are going through chemotherapy.  However, chemotherapy drugs interrupted the normal cellular processes and this processes arrested. Moreover, Oxidative damage of DNA in somatic and germ line cells observed in patient after going through the process of chemotherapy (Dieci et al., 2018) . Degree of damage also varies in different individuals and types of chemotherapeutics used to treat breast cancer. Moreover, the older women are more susceptible to loss of ovarian reserve due to low amount of oocyte as compared to the young women with significant amount of ovarian reserve. Even women experiencing early menopause in their life if they menstruated during the session of chemotherapy .Therefore, depending on age and menstrual cycle, women are experiencing premature ovarian failure (Dabrosin, 2015). Recent evidence suggested that this loss can be prevented by using adjuvant therapy with combination with chemotherapy. The adjuvant therapy that is used for preserving the ovary termed as Ferto-protective adjuvant therapy. This adjuvant therapy should be administrated in patient prior to chemotherapy according to the guideline of the cancer therapy. Mainly hormonal based adjuvant therapies are used to prevent the loss of chemotherapy. The mechanism of this therapy is that the hormone suppresses the functions of ovary during chemotherapy (Sparano et al., 2018). Subsequently, it prevents the premature ovarian failure during chemotherapy. However, to administrate the hormones in the patient with breast cancer, collaboration between oncologists, reproductive endocrinologists, and urologists is important. Otherwise, patients might experienced other complication associated with cancer ( Dabrosin ,2015) .

Conclusion:

Thus, it can be concluded that breast cancer is considered as one of the leading cancer around the globe that affects the pregnancy of women. However, chemotherapy for curing breast cancer had huge effect on the disease. In majority of the cases, due to chemotherapy a significant number of women become fertile. However, combinations of adjuvant therapy with chemotherapy prevent all the loss of oocytes during the chemotherapy.  Therefore, many women can plan their pregnancy even after survival with breast cancer.

References

Dabrosin, C. (2015) . An overview of pregnancy and fertility issues in breast cancer patients. Annals of medicine, 47(8), 673-678. Retrieved from : https://dx.doi.org/10.3109/07853890.2015.1096953

Dieci, M. V., Ghiotto, C., Barbieri, C., Griguolo, G., Saccardi, C., Gangemi, M., … & Tasca, G. (2018). Patterns of Fertility Preservation and Pregnancy Outcome After Breast Cancer at a Large Comprehensive Cancer Center. Journal of Women’s Health. Doi: 10.1089/jwh.2018.6986

Drageset, S., Lindstrøm, T. C., Giske, T., & Underlid, K. (2016). Women’s experiences of social support during the first year following primary breast cancer surgery. Scandinavian journal of caring sciences, 30(2), 340-348. doi: 10.1111/scs.12250

Gnant, M., Pfeiler, G., Dubsky, P. C., Hubalek, M., Greil, R., Jakesz, R., … & Bjelic-Radisic, V. (2015). Adjuvant denosumab in breast cancer (ABCSG-18): a multicentre, randomised, double-blind, placebo-controlled trial. The Lancet, 386(9992), 433-443.

Grantzau, T., & Overgaard, J. (2015). Risk of second non-breast cancer after radiotherapy for breast cancer: a systematic review and meta-analysis of 762,468 patients. Radiotherapy and Oncology, 114(1), 56-65. Retrived from: https://www.thegreenjournal.com/article/S0167-8140(14)00412-5/pdf

Harris, L. N., Ismaila, N., McShane, L. M., & Hayes, D. F. (2016). Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: American Society of Clinical Oncology clinical practice guideline summary. Journal of oncology practice, 12(4), 384-389.retrived from: https://ascopubs.org/doi/pdfdirect/10.1200/JOP.2016.010868

Sparano, J. A., Gray, R. J., Makower, D. F., Pritchard, K. I., Albain, K. S., Hayes, D. F., … & Lively, T. (2018). Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. New England Journal of Medicine.DOI: 10.1056/NEJMoa1804710.

Pavone, M., Moravek, M. B., Lawson, A. K., Klock, S., Confino, R., Smith, K. N., & Kazer, R. R. (2017). Fertility preservation (FP) in breast cancer patients does not delay time to cancer treatment. Fertility and Sterility, 108(3), e184. Retrived from: https://cancerforum.org.au/wp-content/uploads/2017/03/Cancer-Forum-March-2017small21.pdf#page=35

Welch, H. G., Prorok, P. C., O’Malley, A. J., & Kramer, B. S. (2016). Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness. New England Journal of Medicine, 375(15), 1438-1447. DOI: 10.1056/NEJMoa1600249