Case Presentation Katrina Wells, a 54-year-old African American female, works a sedentary job in telecommunications. She has been overweight most of her life and has never engaged in physical activity on a regular basis. Because of limited finances and limited healthcare coverage, Katrina seeks health care only when she is ill.
Through a community outreach program, Katrina met Lydia Robinson, a nurse who helped her gain access to basic preventive healthcare services. Acting on the advice of Lydia, Katrina agreed to have a screening mammogram. The radiologist who reviewed the mammography films discovered a small mass in the upper outer quadrant of Katrina’s left breast. She was contacted by the radiologist and told she had an abnormal mammography result and that she needed to return to the imaging center for further workup. Katrina, not knowing what this meant, asked if she had cancer. She was told that cancer was a possibility but that further testing was needed to determine if this was the case. Katrina was upset by this information, and she was not sure she wanted any additional tests. Her mother had breast cancer, and Katrina watched her lose her breast and hair, in addition to becoming very sick from the medications. Lydia helped Katrina understand the need for the additional workup. During the next 4 weeks, Katrina underwent several tests as part of her diagnostic workup. Lydia helped Katrina by explaining the process and providing emotional support. The diagnostic mammogram and ultrasound examination of the breast revealed a 7.4 mm lesion, and a needle biopsy confirmed the diagnosis of breast cancer. The pathology showed it to have low-risk features and that it would be responsive to hormonal therapy. Katrina was referred to a surgical and medical oncologist at the local cancer center for treatment.
An oncology clinical nurse specialist at the cancer center met with Katrina at her first oncology appointment to begin guiding her through the treatment process. Due to the small size of the lesion and the low-risk features, she was told she would not need chemotherapy. Her treatment would involve only surgery and radiation, followed by 5 to 10 years of hormonal therapy to decrease the risk of recurrence. She underwent a lumpectomy followed by 5 weeks of radiation to the left breast and axillary region. Following completion of radiation, she was started on an oral aromatase inhibitor, which she was to take daily for at least the next 5 years. She was to continue visiting the medical oncologist at the cancer center every 3 to 6 months during that time. At those visits, she would get a clinical breast exam and reinforcement about how to do a breast selfexam between visits. The staff at the cancer center also arranged for her to get yearly mammograms to screen for a new or recurrent breast cancer.
Case Analysis Questions
1. What were a Katrina’s risk factors for developing breast cancer?
2. How did Katrina’s nurses help navigate her journey from diagnosis through treatment and follow up? From Jeremy Woodhouse/Blend Images/Thinkstock