Specialist breast care nurses for supportive care of women with breast cancer

Breast cancer is a complex disease which has seen survival for women improve over the last 20 years. Many of these improvements are linked to treatment advances, improved screening and a multiprofessional approach to its management. Breast Care Nurses (BCNs) work within this multiprofessional environment providing a range of interventions including support, information, patient advocacy and general liaison among the various members of the healthcare team. The objective of this review was to assess the effectiveness of individual interventions carried out by BCNs on quality of life outcomes for women with a diagnosis of breast cancer. We reviewed five studies which met the criteria for this systematic review. These involved a range of interventions and outcome measurements, and included women of various ages and in various stages of breast cancer assessment and treatment. These studies also used many different methods of reporting statistical findings and for this reason, the results of the studies could not be combined. Despite limited evidence to support their BCN role, one study which looked at follow up by the BCN compared to a doctor concluded that there were no differences for either group in terms of satisfaction with care or the ability of the healthcare provider to identify anxiety and depression. Another study showed that specific BCN interventions can alleviate perceived distress for women undergoing radiotherapy treatment however this did not have any impact on coping skills, mood or overall quality of life.

Generally speaking, this review found limited evidence to identify the components of the BCNs role which impact on a woman's quality of life but acknowledge that the nature of their work, provided within a multiprofessional team, serves to complement the team as a whole rather than highlighting the impact of the BCN alone. Further research is, however, needed which addresses the impact that BCNs may have on aspects of quality of life for women with breast cancer.

Authors' conclusions: 

There is limited evidence at this time to support the contention that interventions by BCNs assist in the short-term with the recognition and management of psychological distress for women with breast cancer. Further research is required before the impact of BCNs on aspects of quality of life for women with breast cancer can be known.

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Background: 

Breast Care Nurses (BCNs) are now established internationally, predominantly in well resourced healthcare systems. The role of BCNs has expanded to reflect the diversity of the population in which they work, and the improvements in survival of women with breast cancer. Interventions by BCNs aim to support women and help them cope with the impact of the disease on their quality of life.

Objectives: 

To assess the effectiveness of individual interventions carried out by BCN's on quality of life outcomes for women with breast cancer.

Search strategy: 

We searched the Cochrane Breast Cancer Group Specialised Register and the Cochrane Central Register of Controlled Trials (15 January 2007). We also searched MEDLINE (1966 to September 2006), CINAHL (1982 to September 2006), EMBASE (1980 to September 2006), British Nursing Index (1984 to September 2006), CancerLit (1961 to September 2006), PsycInfo (1967 to September 2006), Library and Info Science Abstracts (LISA) (1969 to September 2006), Dissertation Abstracts International (only available 2005 to September 2006). We contacted authors as appropriate.

Selection criteria: 

Randomised controlled trials assessing the effects of interventions carried out by BCN's on quality of life outcomes, for women with breast cancer.

Data collection and analysis: 

Two authors independently assessed relevant studies for inclusion and undertook data extraction and quality assessment of included studies.

Main results: 

We included five studies, categorised into three groups. Three studies assessing psychosocial nursing interventions around diagnosis and early treatment found that the BCN could affect some components of quality of life, such as anxiety and early recognition of depressive symptoms. However, their impact on social and functional aspects of the disease trajectory was inconclusive. Supportive care interventions during radiotherapy was assessed by one study which showed that specific BCN interventions can alleviate perceived distress during radiotherapy treatment, but did not improve coping skills, mood or overall quality of life. One study assessed nurse-led follow-up interventions in which no statistically significant difference was identified for main demographic variables, satisfaction with care, access to medical care or anxiety and depression.

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