Jakel on a Multidisciplinary Discussion About Individualized Breast Cancer Management

“Nurses [need to] find their voices and be part of that decision-making with the [medical oncologist], [other health care] providers, and the patient.”

Patricia Jakel, MSN, an oncology nurse consultant, discussed the details of a comprehensive case study that formed the basis for several presentations at the 43rd Annual Miami Breast Cancer Conference.

The case study focused on a 37-year-old patient diagnosed with breast cancer who initially prioritized fertility over standard oncological protocols, Jakel began. This clinical scenario, which included specialized commentary from Don Dizon, MD, FACP, FASCO, of Tufts Medicine, on the subjects of fertility preservation and sexual health, tracked the patient’s complex journey from her primary diagnosis through a later disease recurrence, Jakel said.

Jakel argued that the patient’s initial decision to refuse chemotherapy was driven by concerns regarding her future reproductive capabilities, a choice that ultimately led her to agree to what was characterized as suboptimal care. This case highlights a critical tension in the treatment of young patients, for whom fertility concerns may overshadow traditional medical recommendations, according to Jakel. She noted the importance of understanding how a patient’s initial fears and personal values dictate their long-term treatment trajectories and the subsequent management of their disease.

Following the initial treatment phase in this case, the patient successfully conceived a child through in vitro fertilization; however, she later experienced a recurrence of her cancer, Jakel reported. This altered the patient's priorities, transitioning her focus from family building toward a primary goal of survival, she shared. During this recurrent phase, the patient began anti-estrogen therapy, which brought issues of sexual health to the forefront of her clinical management, Jakel added. Dizon’s insights further emphasized that as patients age and their disease state evolves, the multidisciplinary team must expand its focus to include these essential quality-of-life factors.

Jakel explained that the nursing perspective is also vital in these high-level clinical discussions, particularly when identifying patterns of treatment refusal. She advocated for nurses to speak up during tumor board meetings to remind the medical team of a patient’s historical context. Jakel noted that if a patient has a history of declining therapy due to concerns about adverse effects, prescribing treatments associated with several toxicities in the future is likely to result in poor adherence. This case study underscores the necessity of collaborative decision-making between medical oncologists, nurses, and patients to ensure that treatment pathways remain realistic, patient-centered, and informed by the patient’s previous interactions with the health care system, Jakel concluded.