From Prevention to Palliative Care: Optimizing the Breast Cancer Patient Experience With Nurse Navigation

In In The News by Barbara Jacoby

By: Darcy Burbage, MSN, RN, AOCN, CBCN


Breast cancer is the most commonly diagnosed cancer in women, with incidence rates of invasive cancer upwards of 200,000 new cases per year plus an estimated additional 63,000 cases of in situ breast cancer.1 Because of this, more than 3.5 million breast cancer survivors are alive today either with a history of breast cancer or are currently undergoing treatment for metastatic disease.

The role of the breast cancer nurse navigator is an essential component of providing quality care to patients throughout the continuum of breast care. In most clinical practices, the role of the nurse navigator was implemented in breast imaging centers to help facilitate a timely diagnosis for patients who were recommended to undergo breast biopsy. Then, the role was expanded to include assisting patients with newly diagnosed disease through the complexities of a breast cancer care from diagnosis to survivorship.

Regardless of their practice setting, the breast care nurse navigator should be knowledgeable in all aspects of the breast cancer care continuum. The most common responsibilities for the nurse navigator working to improve early detection are to provide evidence-based education on the screening guidelines, risk assessment, and reduction interventions, and collaborate with the multidisciplinary team to ensure care is coordinated in a timely manner.2

Once a patient receives a diagnosis of breast cancer, providing psychosocial support, assessing barriers to care along with ongoing education is vital to helping the patient have a better understanding of her diagnosis and proposed treatment plan. The unique relationship between the nurse navigator and the patient has been shown to reduce gaps in care, thus improving adherence to the recommended treatment plan and greater patient satisfaction.3

As the number of people with breast cancer continues to increase, challenges exist for the nurse navigator to balance volume along with acuity. In many settings, acuity tools have been developed to assist the navigator with this process. Acuity tools take into account the stage of the cancer, treatment(s) recommended, and comorbidities, as well as social determinants of health that may affect treatment adherence, such as literacy, insurance, and transportation. The higher the acuity, the more time the nurse navigator will need to spend with the patient.4

Treatment for breast cancer is usually a combination of surgery, with or without breast reconstruction, systemic treatments such as chemotherapy and/or hormonal therapy, and in some cases, radiation therapy to help with local control.1 As treatments for breast cancer are constantly changing, the breast cancer nurse navigator needs to remain current with evolving treatment modalities to continue to provide the most up-to-date education and symptom management. Potential physical effects of treatment depend on the type of treatment recommended and the patient’s overall health before treatment initiation, including any co-morbidities. Referring patients to a cancer rehabilitation specialist can help them learn how to manage symptoms such as decreased range of motion, fatigue, and neurosensory changes that may occur as a result of treatment.5 A survivorship care plan that begins at diagnosis can help patients take an active role throughout their treatment and be better prepared for transitions in care, including when treatment is completed.

In addition to the physical challenges that breast cancer can bring, the psychosocial effects of a breast cancer diagnosis can be equally as stressful. Changes in body image, anxiety, concerns with sexuality, fertility and intimacy, and changes in roles and responsibilities can affect quality of life and should be assessed throughout treatment and follow-up.6 The purpose of follow-up after treatment is to assess long-term and late effects of treatment as well as monitoring for signs of recurrence. Models of survivorship care are based on the clinical setting and may include alternating visits between the oncologist and primary care provider.7

Although supportive and palliative care is appropriate for patients at any stage of cancer, the perception is that this subspecialty is synonymous with end-of-life care. However, this is not the case. The supportive and palliative care team is an additional resource for patients and caregivers to help with symptom management.8 Most patients with recurrent breast cancer will be candidates for multiple lines of treatment to control further spread of the disease. As in early stage breast cancer, patients with recurrent disease are living longer because of increased treatment options and improved symptom management. However, despite our best efforts, patients with recurrent breast cancer will eventually face decisions regarding end-of-life care. Palliative care can also help support family caregivers who provide care to patients, as well as facilitate crucial conversations between the patient and her family to plan for the future.

In summary, the nurse navigator’s role in the breast cancer care continuum encompasses prevention through palliative care, and as such, defining your patient population and the role of your nurse navigator is an important consideration when developing a program. Additionally, determining metrics and documenting outcomes are essential in demonstrating the value of your breast cancer nurse navigation program to senior leadership.


1. American Cancer Society. Breast Cancer Facts and Figures 2017-2018. Atlanta, GA: American Cancer Society Inc; 2017.

2. McMullen L. Oncology nurse navigators and the continuum of care. Semin Oncol Nurs. 2013;29(2):105-117.

3. Korber SF, Padula C, Gray J, Powell M. A breast navigator program: barriers, enhancers, and nursing interventions. Oncol Nurs Forum. 2011;38(1):44-50.

4. Baldwin D, Jones M. Developing an acuity tool to optimize nurse navigation caseloads. Oncol Issues. 2018;33(2):17-25.

5. Martz CH, Kirby K. Symptom management. In Mahon S, ed. Guide to Breast Care for Oncology Nurses. Pittsburgh, PA: Oncology Nursing Society; 2011:141-177.

6. Campbell-Enns HJ, Woodgate RL. The psychosocial experiences of women with breast cancer across the lifespan: a systematic review. Psychooncology. 2017;26(11):1711-1721.

7. Stricker CT, O’Brien M. Implementing the commission on cancer standards for survivorship care plans. Clin J Oncol Nurs. 2014;18(suppl):15-22.

8. Ferrell BR, Temel JS, Temin S, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017;35(1):96-112.