Triple-negative Breast Cancer: What Is Known About It?

Lisa L. Ferguson, DNP, RN, WHNP-BC; Britne Curran, MSN, RN, WHNP-BC; Mary Martinez, MSN, RN, WHNP-BC; Peggy Mancuso, PhD, RN, CNM

Disclosures

Clin J Oncol Nurs. 2014;18(1) 

In This Article

Nursing Implications

Women living with breast cancer may experience depression, anxiety, low self-esteem, and poor quality of life (Boutin, 2007). Breast cancer frequently causes emotional trauma in patients, expressed with increased feelings of vulnerability, loss of control, and doubt (Schmid-Büchi, van den Borne, Dassen, & Halfens, 2010). Women affected by breast cancer may not seek help from family and friends because of feelings of guilt in burdening others (Boutin, 2007). Women with TNBC may experience increased emotional distress when faced with their higher odds of early recurrence and poorer survival rates.

Healthcare professionals, particularly nurses, are positioned to identify signs of emotional distress and plan interventions to help alleviate it early (Lim, Devi, & Ang, 2011). Having a list of resources readily available to share with patients is a key item for nurses to maintain for this purpose. Number one on any list of resources should be a breast health navigator. Breast health navigators intimately assist patients in understanding the diagnosis and available treatment options; the roles of a navigator also can include finding transportation, exploring solutions for work or financial issues, education on prescribed medication, and providing support. They assist in compiling all of the patient medical information and presenting it to them in a concrete, organized, understandable manner. This serves to decrease anxiety and reduce an overwhelming medical issue into pieces that can be comfortably managed by the patient. If institutions do not offer the services of a breast health navigator, a case manager or outpatient social worker can assist with many of the needs of patients diagnosed with TNBC. Because of the short, disease-free interval and low overall survival rate of TNBC, these patients need someone who can offer them hope. Knowledge and information is a powerful tool to decrease anxiety related to a cancer diagnosis (Cho et al., 2011). A list of psychologists is the next needed item in the nurse's resource list. Psychologists can assist patients in dealing with the emotional distress caused by a cancer diagnosis and the uncertainty of living with this chronic condition. Specific issues for patients with TNBC are the risks of earlier recurrence and lower survival rates seen in this group.

Face-to-face and online support group information are other items the nurse should provide to their patients. Winzelberg et al. (2003) found that an expertly led, web-based support group decreased distress in patients with breast cancer. Pamphlets, flyers, and internet addresses of peer support groups should be made available to patients with TNBC.

Many patients and their families will explore and gather as much data as they can. Supplying them with a list of patient education sites that are medically based and known to be accurate will help to decrease any additional distress brought on by erroneous information (see Figure 2). In addition, providing evidence-based education to patients has become recognized as standard of care. Research has shown that most effective educational methods include patient decision aids, counseling, videos, computer-based information or education, and interactive computer and multimedia interventions (Johnson et al., 2011).

Figure 2.

Patient Education and Support Resources

The risk factors for TNBC are an additional facet that nurses should incorporate into teaching women about risks for breast cancer. TNBC is more prevalent in younger women, African American and Hispanics, and women with BRCA1 mutation (Chu et al., 2011).

Interval breast cancer is defined as in situ or invasive cancer that is discovered after a negative screening mammogram and before the time of the next suggested mammogram. A larger number of interval breast cancers are TNBC (Rayson et al., 2011). Nurses must teach women about breast self-awareness to detect breast problems and emphasize routine screenings. According to the American College of Radiology (2008) and Smith, Brooks, Cokkinides, Saslow, and Brawley (2013), women aged 40 years and older should have a yearly screening mammogram. Women in their 20s and 30s are advised to have a clinical breast examination with their regular physical examination at least every three years and annually thereafter (Smith et al., 2013).

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