Oncology Nursing
Clinical Nurse Resesarcher/Oncology Nurse Specialist
Goals and Areas of Research
People with cancer or at risk of cancer benefit from many kinds of research. Advances in laboratory research and in surgical research at the John Wayne Cancer Institute at Saint John’s Health Center (such as sentinel lymph node biopsy in breast cancer) have significantly changed the experience of many women with breast cancer. However, we also need to know more about the psychological, social, spiritual, and physical experience of women and their families during the time of diagnosis, deciding about treatment, getting through treatments, and surviving the disease. In contrast to basic science research, which may be focused on the molecular genetics of cancer, and medical research, which may be focused on finding the best treatment for disease, nursing and social science research is focused on a patient’s overall well-being, or quality of life, during diagnosis, treatment, recovery, and survivorship.
Quality of life, as the core area of research for this program, is an inclusive concept that considers the psychological, physical, spiritual, and social well-being of individuals and their families. This includes such factors as support from family and friends, coping styles, worry or uncertainty about health, prevention and management of side effects of treatment, cultural and spiritual beliefs and values, anxiety, and depression.
Recent Research Achievements
The goal of current clinical research studies is to examine issues important to women in their recovery from breast cancer. Symptoms that persist months after surgery or which change in nature can cause women to be fearful that these may be indications of recurrence of their breast cancer or the onset of lymphedema (swelling of the arm) and may cause them to limit upper arm activities. We have little scientific evidence about the ebb and flow of these symptoms over time.
One study being prepared for publication compared breast, arm, and shoulder symptoms, lymphedema, and sensory changes in 188 women who had breast-conserving surgery with either a standard axillary lymph node removal or sentinel lymph node biopsy at least three or more years previously. Women in the study completed a one-time symptom questionnaire and a brief physical examination of the upper arm (shoulder movement, arm circumference, and sensation to light touch with cotton and needle). We concluded from this study that the extent of the lymph node operation has a significant long-term impact on the quality of life of breast cancer survivors. Sentinel lymph node biopsy is associated with significantly less self-reported and observable long-term symptoms than standard axillary lymph node removal.
Thus our next study is comparing breast, arm, and shoulder symptoms, lymphedema, and quality of life changes over time in 129 women after breast conserving surgery with either a standard axillary lymph node removal or sentinel lymph node biopsy (“Improving Quality of Life for Women with Breast Cancer: The Role of Sentinel Lymph Node Biopsy”). Women in the study complete questionnaires about symptoms, mood, and quality of life, and have a brief physical examination of the upper arm before surgery, right after surgery, and every 6 months until 2 years after surgery. Similar to the previously mentioned study, the physical examination also includes light touch of the upper arm with a nylon type of filament (monofilament). Our preliminary findings from this study suggest that standard axillary lymph node removal is associated with significantly more self-reported and observed sensory loss immediately and through 24 months after surgery. When this study is completed, we hope to understand better how quality of life and symptom patterns change in the first two years after surgery.
Our third quality of life study is testing the role of peer counseling by telephone as an additional support after surgery for 139 women 50 years of age and older (“Enhancing Social Support for Women with Breast Cancer: Testing a Model of Volunteer Outreach”). Few studies address the effectiveness of support for older women during the stress-filled time between breast cancer surgery and start of radiation or chemotherapy, and none explore the use of senior peer counselors, volunteers trained to provide older adults with emotional support during life transitions. In partnership with Center for Healthy Aging, a nationally recognized leader in developing and providing innovative services for older adults, such as peer counseling, we trained a group of peer counselors on breast cancer and telephone counseling. Through the course of the study, 6 volunteer senior peer counselors have provided the research intervention to breast cancer survivor participants. Over 200 hours of telephone support were provided by the volunteers. Preliminary findings suggest that senior peer counseling with trained and supervised lay volunteers is a feasible intervention for supporting women after breast cancer surgery, in partnership with the clinical team. In addition, peer counseling often provided an additional level of support not found in family, friends, or other resources. Narrations of all study-related communications are being transcribed and will be analyzed to enhance our understanding of the effects of this intervention.
A fourth study is just beginning to determine the cosmetic, or body image changes, and quality of life after a woman with breast cancer undergoes total breast removal (mastectomy) and reconstruction while preserving her nipple and surrounding areola. Women in this study complete questionnaires before and every 6 months after surgery for two years. This study is a part of a larger study evaluating the long-term surgical effects of this procedure by other scientists of the John Wayne Cancer Institute at Saint John’s Health Center.