A healthy lifestyle leads to better recovery during and after breast cancer treatment
Care project: involving family members in post-operative care
Around 14,000 women are diagnosed with breast cancer each year. About a quarter of them are under 50. Breast cancer treatment is becoming increasingly successful, and the majority of patients have a good prognosis. However, both treatment and disease are far-reaching, both having a major impact on physical as well as psychosocial function, and getting back to work.
Scientific research has shown that adapting lifestyle and mindset early on leads to better recovery and therefore better quality of life in both the short and longer term. "Good aftercare starts with advance care."
We started two years ago with a project called 'nutrition advice for breast cancer patients having systemic therapy'. The aim of the project was, in particular, a survey of whether to give lifestyle advice, and how useful it is.
Recipe book and cookery workshop for oesophageal cancer patients
At the Amsterdam University Medical Center, AMC site, care of cancer patients who have undergone major abdominal surgery is shared between nurses and carers.
These patients require highly complex care. Following discharge, care continues at home with family members. Family members are not usually well-prepared for this active role. A programme was therefore developed for actively involving family members in care, during the stay in hospital. This programme fits in well with the current trend for patient and family-centred care. Family members get involved in precisely those activities that are known to have a preventive effect against complications arising. Examples include: early exercise, oral hygiene, breathing exercises or cognitive activities reducing the risk of episodes of sudden confusion. The programme was devised at a multidisciplinary level, and includes the following elements: rooming-in (optional), attending a doctor's round, written information, training by nurses, hands-on participation in care activities. Depending on the patient’s care needs and the carer’s skills, they can also help with other care activities such as dealing with wounds, running enteral feeds or injecting fraxiparin. An app has also been developed, where carers can look up information and keep track of their activities. Nurses were trained prior to the project, to involve carers actively in healthcare. To facilitate the family's presence in the hospital, two special informal care rooms were set up in the department. These rooms have a homely feel to them, and there is also a bed for the carer.
Cardiotoxicity risk factor screening in breast cancer
Everyday activities such as eating and swallowing are very difficult for patients with oesophageal cancer. The therapy they get can also lead them to lose, change or reduce their sense of taste. Oesophageal cancer patients shared tips with each other as part of a cancer rehabilitation programme, helping them keep in shape, make swallowing easier, prevent weight loss, and combat nausea. These tips had proven themselves in practical, everyday life but appeared not to be written down anywhere.
So, the Upper GI service at Ziekenhuisgroep Twente in Almelo published a recipe book for patients with oesophageal cancer. The recipe book includes recipes, stories and tips for and by patients following treatment for oesophageal cancer. Various professionals also talk about the diagnosis and treatment of this form of cancer.
Following on from the book, patient workshops have also been devised. For this, recipes from the book were prepared under the guidance of a chef and a dietician. The doctors involved took part in the workshop, so that patients could not only talk to one other, but also to the doctors in an informal setting.
Patient hand massage by volunteers
Cardiovascular disease is the leading cause of death in the Western world. Cancer treatment can also have cardiotoxic effects on cardiac function and cardiovascular structures, creating a risk of cardiovascular complications. Breast cancer patients have a 10% chance of developing cardiotoxicity following surgery and (neo)adjuvant therapy. To identify this issue early, and respond to it quickly, all patients at the Beatrix Hospital in Gorinchem are screened, following breast cancer diagnosis.
‘Logical? Oncological!’ board game
Every day, volunteers working at the Groene Hart Hospital offer patients in 12 therapy departments a hand massage. The massage is for relaxation. Nurses are also trained in this. The massage uses essential oils, so aromatherapy is also contributing to relaxation. Massages can be used widely. Not only do the patients get a massage, it is also sometimes given or taught to a loved one. District nurses and Pluszorg workers in the Groene Hart region are now also having massage lessons. Massages are also being given to members of the public during hospital open days, and even to nurses themselves on working days.
Book ‘Borst vooruit’ (Chest out)
This game was devised by an oncology nurse from the ETZ Twee Steden Hospital, in collaboration with her oncology nurse colleagues and physician associates (PA) from the gastro-intestinal surgery department. The patient benefits indirectly from the game, as it improves nurses’ expertise.
This game helps to improve nurses’ expertise in the field of stomach, (rectal) bowel and oesophageal cancer, in an interactive way. The tricky questions in the game challenge players to reason clinically in order to link their observations to medical expertise. Playing the game together increases nurses’ knowledge in a fun way. The care path relating to the gastrointestinal cancer surgery patient is incorporated into the game. This game is intended to keep everyone talking to one another.
At the Albert Schweitzer Hospital, breast cancer patients are given the “Borst vooruit” book. It includes the experiences of 64 women with breast cancer. Their experiences and advice can support women who have recently been diagnosed. The book is an initiative of the breast cancer unit at the Erasmus University Medical Center, and proceeds will go to breast cancer research.