By Carrie Vittitoe

Leah Gantz was diagnosed with Stage 2 infiltrating ductal carcinoma and underwent a bilateral mastectomy. 

If life is a journey, a diagnosis of breast cancer is one of its harrowing valleys. A woman who has to cross this valley is often fearful of what lies ahead. What unexpected threats await her? Does she have enough in her survival pack to make it through?

Local hospitals have realized that breast cancer patients are stressed and worried. That stress and worry may make it difficult for them to fully comprehend everything the doctor says during consultations. They may have worries that they think of after the office visit or that are beyond the spectrum of just surgery or just chemotherapy.

Someone to Hold Your Hand
Tina Toole-Harper, registered nurse and certified breast cancer nurse, is a cancer resource nurse specialist/nurse navigator at Baptist Health Louisville. She says the navigation program sprung from former breast cancer patients advocating for others to have what was missing when they were treated for the disease. The American College of Surgeons now has accreditation standards that address the importance of navigation programs for breast cancer patients. Toole-Harper says, “When you’ve seen one navigation program, you’ve seen one navigation program,” meaning each hospital that offers nurse navigation tweaks its program to make it uniquely special.

As a nurse navigator, Toole-Harper works with numerous surgeons, but three of them specifically request that she attend breast cancer consultations where she takes notes for the patients, some of whom come alone.

Leesa Mattingly, RN, CBCN, is a nurse navigator at Norton Cancer Institute. She has a bachelor of science in nursing and is an oncology certified nurse. One of the services she offers to patients is to help expedite appointments for diagnostic mammogram or biopsy so that patients can be seen the same day or next day. She says, “I follow the patient from suspicious finding to survivorship.”

All the Questions Answered
The questions patients have upon diagnosis are many. Mattingly says these include, “How much pain will the surgery involve?” and “Is there going to be nausea with chemotherapy?” but they also include questions such as, “How can I talk to my children about (my diagnosis)?

As nurse navigators, Mattingly and Toole-Harper provide a safe place for such questions to be asked and provide the answers to as many questions as their patients have. Mattingly says, “Knowledge is power. It empowers women to make the best choices for their care and helps take fear out of the cancer diagnosis.” Norton Cancer Institute has found that nurse navigation results in fewer missed appointments by patients.

Decisions to be Made
Women may think that their clinicians make all of the decisions about care, but this isn’t true. One of the decisions many women have is whether to have breast conserving surgery (like lumpectomy) or a mastectomy. Toole-Harper says this causes a great deal of anxiety for patients, even if survival rates are the same regardless of which surgery a woman chooses. She helps patients think about the pros and cons of their choices. Some women have to decide whether to have prophylactic removal of the other noncancerous breast. Women also have the choice of whether or not to have reconstruction following the removal of their breast.