Evidence Based Health Research on Breast Cancer

This research paper explores the latest evidence based health research on breast cancer and focuses on preserving fertility in breast cancer survivors with modified chemotherapy. The paper includes annotated bibliography, justification of evidence, relevance to nursing and barriers to practice.

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EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
Evidence based health research on breast cancer
Name of the student
Name of the university
Author note:

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EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
Assessment 3
Introduction
Breast cancer considered the major category of cancer that experienced by the majority of the
women in Australia. Approximately, 49 women are diagnosed with breast cancer each day in
Australia . The issues were resolved by the implementation of chemotherapy in the medical field.
However, the treatment of breast cancer gives rise to the ovarian failure that experienced by
approximately more than 11,000 women younger than 40 years old (Burstein, Lacchetti, &
Griggs, 2016). Since majority of the breast cancer patient are facing the fertility issues I am
interested in the topic so that I can use the knowledge in my nursing practice. Although the
survival rate of breast cancer improved every year, many women were advised against pregnancy
for avoiding complications due to chemotherapy (Francis et al.,2016). Therefore, the aim of the
research is to preserve the fertility of breast cancer survival with modified chemotherapy for
preventing ovum loss.
Best Evidence
Best Practice Level of Evidence Study Design In-text Citation in CDU
APA 6th Format
Hormonal receptor positive
breast cancer
Level ii Prospective
randomized trial
Sparano et al., 2018
Pregnancy after breast Level iv Survey and Dabrosin, 2015

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EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
cancer quantitative
Breast cancer survival Level iii Retrospective
cohort study
Dieci et al., 2018
Annotated Bibliography
Sparano, J. A., Gray, R. J., Makower, D. F., Pritchard, K. I., Albain, K. S., Hayes, D. F., ...
& Lively, T. (2018). Adjuvant chemotherapy guided by a 21-gene expression assay in
breast cancer. New England Journal of Medicine. doi: 10.1056/NEJMoa1804710.
The major purpose of the study is to evaluate whether the adjuvant therapy along with
chemotherapy is effective to the preserve fertility in the patient who survived the breast cancer.
According to the author Sparano et al., 2018, Adjuvant chemotherapy reduces the risk of
recurrence of breast cancer in younger women compared to the women of mid-age. The benefit
of adjuvant chemotherapy predicted based on the reoccurrence score of 21 gene breast cancer
assay. The study suggested that up to 85 % of women benefited by the adjuvant chemotherapy of
age of 50 years or older but reoccurrence score is low than 25 and effective for younger who has
the score lower than 15.
The strength of the paper relies on the study design. The authors conducted the prospective
randomized trial with 10,273women with hormone positive respecter along with other factors.
However, the limitation of the study is that the authors did not collect the data on the
chemotherapy-induced menopause

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EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
Dabrosin, C. (2015). An overview of pregnancy and fertility issues in breast cancer
patients. Annals of medicine, 47(8), 673-678.
http://dx.doi.org/10.3109/07853890.2015.1096953
The major purpose of the study is to evaluate the effect of the adjuvant therapy with the
combination of chemotherapy breast cancer survival patients. The study suggested that
chemotherapy drugs interrupted the normal cellular processes and arrests the cell division.
Therefore, the use of chemotherapy leads to the fertility loss in women with breast cancer.
However, most of the women experience fertility loss after the chemotherapy along with
premature menopause. The older women are more susceptible to the therapy as compared to the
younger women due to fewer amounts of reserved oocytes. They experience the early menopause
if they menstruated during the chemotherapy. The hormone-based therapies prevent the loss of
the oocyte by suppressing the activity of the ovary during chemotherapy.
The strength of study relies on the choice of study such as survey and literature of 30 other
studies and limitation of the study relies on the fact that the researcher did not focus on the
primary data rather secondary data and there was no data for randomized trial control.
Dieci, M. V., Ghiotto, C., Barbieri, C., Griguolo, G., Saccardi, C., Gangemi, M., ... & Tasca,
G. (2018). Patterns of Fertility Preservation and Pregnancy Outcome After Breast Cancer
at a Large Comprehensive Cancer Center. Journal of Women's Health. 386(9992), 433-443.

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EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
Doi: 10.1089/jwh.2018.6986
The major purpose of the study is to evaluate the long term outcome of breast cancer survival
along with the efficiency of being pregnant. This study assesses the evolution of preservation of
fertility over time and reports of the outcome related to the pregnancy of the younger patient.
The researchers conducted the study by retrospective cohort with 590 breast cancer patient. The
fertility issues identified in the patient who received the chemotherapy because of the breast
cancer. Two cohort studies were conducted within 2004- 2006 and 2014-2016 respectively. The
fertility issues decreased over the time in the patients due to the adjuvant therapy.
The strength of the study relies on the study design such as retrospective cohort and sample size
of 590 breast cancer patient. However, the limitation of the study relies on the fact that it has
insufficient data of formal recommendation on correct timing of pregnancy.
Justifying the Evidence
In the paper, the authors conducted a prospective clinical trial with the help of the national
cancer institute (, Sparano et al., and 2018). The women who were participated in the clinical
trials were in between 18 to 72 with hormone receptor positive. On the basis of 21 gene assay
reoccurrence score, women with the score lower than 10 received only endocrine therapies and
who scored more than 26 assigned to received the chemotherapy along with the endocrine
therapy (Sparano et al., 2018). Women with the reoccurrence score of 11 to 26 received either of

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EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
the therapy randomly chosen. In the prospective study of these women, the results suggested that
those women who score in between 11 to 25 on the basis of 21 gene assay, the effect of
chemotherapy and chemoendotherapy are nearly similar. This result suggested that the adjuvant
therapy is not effective for the individuals who had midrange reoccurrence. On the other hand,
women who are 50 years or younger than that and had the scores in between 16 to 25. Adjuvant
showed the greater effect than compared to others. The reason partly explained by the fact the
anti-estrogenic effect that is correlated with chemotherapy-induced menopause (Cameron et al.,
2016). Therefore, pregnancy can be restored. However, the researchers did not collect the data on
chemotherapy-induced menopause or the effect of ovarian suppression. Therefore, further
research can be needed.
In the paper, Dabrosin, (2015), the author conducted a survey and collected information from
and surveys suggested that the mortality rate is more likely higher in case of pregnancy-
associated breast cancer compared to women with non-pregnancy associated breast cancer.
Although the breast cancer survival rate increased over the year, the issues related to the
pregnancy still requires a solution. The data on pregnancy after breast cancer diagnosis suggested
the option of fertility preservation found to be safe before starting the chemotherapy, especially
in premenopausal women who were diagnosed with early stage of breast cancer. However, the
risk of chemotherapy depends on the women the age and type of the chemotherapy received by
women. Older women showed the higher risk of premature failure, approximately 61% to 97%
compared to the younger women who have the lower risk, approximately 22 to 61% (Dabrosin,
2015). The reason explained by the limited number of oocytes in the ovary in older women
compared to younger women significant amount of ovarian reserve. The loss can be prevented
by administration of adjuvant therapy prior to chemotherapy according to the guideline of the

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EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
cancer therapy (Crown, et al., 2016). This adjuvant therapy suppresses the activity of ovary
during the chemotherapy and prevents the loss.
In the paper, Dieci et al., (2018), The researchers conducted the study by retrospective cohort
with 590 breast cancer patient. The fertility issues identified in the patient who received the
chemotherapy. Two cohort studies were conducted within 2004- 2006 and 2014-2016
respectively (Dieci et al., 2018). The fertility issues decreased over the time in the patients due to
the adjuvant therapy. Within 26 cases in the medical records suggested the successful pregnancy
after diagnosis due to fertility preservation. The main fertility issues also observed due to
unawareness of physicians which decreases over the years (Crown, et al., 2016). In this study
and supporting literature suggested that the concern of fertility issues in both ends significantly
reduces the chances of ovarian failure.
The aim of the research is to reduce the premature ovarian failure with help of adjuvant therapy
which will suppress the activity of the ovary. These papers showed that the adjuvant therapy
along with chemotherapy is more effective in younger women who had breast cancer or survived
breast cancer compared to older women with limited ovarian reserve.
Relevance to Nursing and Barriers to Practice

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EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
The issues of the breast cancer are experienced by the considerate number of the Australian
woman and can be resolved by the implementation of chemotherapy in a medical field (Turner et
al., 2015). However, the chemotherapy induces the premature loss of ovary and can be preserved
by administration of adjuvant therapy prior to the chemotherapy. Nurses play the massive role in
successful adjuvant therapy, therefore, the implementation is important for evidence-based
practices (Crown, et al., 2016). The nurses are the direct caregiver and important part of the
multidisciplinary team since they check the toxicity before the therapy, assessment of
chemotherapy, patient’s history and decision making and effective communication with the
patient and family members of the patient (Harris, Ismaila, McShane & Hayes,2016).The
structured documentation of the information, detailed diet after the adjuvant and monitoring of
vital signs of the patient evaluated by the nurse and, informed consent from the patient respecting
the values of the patient also taken in to consideration by the nurse (Cameron et al., 2016).
The prime barrier of the practice of the adjuvant therapy is the non-adherence to the adjuvant
therapy. Due to the high cost of adjuvant therapy, patients do not adhere to the practices. In
many health care centres, lack of accurate infrastructures, advanced technology and lack of
sound knowledge of the practitioner act as a major barrier of the practice (Willson et al., 2017).
Women who are the higher risk were more non-adherent to the therapy due to the negative
experience of previous chemotherapy. The current researches suggested that women who tend to
experience the menopausal symptoms. Due to the lack of sound knowledge, most of the
individual treated by a general practitioner, not by the specialist (Jun, Kovner, & Stimpfel,
2016). Therefore, the adherence to adjuvant therapy decreases. Regardless of the high quality of
researches, The personal beliefs and cultures have are the massive hindrance to clinical practice.
Due to persistent believes the huge number of individuals do not adhere to the therapy and find

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EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
the clinical approaches offensive.
References
Burstein, H. J., Lacchetti, C., & Griggs, J. J. (2016). Adjuvant Endocrine Therapy for
Women With Hormone Receptor–Positive Breast Cancer: American Society of Clinical
Oncology Clinical Practice Guideline Update on Ovarian Suppression Summary. Journal
of oncology practice, 12(4), 390-393.
http://ascopubs.org/doi/full/10.1200/jop.2016.01123.
Cameron, D., Piccart-Gebhart, M. J., Gelber, R. D., Procter, M., Goldhirsch, A., de
Azambuja, E., ... & Baselga, J. (2017). 11 years' follow-up of trastuzumab after adjuvant
chemotherapy in HER2-positive early breast cancer: final analysis of the HERceptin
Adjuvant (HERA) trial. The Lancet, 389(10075), 1195-1205. doi: 10.1016/S0140-
6736(16)32616-2
Crown, J., Walshe, J., Fennelly, D., Long, J. C., Cairney, S., McDonnell, D., ... & Gullo, G.
(2017). 206PIncidence of permanent alopecia following adjuvant chemotherapy in
women with early stage breast cancer. Annals of Oncology, 28(suppl_5).
https://doi.org/10.1093/annonc/mdx362.056
Dabrosin, C. (2015) . An overview of pregnancy and fertility issues in breast cancer patients.

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EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
Annals of medicine, 47(8), 673-678. http://dx.doi.org/10.3109/07853890.2015.1096953
Dieci, M. V., Ghiotto, C., Barbieri, C., Griguolo, G., Saccardi, C., Gangemi, M., ... & Tasca,
G. (2018). Patterns of Fertility Preservation and Pregnancy Outcome After Breast Cancer
at a Large Comprehensive Cancer Center. Journal of Women's Health. doi:
10.1089/jwh.2018.6986
Francis, P. A., Regan, M. M., Fleming, G. F., Láng, I., Ciruelos, E., Bellet, M., ... & Martino,
S. (2015). Adjuvant ovarian suppression in premenopausal breast cancer. New England
Journal of Medicine, 372(5), 436-446. doi: 10.1056/NEJMoa1412379
Harris, L. N., Ismaila, N., McShane, L. M., & Hayes, D. F. (2016). Use of biomarkers to
guide decisions on adjuvant systemic therapy for women with early-stage invasive breast
cancer: American Society of Clinical Oncology clinical practice guideline summary.
Journal of oncology practice, 12(4), 384-389.
http://ascopubs.org/doi/pdfdirect/10.1200/JOP.2016.010868
Jun, J., Kovner, C. T., & Stimpfel, A. W. (2016). Barriers and facilitators of nurses’ use of
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Krop, I., Ismaila, N., & Stearns, V. (2017). Use of biomarkers to guide decisions on adjuvant
systemic therapy for women with early-stage invasive breast cancer: American Society of
Clinical Oncology clinical practice focused update guideline summary. Journal of
oncology practice, 13(11), 763-766.
http://ascopubs.org/doi/full/10.1200/jop.2015.005215

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EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
Sparano, J. A., Gray, R. J., Makower, D. F., Pritchard, K. I., Albain, K. S., Hayes, D. F., ... &
Lively, T. (2018). Adjuvant chemotherapy guided by a 21-gene expression assay in
breast cancer. New England Journal of Medicine.doi : 10.1056/NEJMoa1804710.
Turner, N. C., Ro, J., André, F., Loi, S., Verma, S., Iwata, H., ... & Giorgetti, C. (2015).
Palbociclib in hormone-receptor–positive advanced breast cancer. New England Journal
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Willson, M. L., Vernooij, R. W., Gagliardi, A. R., Armstrong, M., Bernhardsson, S.,
Brouwers, M., ... & Jones, S. (2017). Questionnaires used to assess barriers of clinical
guideline use among physicians are not comprehensive, reliable, or valid: a scoping
review. Journal of clinical epidemiology, 86, 25-38.
https://doi.org/10.1016/j.jclinepi.2016.12.012.