Evidence Based Health Research on Breast Cancer

This research paper discusses breast cancer, its impact on fertility, and the importance of adjuvant therapy with chemotherapy in preserving fertility. It also covers the role of nurses in caring for breast cancer patients and personal reflections on a patient case. The study's aim is to explore the effectiveness of adjuvant therapy in preserving fertility in women with breast cancer.

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

1
EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
Introduction:
Breast cancer is defined as one of the major catagory of cancer that developed in breast
tissues. The symptoms of breast cancer include the lump observed in the breast, swelling
observed in nipples, laceration in nipples. Breasts of the individuals might change shape due to
breast cancer. In Australia, it is the leading cancer that experienced by majority of the women in
Australia. Hence, this paper will focus on background of the breast cancer, importance to
nursing, personal reflection, aim of the study, search strategy and findings in following
paragraphs.
Assessment 2a
Background
Breast cancer is described as the second leading category of cancer that Australian female are facing.
Breast cancer is defined as the abnormal growth of cell line that is observed in breast ducts in
women. These cells have the potential to spread in different parts of the body (Welch, Prorok,
O’Malley & Kramer, 2016). Both the genders can develop breast cancer although it is more
predominant in the case of the female population. However, the survival rate for breast cancer is
higher than any other disease. In Australia, the report of the five-year survey suggested that
approximately 90% of the individual in population survived. 96% of the individual in the community
survived where the cancer was limited did not spread to other parts (Harris, Ismaila, McShane &
Hayes,2016). Some people do not show any symptoms of breast cancer, but some individuals show
signs after screening with the mammogram. Breast cancer is genetic and inherited to the next
generation.

2
EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
Importance to Nursing
Breast cancer is one of the major category of cancer that predominant in female. However, it is the
preventable disease if appropriate precautions along with the care are provided to the patient. Nurses
play an essential role in curing breast cancer (Welch, Prorok, O’Malley & Kramer, 2016). By
understanding the fundamental principles of radiotherapy, nurses generally provide two kinds of care
to the patient. One care is supportive care where nurses identify, validate the physical and social and
psychological problem associated to the breast cancer (Grantzau & Overgaard, 2015). Moreover,
nurses demonstrate the therapeutic advantage of curing breast cancer by effective communication
with family members of the patient. Nurses collaborate with the multidisciplinary team for providing
care that is best for the patient. Another type of the care nurses contribute to the patient is
informative provision and education. In this type of care, nurses demonstrate the advantage of the
importance of self-care and significance of healthy lifestyle, how to reduce distress and make
informed decision about different option of treatment procedure (DragesetLindstrøm, Giske &
Underlid, 2016)
Personal Reflection
Reporting
When I was posted in emergency department of oncology of Royal prince
Alfred hospital, a 65 years old woman was admitted to the hospital at

3
EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
evening 6:30pm. Her family was waiting outside of the hospital.
Responding
She had severe pain in breast and her nipples were swollen. She had
discomfort in her face and she was continuously saying that she had severe
pain in every portion of breast and her breast was heavy. I noticed that her
nipples were abnormal. Moreover, she had a huge lump in her breasts.
.
Relating
I immediately carried out the screening of the breasts by using
mammograms. I took the sample of the abnormal breast with a needle for
core biopsy of the breast and sent it to the pathological lab. I was
providing her mental support to ease her discomfort.
Reasoning After analysing her biopsy report I understood that she had breast cancer.
After analysis, I talk to multidisciplinary team for providing her
chemotherapy. Moreover, I demonstrated her family members the
advantage of chemotherapy and side effects of chemotherapy. It was also

4
EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
suggested to use the adjuvant therapy as optional therapy to the
multidisciplinary team for the sake of the patient (Gnant et al., 2015).
Reconstructing
Thus, it can be concluded that she was admitted to the hospital due to
severe breast pain and after mammogram, biopsy it was confirmed that she
had breast cancer. Chemotherapy, proper life style and self care are the
important factors in order to prevent breast cancer (Pavone et al., 2017).
Assessment 2b
Aim
Breast cancer is considered as one of the leading cancer around the globe that affects the pregnancy
of women. Majority of the women diagnosed with breast cancer before they complete their
reproductive plan. Although the survival rate improved over the year, due to chemotherapy, a
significant number of females are experiencing the issues related to the fertility. Therefore, many
women were advised against pregnancy for avoiding such complication due to chemotherapy. Thus,
the aim of this study is to preserve fertility by using modified chemotherapy for the sake of the
patient with breast cancer.

5
EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
PICO (Quantitative)
Population
Female with breast cancer that suffering from the fertility issues due to
chemotherapy
Intervention Chemotherapy with adjuvant therapy
Control/ comparison
Adjuvant and chemotherapy combination is more effective than traditional
chemotherapy
Outcome Fertility preservation by preventing loss of ovarian reserve
Research Question
Is adjuvant therapy with combination with chemotherapy is efficient than tradition chemotherapy in
females with breast cancer?
Search Strategy
In order to get the best evidence for research, Key words were used such as breast cancer, fertility
issues, how adjuvant therapy helped to preserve fertility. The databases used for research are pub
med, Medline, Google scholar, CINAHL. The methods used for search strategy are both qualitative
and quantitative. To strengthen the research, accumulated evidences and best practice has been
searched for accurate information. Moreover, the research information mainly based on the
population who were going through the therapy or already survived the therapy.
Best Evidence

6
EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
Best Practice Level of Evidence Study Design In-text Citation in
CDU APA 6th Format
Breast cancer survival Level iv quantitative Dieci et al., 2018
Pregnancy after breast
cancer
Level iv Survey and quantitative Dabrosin ,2015
Hormonal receptor
positive breast cancer
Level v Quantitative study with
primary analysis
Sparano et al., 2018
Findings
Fertility preservation becomes increasingly important for women who survived cancer along with
women who are going through chemotherapy. However, chemotherapy drugs interrupted the normal
cellular processes and this processes arrested. Moreover, Oxidative damage of DNA in somatic and
germ line cells observed in patient after going through the process of chemotherapy (Dieci et al.,
2018) . Degree of damage also varies in different individuals and types of chemotherapeutics used to
treat breast cancer. Moreover, the older women are more susceptible to loss of ovarian reserve due to
low amount of oocyte as compared to the young women with significant amount of ovarian reserve.
Even women experiencing early menopause in their life if they menstruated during the session of
chemotherapy .Therefore, depending on age and menstrual cycle, women are experiencing premature
ovarian failure (Dabrosin, 2015). Recent evidence suggested that this loss can be prevented by using
adjuvant therapy with combination with chemotherapy. The adjuvant therapy that is used for
preserving the ovary termed as Ferto-protective adjuvant therapy. This adjuvant therapy should be
administrated in patient prior to chemotherapy according to the guideline of the cancer therapy.
Mainly hormonal based adjuvant therapies are used to prevent the loss of chemotherapy. The

7
EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
mechanism of this therapy is that the hormone suppresses the functions of ovary during
chemotherapy (Sparano et al., 2018). Subsequently, it prevents the premature ovarian failure during
chemotherapy. However, to administrate the hormones in the patient with breast cancer,
collaboration between oncologists, reproductive endocrinologists, and urologists is important.
Otherwise, patients might experienced other complication associated with cancer ( Dabrosin ,2015) .
Conclusion:
Thus, it can be concluded that breast cancer is considered as one of the leading cancer around the
globe that affects the pregnancy of women. However, chemotherapy for curing breast cancer had
huge effect on the disease. In majority of the cases, due to chemotherapy a significant number of
women become fertile. However, combinations of adjuvant therapy with chemotherapy prevent all
the loss of oocytes during the chemotherapy. Therefore, many women can plan their pregnancy even
after survival with breast cancer.
References

8
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. Retrieved from : 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
Drageset, S., Lindstrøm, T. C., Giske, T., & Underlid, K. (2016). Women's experiences of social
support during the first year following primary breast cancer surgery. Scandinavian journal
of caring sciences, 30(2), 340-348. doi: 10.1111/scs.12250
Gnant, M., Pfeiler, G., Dubsky, P. C., Hubalek, M., Greil, R., Jakesz, R., ... & Bjelic-Radisic, V.
(2015). Adjuvant denosumab in breast cancer (ABCSG-18): a multicentre, randomised,
double-blind, placebo-controlled trial. The Lancet, 386(9992), 433-443.
Grantzau, T., & Overgaard, J. (2015). Risk of second non-breast cancer after radiotherapy for breast
cancer: a systematic review and meta-analysis of 762,468 patients. Radiotherapy and
Oncology, 114(1), 56-65. Retrived from: https://www.thegreenjournal.com/article/S0167-
8140(14)00412-5/pdf
Harris, L. N., Ismaila, N., McShane, L. M., & Hayes, D. F. (2016). Use of biomarkers to guide

9
EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER
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.retrived from:
http://ascopubs.org/doi/pdfdirect/10.1200/JOP.2016.010868
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.
Pavone, M., Moravek, M. B., Lawson, A. K., Klock, S., Confino, R., Smith, K. N., & Kazer, R. R.
(2017). Fertility preservation (FP) in breast cancer patients does not delay time to cancer
treatment. Fertility and Sterility, 108(3), e184. Retrived from: https://cancerforum.org.au/wp-
content/uploads/2017/03/Cancer-Forum-March-2017small21.pdf#page=35
Welch, H. G., Prorok, P. C., O’Malley, A. J., & Kramer, B. S. (2016). Breast-cancer tumor size,
overdiagnosis, and mammography screening effectiveness. New England Journal of
Medicine, 375(15), 1438-1447. DOI: 10.1056/NEJMoa1600249

10
EVIDENCE BASED HEALTH RESEARCH ON BREAST CANCER