13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings
THE 13TH INTERNATIONAL CONFERENCE
HOSPITALS (HPH) - DUBLIN – MAY 18-20 2005
ON
HEALTH
PROMOTING
BREAST CANCER CARE: FINDING OUT MORE
Dr.ssa K.Cagossi, Dr.ssa L. Scaltriti, Dr.ssa M. Leporati, Dr. G. Giovanardi, Dr.ssa L.
Botticelli, Dr.ssa A.M. Pietrantonio, Dr.ssa M.G Lazzaretti, Dr. F. Artioli
INTRODUCTION
The Breast Unit provides diagnosis and management of benign and malignant breast disease
for inpatients and outpatients. The Breast Clinic joints together surgeons, medical oncologists,
physicians, physiotherapies and breast care nurses, with consultative radiotherapy services,
integrated with pathology, nuclear medicine and radiology. The Familiar Breast Cancer Clinic
provides women with a familiar history of breast cancer with advice re assessment of risk, genetic
testing where appropriate, and development of appropriate follow up and early detection methods.
The Unit offers a multidisciplinary approach including all steps from risk assessment to long
term follow up. The Unit is part of the Operative Oncologist Unit of Carpi Hospital where all types
of tumours are treated. Multidisciplinary meetings are held once in a month involving specialists,
pathologists, radiotherapists, medical oncologists, plastic surgeons and breast surgeons.
The examination of breast cancer patient is made from a team (medical oncologist, surgeon
and sometimes radiologist), twice a week.
The Breast Unit Clinic guaranties to the patients:
1. a first approach with specialist oncologist or specialist nurse experienced in diagnosing and
treating breast problems within two weeks of the GP or other specialist request,
2. a prompt referral to a team specialised in the diagnosis and treatment of breast cancer,
3. a firm diagnosis within three weeks of being referred to a hospital,
4. the opportunity of a confirmed diagnosis before consenting to treatment, including surgery,
5. access to a specialist breast care nurse trained to give information and psychological
support,
6. full information about types of surgery (including breast reconstruction, where appropriate),
and the role of medical treatments (this includes radiotherapy, chemotherapy and drugs such
as tamoxifen),
7. a full explanation about the aims of the treatments proposed and their benefits and possible
side effects,
8. as much time as the woman needs to consider treatment options,
9. a sensitive and complete breast prosthesis fitting service, where appropriate,
10. the opportunity to meet patient already treated for breast cancer and trained to offer
psychological support to new patients
11. information on all support services available to patients with breast cancer and their
families.
THE CURRENT PROBLEM IN BREAST CANCER WOMEN
Women with newly diagnosed breast cancer seek answers to many questions about their
disease and treatment options. Failure to meet these needs may cause dissatisfaction with the care
process. Physicians and other health care professionals play a key role in providing support and
information, but communication may be difficult. In one study, 84% of 97 women with stage I or II
breast cancer reported difficulties in communicating with their medical team. The most common
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13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings
difficulties reported are understanding information, expressing feelings and asking questions to the
physicians about the disease.
Supportive activities of Breast Cancer Team include:
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Explanation of pre and post surgery management
Complete psychological and emotional support
Advice on physical recuperation
Understanding of the fear of an altered body image
Teaching of exercises to enable full recovery of shoulder movements
Care of operation wound
Care of an affected arm
Advice on how cope better when undergoing chemotherapy and radiotherapy.
Provide recommendation about when, where and how obtain prosthesis and hair wigs
information on supportive group.
PSYCOLOGICAL SUPPORT
A small percentage of breast cancer patients do need in-depth psychotherapy to help them
cope with the problems that are stirred up by diagnosis and treatment. However, the decision to go
beyond seeking emotional support and enter in-depth psychotherapy is difficult.
For Stage I and Stage II disease, the general rule is that one can expect the return of both
normal physical functioning and emotional equilibrium roughly two years after diagnosis and
treatment. When emotional equilibrium does not return within that time frame, it would be wise to
ask for a psychological evaluation to determine if the woman is experiencing psychological
problems.
We have encountered several problems which may occur separately or in some combination,
and which we believe interfere with the return to emotional balance. The problems are difficulties in
interpersonal relations, the revival of conflicts existing before diagnosis and treatment, repeated loss
of functionality, and the continued intensification of emotional reactivity.
COUNSELLING
The Breast Care Unit offers a Counselling Service too.
What is counselling?
Counselling takes place when a counsellor and a client (in this case a patient) make an agreement to
meet in a private and confidential setting to explore a difficulty or distress in the client's life. One
very popular definition of counselling is that it is "helping people to help themselves". Do not
expect the counsellor to give instant and magic solutions, but rather to work with the patients
towards understanding their situation and finding their own solutions.
Why go for counselling?
Coping with a diagnosis of cancer can be devastating. Patients and their families may have
difficulty coming to terms with the illness and can experience feelings such as anxiety, fear, anger,
sadness and depression. These feelings can occur at any time during their cancer journey - possibly
many months or years down the road. Many people feel they have a difficulty speaking to a close
friend or relative. However, it is often very useful to speak to someone who is not personally
involved. A patient may be able to express worries or concerns to a counsellor that he does not wish
others to know. Also, it can be difficult for people undergoing a stressful and emotional experience
to talk to the people closest to them, as they may also be very upset.
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13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings
How can counselling help?
A counsellor will be able to provide emotional support by allowing the patients to express their
feelings and fears. The counsellor will not tell to the patient what to do, but counselling may help
the patients to see things differently and help them to find the way through a difficult patch.
Practical support
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Breast Cancer Care provides a range of practical support services for women living with
breast cancer, their friends and families.
.Breast Cancer Care also offers prosthesis fitting.
Our oncologist rehabilitator hold an extensive range of stock for women to try and choose
from.
Sometimes it helps to talk to someone who has had breast cancer.
We have several women and men throughout the hospital who had direct personal
experience of breast cancer or benign breast disease.
Breast Cancer Care also offers a range of educational courses aimed at helping women to
live with breast cancer, covering issues such as complementary therapies, healthy living
options, stress and relaxation, body awareness and talking about breast cancer.
CONCLUSIONS
The Breast Care Unit of Carpi Hospital treats patients affected by breast cancer through a
multidisciplinary approach, and try to improve their satisfaction giving them a prompt referral to a
team of specialists, psychological and practical support, counselling, information, every type of
oncological rehabilitation, included prosthesis service, and palliative care.
The results of the program's evaluation suggest that the goal has been reached, and actually the
outpatient clinic activities include:
 Breast surgical oncology (about 280 new consultations per year)
 Breast plastic surgery (about 40 consultations per year);
 Medical oncology for breast cancer (about 650 consultations per year, including 300
consultations for new patients);
 Radiotherapy for breast cancer (about 190 consultations per year).
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