Breast cancer is a tough road, affecting patients and their families profoundly. As a hospice nurse case manager specializing in compassionate end-of-life care, I comprehend the significance of offering clear, empathetic guidance to families in this challenging situation. This article delves into the journey through breast cancer, the changes your loved one might undergo, and how to deliver optimal care from diagnosis to life’s end.
Understanding Breast Cancer Stages and Expectations
Breast cancer is a disease that affects the cells in the breasts. Sometimes, these cells grow too fast and form lumps or tumors. These tumors can differ in size, shape, and how much they spread to other body parts. Doctors use stages to describe how serious the breast cancer is and what kind of treatment is needed. Knowing the stages can help you and your family understand what your loved one is going through and how you can help them.
Early Stages (Stage 0-2)
In the early stages, breast cancer is small and has not spread to other parts of the body. The main goal of treatment is to remove the tumor and stop it from growing back. Treatment may include surgery, radiation, or targeted therapies. Surgery is when the doctor cuts out the tumor and some of the healthy tissue around it. Radiation is when the doctor uses high-energy rays to kill the cancer cells. Targeted therapies are medicines that work on specific types of breast cancer cells.
Possible Changes: Your loved one may need time to recover and heal after the treatment. They may feel tired, sore, or weak. They may also lose some or all of their hair due to radiation. They may have different emotions, such as sadness, anger, fear, or hope. It is normal to have these feelings, and it is important to talk about them. You can help your loved one by being there for them, listening to them, and encouraging them. You can also help them with daily activities, such as cooking, cleaning, or driving.
Advanced Stages (Stage 3-4)
In the advanced stages, breast cancer is large and has spread to other parts of the body, such as the bones, lungs, liver, or brain. The main goal of the treatment is to slow down the growth of the cancer and make the symptoms less severe. The treatment may include chemotherapy, immunotherapy, or hormone therapy. Chemotherapy is when the doctor uses strong medicines to kill the cancer cells. Immunotherapy is when the doctor uses medicines to boost the immune system, the body’s natural defense against diseases. Hormone therapy is when the doctor uses medicines to block or lower the hormones that make the cancer grow.
Possible Changes: The treatment for advanced breast cancer can have many side effects, such as nausea, vomiting, diarrhea, mouth sores, infections, or bleeding. These side effects can make your loved one feel extremely sick and uncomfortable. They may also lose more of their hair and weight. They may have more emotional challenges, such as depression, anxiety, guilt, or loneliness. They may worry about their future and their family. It is hard to cope with these changes, and it is okay to feel overwhelmed. You can help your loved one by being supportive, understanding, and respectful. You can also help them find comfort, joy, and meaning.
End-of-Life Stage
In the end-of-life stage, the breast cancer has spread too much, and the treatment is no longer working. The main goal of the care is to make your loved one feel as comfortable and peaceful as possible. The care may include palliative care, pain management, or emotional support. Palliative care is when the doctor and nurse work together to provide your loved one with the best quality of life. They can help with physical, emotional, social, and spiritual needs. Pain management is when the doctor and the nurse use medications or other methods to reduce or relieve the pain. Emotional support is when the doctor, the nurse, the counselor, or the chaplain helps your loved one and your family cope with the emotions and the grief.
Possible Changes: In the end-of-life stage, your loved one may have more physical and emotional symptoms, such as increased fatigue, pain, reduced appetite, difficulty breathing, confusion, or restlessness. They may also have more spiritual needs, such as finding peace, forgiveness, or closure. They may want to say goodbye to their loved ones and express their wishes. It is hard to say goodbye, and it is normal to feel sad, angry, or scared. You can help your loved one by being present, attentive, and loving. You can also help them fulfill their wishes, such as playing their favorite music, reading their favorite book, or visiting their favorite place. You can also help them say goodbye in their way, such as writing a letter, making a video, or giving a gift.
Recognizing Changes and Providing Tender Care
When someone you love has breast cancer, you want to do your best to help them. You can help them by noticing the changes in their body and mind and giving them the support they need.
Physical Changes: Breast cancer and its treatment can make your loved one feel different in their body. They may feel more tired, hungry, or in pain. They may also have trouble moving around or doing things they used to do. You can help them by watching how they feel and what they need. You can help them with their daily tasks, such as dressing, showering, or going to the bathroom. You can also make them healthy and tasty food and ensure they have a comfortable resting place.
Emotional Changes: Breast cancer and its treatment can also make your loved one feel different in their mind. They may have many emotions, such as sadness, anger, fear, or hope. Sometimes, they may feel happy, and sometimes they may feel low. You can help them by being aware of their mood and how they cope. You can start honest conversations, listen to them compassionately, and encourage them to share their feelings. You can also help them find ways to relax, such as reading, listening to music, or meditating.
Communication and Support: Breast cancer and its treatment can be hard to understand and deal with. You and your loved one may have many questions and concerns. You can help them by keeping the lines of communication open. You can offer your company and let them know you are there for them. You can also go to the medical appointments with them, write down notes, and ask the doctor or nurse questions. You can help them understand their treatment plan and what to expect.
Palliative and Hospice Care: As the breast cancer gets worse, the treatment may not work anymore. The goal of the care is to make your loved one feel as comfortable and peaceful as possible. You can help them by focusing on their comfort and quality of life. You can work with the healthcare experts to manage their symptoms, make sure they have less pain, and give them emotional support. You can also help them find meaning and purpose in their life and prepare for the end of their life.
Providing End-of-Life Care
There may come a time when the cancer treatment is no longer working, and your loved one is nearing the end of life. This can be an exceedingly difficult and emotional time for both of you. You may feel sad, angry, scared, or numb. You may also have many questions and concerns about what will happen and how to help your loved one. This section will give tips on providing end-of-life care and ensuring comfort and peace for your loved one.
Hospice Care: Hospice care focuses on making your loved one as comfortable as possible in the last months, weeks, or days of life. Hospice care does not try to cure cancer or prolong life but rather to relieve pain and other symptoms, such as nausea, shortness of breath, or anxiety. Hospice care also provides emotional and spiritual support for your loved one and family. Hospice care can be given at home, in a hospital, or at a hospice facility, depending on your loved one’s needs and preferences. You can help your loved one by:
Talking to the doctor about hospice care. You can ask the doctor if your loved one is eligible for hospice care and when it might be appropriate to start. You can also ask the doctor for a referral to a hospice program in your area. You can find more information about hospice care from the National Hospice and Palliative Care Organization or the American Cancer Society.
Choosing a hospice program that meets your loved one’s needs. You can compare hospice programs based on their services, staff, costs, and location. You can also visit the hospice facility or talk to the staff to understand their philosophy and approach. You can ask questions such as:
What services do you offer, and how often?
Who will be part of the hospice team, and how will they communicate with us?
How do you manage pain and other symptoms?
How do you provide emotional and spiritual support?
How do you involve the family in the care plan?
How do you handle emergencies or after-hours calls?
How do you coordinate with other healthcare providers?
How do you bill for your services, and what insurance do you accept?
Working with the hospice team to create a care plan. The hospice team will include a doctor, a nurse, a social worker, a chaplain, a counselor, a home health aide, and a volunteer. They will work with you and your loved one to create a care plan that reflects your loved one’s wishes and goals. The care plan will include details such as:
What medications and treatments will your loved one receive, and how will they be administered?
What equipment and supplies will your loved one need, and how will they be delivered?
What comfort measures and complementary therapies will your loved one use, such as massage, music, or aromatherapy?
What emotional and spiritual support will your loved one and your family receive, such as counseling, prayer, or rituals?
What legal and financial matters must your loved one and your family address, such as advance directives, wills, or funeral arrangements?
Providing care and support for your loved one. You will be the primary caregiver for your loved one, but you will not be alone. The hospice team will visit your loved one regularly and be available by phone 24/7. They will teach you how to care for your loved one, such as giving medications, changing dressings, or using equipment. They will also monitor your loved one’s condition and adjust the care plan. You can also ask for help from other family members, friends, or volunteers. You can help your loved one by:
Giving them their medications and treatments as prescribed and on time. Do not skip or change the doses without consulting the hospice team.
Keeping track of their pain and symptom level and how well the medications and treatments are working. Report any changes or concerns to the hospice team.
Providing comfort measures, such as massage, heat, ice, or distraction. You can also help them find a comfortable position, use pillows or cushions, or adjust the lighting or temperature in the room.
Being there for them emotionally and spiritually. Listen to their feelings and concerns without judging or interrupting. Try to be positive and hopeful but also realistic and honest. Share your feelings and fears with your loved one or someone you trust. You can also seek professional help from a counselor or therapist if you or your loved one are feeling overwhelmed, depressed, or anxious.
Emotional Well-being: The end of life can be a time of mixed emotions for your loved one and family. Your loved one may feel grateful, peaceful, or relieved but also sad, angry, or scared. They may also have regrets, unfinished business, or unfulfilled dreams. You can help your loved one by:
Help them find meaning and purpose in their lives. You can help them reflect on their life story, achievements, values, and legacy. You can also help them express their gratitude, forgiveness, or love to those who matter to them. You can use different methods like writing, drawing, recording, or making a scrapbook.
Helping them cope with their fears and worries. You can help them identify and address their sources of fear and worry, such as pain, suffering, loss of control, or the unknown. You can also help them find ways to reduce their anxiety and worry, such as talking, praying, meditating, or breathing. You can also help them find comfort and hope in their faith, beliefs, or philosophy.
Helping them create cherished memories. You can help them make the most of their time with their loved ones. You can help them plan and enjoy special occasions like birthdays, anniversaries, or holidays. You can also help them create meaningful gifts, such as letters, videos, or jewelry, for their loved ones to remember them.
Conclusion
The journey through breast cancer is a challenging and life-altering experience for patients and their families. Understanding the stages of breast cancer and the changes your loved one might undergo is crucial in delivering optimal care from diagnosis to end of life. The early stages involve treatments such as surgery, radiation, and targeted therapies, while the advanced stages may require chemotherapy, immunotherapy, or hormone therapy. In the end-of-life stage, the focus shifts to providing comfort and peace through palliative care, pain management, and emotional support. Patients’ experiences are deeply affected by the different medical stages, each unleashing specific physical, emotional, cognitive, and social processes. Recognizing the physical and emotional changes, providing tender care, and offering communication and support are essential in helping patients navigate this journey compassionately. As a hospice nurse case manager specializing in compassionate end-of-life care, I emphasize the importance of empathy, understanding, and respectful support throughout the breast cancer journey, from diagnosis to end-of-life, to empower patients, caregivers, and families.
