reprinted with permission
from the publisher
Innovations in Oncology Nursing Vol 10, No. 1, pp. 1,27 1994
Coyright, 1994, Meniscus Health Care Communications
THE THEME FOR THE FOUR issues of innovations in Oncology Nursing, Volume 10, is
"Reconstructing the Body, Mind, and Soul." This first issue addresses reconstructing
the body after breast cancer. This subject encompasses several topics currently
being discussed. Two of these are the use of lumpectomy and radiation therapy
versus mastectomy, and the ongoing controversy surrounding silicone gelfilled
implants.
A trial conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP) demonstrated the value of lumpectomy with or without radiation therapy versus total mastectomy. [1] Although this trial changed the possibilities for managing the patient surgically, there are still many instances where women may not be eligible for breastconserving surgery. Reasons include the size of the breast, size of the tumor, and the patient's psychological adjustment to this surgical procedure.
Recently, the media flooded the ears of listeners with a subject that many of us thought had been put to rest--the controversy over silicone gel-filled implants. Despite the fact that these implants were introduced over 30 years ago, the FDA and the American Medical Association continue to take diverse stands on their uses. The FDA announced on April 16, 1992, that its policy would be to make these implants available only through controlled clinical trials. Women who wished to receive them for reconstruction could do so only through these studies. Women who wanted implants for augmentation would have limited access to them by participating in stage III clinical trials. [2]
Thus, the FDA dictated that implants would be available to only certain defined groups under defined conditions for a period of time, while additional effectiveness and safety information is being compiled. The AMA, on the other hand, states that women "have the right to choose silicone gel-filled or saline breast implants for both augmentation and reconstruction, after being fully informed about their risks and benefits." [2] The FDA questions whether ample information is available for women to make informed decisions.
The ongoing media attention and lack of consensus about breast surgery and reconstructive options are enough to make women faced with breast cancer ask these questions: What reconstructive option should I choose? What are my options based on? Should I have implant surgery, and is it safe? What steps should I follow to make a decision?
These are some of the questions that led to the selection of breast reconstruction as the topic for this issue of innovations in Oncology Nursing. In the feature article, Coni Ellis provides a comprehensive overview of breast reconstruction options that are available following mastectomy, along with the indications and pros and cons for each procedure.
In the article by Katharine Kostbade Hughes and her colleagues on decision making about reconstruction, the authors state, "Additional inquiry is needed to understand better the relationships among knowledge about breast cancer and its treatment, preferences for specific treatments, and the format of educational material." An excellent opportunity exists to examine further the role of information in guiding decision making on a larger scale. The decision-making process provides an arena in which nurses can conduct their own research.
The article by breast cancer survivors Susan Leigh and Norma Webb is very comprehensive not only in outlining the decision-making process that they faced as individuals, but also in pointing out that patients must be comfortable with their caregivers. In reviewing their articles, I was struck by the fact that although both had extensive nursing backgrounds and access to information that may not readily be available to the average woman facing surgery, roadblocks were still present (especially in Susan Leigh's case).
In Johanna Lombardo Ehmann's article about the role of the mastectomy nurse prosthetist, she provides information for nurses about image counseling and product options for patients who will undergo or have undergone mastectomy. The design of prostheses continues to improve, with those available today being far superior to those of the past. The author urges nurses to familiarize themselves with the products and options available to women who have had mastectomies. In addition, emphasis is placed on breast cancer rehabilitation as an ongoing process; rehabilitation does not end when one decides to have the surgical procedure.
These articles constitute an overview of reconstructive issues in breast cancer. It is clear that nurses in direct contact with breast cancer patients must continue to expand their knowledge in all of the areas discussed, and be accessible and supportive to patients as they make important choices about breast reconstruction.
2. Kessler D, Merkatz R, Schapiro R. A call for higher standards for breast implants. JAMA. 1993;270: 2607-2608,