Elsevier

European Journal of Cancer

Volume 42, Issue 18, December 2006, Pages 3117-3126
European Journal of Cancer

Review
A nurse is a nurse? A systematic review of the effectiveness of specialised nursing in breast cancer

https://doi.org/10.1016/j.ejca.2006.07.007Get rights and content

Abstract

The effectiveness of specialised nursing in breast cancer has received limited attention. This systematic literature review aims at (i) presenting and discussing role models of specialised nursing in the area of breast cancer and (ii) suggesting avenues for future research in this field. The ten studies included in the review differ with respect to the roles of specialised nurses as well as the measured outcome variables; thus, the comparability and generalisability of results are limited. Nevertheless, the review indicates that specialised nursing in breast cancer may contribute to improved physical and psycho-social well-being. In view of the limited comparability, the authors call for (i) a more uniform definition of models of specialised nursing in breast cancer care, as well as (ii) rigorous confirmatory studies to evaluate their effectiveness. These two aspects are pivotal in providing a reliable basis for future health care strategies.

Introduction

The diagnosis of breast cancer initiates a complex process of coping with disease and different therapies. This process includes physical and psychosocial issues involving wide-ranging treatment and care needs. Thus, women with breast cancer require comprehensive nursing interventions. As breast cancer is one of the most intensively investigated areas in oncology, innovations are frequent, making breast cancer care a rapidly changing specialty. The current trend of establishing breast centres is paralleled by an increasing interest in specialised breast cancer nursing in Europe.1

In Anglo-American and Scandinavian countries, nursing of women in breast centres has been provided by specialised nurses, namely Breast Care Nurses (BCN), for at least the past 20 years.2, 3 Nurse specialists can be divided into nurse practitioners and clinical nurse specialists. In clinical practice, however, a variety of other role models of specialised nursing in breast cancer can be found. The United Kingdom is the first country to have defined the role of Breast Care Nurses on a national level: ‘Breast Care Nurse’ (level 1) refers to graduate nurses with postgraduate training in Breast Care Nursing, ‘Clinical Nurse Specialist’ (level 2) refers to BCNs with a Master’s degree, and Clinical Nurse Specialists with a PhD in the breast care area are ‘Nurse Consultants’ (level 3).4

To date, few publications have explored and discussed educational models and competency standards for specialised nurses in the field of breast cancer care. A systematic search in December 2005 in the databases CINAHL (Cumulative Index to Nursing and Allied Health Literature) (‘Breast Neoplasms’, ‘Education-Nursing’, ‘Curriculum Development’, ‘Professional Competence’, ‘Advanced Practice Nursing’, ‘Professional Development’) and Medline (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) (‘Nurse Clinician’[MeSH] OR ‘Education, Nursing’ [MeSH] AND ‘Breast Neoplasms’ [MeSH]), as well as a search for related articles, resulted in a small number of publications5, 6, 7, 8, 9 leading more deeply into the description of education models in the field. On the basis of expert interviews and online publications, a broad diversity of established Breast Care Nursing education programs can be illustrated (cf. Table 1).

Two meta-analyses found only weak indications of the effectiveness of psychological interventions by specialised nurses for cancer-patients.10, 11 To date, a systematic overview of the effectiveness of specialised nurses beyond psychological considerations is still lacking. Thus, we conducted a systematic literature search in January 2006, that aimed at examining and summarising the state of the art with respect to the effectiveness of specialised nursing in breast cancer care. Our analysis provides (i) a basis for developing new services and training in this area and (ii) a starting point for further research.

Section snippets

Methods

The review is based on a systematic search of the medical databases MEDLINE and CINAHL for articles published between 1980 and 2006.

Initially, the 383 matches were assessed with regard to the following inclusion criteria.

  • study describes and analyses specialised nursing in a comparative design

  • article is written in German or English language

  • selection of the sampling relates to women with breast cancer

Only six of the articles complied with the inclusion criteria. Four additional articles were

Results

The review systematically analysed a total of ten studies (cf. Table 3).

Discussion

The present systematic literature review provides evidence that specialised nursing can contribute to improvement of a wide range of patient outcomes. With respect to physical impairments specialised nurses may contribute to improving arm-functioning after axillary lymph node clearance, but there is questionable evidence for improved pain prophylaxis. For psycho-social impairments the review suggests a reduction of psycho-social problems including anxiety and depression by specialised nursing.

Conclusion

This review provides an orientation for the design and conceptualisation of new specialised nurse services for breast cancer patients as well as guidance for future research. Specialised nursing can contribute to an improvement in health and well-being of women with breast cancer, both on physical and psycho-social levels. Its positive effect on a reduction of anxiety and depression as well as on an improvement of well-being finds the most robust empirical support to date. Nevertheless, and in

Conflict of interest statement

None declared.

Acknowledgement

Funding was provided by ONCOSUISSE and the Bernische Krebsliga.

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