Utilizing Integrative Care in Metastatic Breast Cancer

Kristie L. Kahl: What is integrative care? And why is it important to include in the treatment of metastatic breast cancer specifically?

Andrea Kassem: So integrative care is a comprehensive, holistic approach to care. It focuses on the whole person: mind, body and spirit. It's also care where the patient and the entire care team are partners throughout the patient's entire care continuum. And what integrative health is not is alternative medicine. Integrative care does not replace conventional therapies. Rather, integrative care works alongside or in addition to conventional treatments to help meet the patient's needs, whether that's physical, emotional or social. I think it's important that we include integrative care in the care of patients, because like I said, it's taking care of the whole person, not just the disease. And we have to remember that integrative care essentially is self-care. It's eating healthy food, it's exercising, it's getting good sleep, it's managing stress, it's nurturing our healthy relationships and finding meaning in life. And all of these things not only help the patient stay on track with their treatment. It supports their overall health, which helps them stay on track with life goals that are important to them, and it improves their quality of life.

Kristie L. Kahl: What are some examples of the side effects that patients might experience from treatment and how integrative care will play a role?

Andrea Kassem: There are many side effects that women unfortunately experience from the treatments of metastatic breast cancer, but I think one of the most common ones is menopausal symptoms. So we know that about 75% of breast cancers are hormone positive or estrogen sensitive, and the anti-hormonal medication that we use to treat hormone-positive breast cancer, block or decrease the estrogen in the bloodstream and then this can result in women having side effects such as hot flashes or night sweats, some fatigue, anxiety and/or depression, sleep disturbances and weight gain. In addition to menopausal symptoms, I think that we also see that some of our patients experience changes in their intimacy and their sexual relationships. And, patients may experience a decrease in their desire secondary to lack of libido and this can be caused by surgery or just from other side effects of their treatment. We know that the anti-hormonal medication can decrease their estrogen levels. Patients may also just have feelings of fear or guilt, or just lack of energy and all of that can impact a patient's libido. So I think the most important thing that we have to remember as providers is just not to assume that our patients aren't interested in their sexual health. Our sexuality is part of our femininity and our self-esteem. And we as clinicians need to facilitate open communication with our patients about their sexual health.

Kristie L. Kahl: In particular, what is the nurse’s role when it comes to managing these side effects for patients with metastatic breast cancer?

Andrea Kassem: I think as nurses, we play a couple of different roles. First and foremost, we are able to provide evidence-based holistic interventions that can help support the patient. And this can be as simple as suggesting to the patient that they start a walking routine, because we know that exercise increases endorphins. Therefore it decreases fatigue, it reduces inflammation, it improves their immune system. And those things not only help the patient feel better and feel stronger, it helps them stay on track with treatment. And the other thing is that nurses are often the single point of contact, not only for patients, but for providers. So, establishing trusted and transparent communication with our patients is key so that we can update physicians on certain side effects that patients may be experiencing in the event that they need some medication management, because we never want our patients to be suffering alone in silence.

Kristie L. Kahl: With all of these benefits from your care team, why is it important for patients to make sure they're talking about their side effects? And can you offer some advice on how they can start that conversation with their care team?

Andrea Kassem: So first and foremost, I think it's really important that patients talk to their clinicians about their side effects so that we can help them stay on track with their treatment plan. And so, we can't have delays in care because of unmanaged side effects. And so that is our primary goal. And so, just having open conversations with clinicians is so important for patients so that we can keep them on track with their treatment. And in addition, I just think, integrative care with things such as nutrition and exercise and self-care, are important components to living well with metastatic breast cancer. We never want, like I said, our patients to be suffering in silence and knowing that there are so many integrative approaches to care that can minimize side effects and improve quality of life is how we want to help our patients. I think patients need to know too, that as providers, we learn from them each and every day. And so it's so important for them to share their stories with us because it helps us care for them and for others. In my experience in working with metastatic breast cancer patients, I've found that just having upfront discussions regarding their stage and their prognosis of the disease from the onset of diagnosis sets the best expectations for their future. Being honest, and having a trusted and open dialogue with patients is the most effective approach.