Breast cancer patients often face stress, anxiety and physical discomfort. The “I do it for me!” workshops are designed to enable those affected to meet these challenges. Dr. Sonja Ebner and PD Dr. Marcus Vetter, Cantonal Hospital Baselland, give their assessment of the campaign in an interview.
Fictitious patient example
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Dr. Sonja Ebner PD Dr. Marcus Vetter
1. the diagnosis of breast cancer brings great changes and challenges. In your experience, what support services are particularly important for breast cancer patients?
Dr. Ebner: In my experience, it is essential to offer sufficient opportunities for discussion. Already when the diagnosis is communicated, there needs to be enough room for discussion, if necessary spread over several sessions, so that the patients can take everything in and process it well. But this is also a central point in the further course of the disease. Even if patients don’t need support right at the beginning, it’s important for them to know that they have a place to go at any time, even at a later date. The physical aspect, for example physiotherapy, must not be lost sight of either, and patients should be referred to appropriate services within the hospital or by physiotherapists in private practice.
2 What services are available at the Baselland Cantonal Hospital?
Dr. Ebner: It is often the case that the doctor alone cannot fully meet the need of the person concerned to talk, because this exceeds the time frame of the consultations. That’s why we have Breast Care Nurses on staff at the Baselland Cantonal Hospital. If necessary, patients can come here again for a consultation or call in. Not every affected person makes use of this, but it is important that such offers exist. The same applies to psycho-oncological care.
Dr. Vetter: We offer an interdisciplinary/additive concept that, in addition to the one mentioned, also includes, for example, an acupuncture consultation for symptomatic female patients. We also have an in-house psycho-oncology department . We can also offer rehabilitation to patients with cancer at the Bruderholz site. Older breast cancer patients in particular can benefit from rehabilitation. But younger patients can also benefit, for example, through rehabilitative physiotherapy. Pre-rehabilitation”, i.e. increasing fitness before cancer treatment, would also be conceivable in the future. Overall, it is important to provide patients with multidisciplinary and interprofessional care. Study data show that in breast cancer, this can improve the prognosis of those affected. In addition, services such as social services, pastoral care, nutritional therapy, cancer league, etc. should be available.
Dr. Ebner: Another point is the case management, in which one takes care of matters after the operation, such as follow-up treatments or cures. These are organized in advance, so that older patients in particular, who might be overwhelmed in an outpatient setting at home, are in good hands during the first two to three weeks.
3. what impact did the pandemic have on offerings? Have you been able to observe the development of alternatives?
Dr. Ebner: Especially in the first half of 2020, fewer initial diagnoses were made at our hospital because many patients were afraid to come to the hospital due to the corona situation. In addition, patients repeatedly failed to keep their appointments and I was frequently asked in my consultation hours whether an appointment for tumor follow-up really had to be made now. Our range of support services, on the other hand, could be used without restriction, and there was no change in the hospital routine.
Dr. Vetter: The European Society of Medical Oncology (ESMO) has published guidelines for individual tumor entities on what adjustments should be made in the pandemic situation. We have oriented ourselves to these in each case. We also offered an additional online consultation in our department, where patients could make a video call through a secure system. In the meantime, however, the patients are coming back to the hospital.
Dr. Ebner: Unfortunately, especially for older patients, the switch to online consultations was difficult or in some cases impossible. We have therefore also offered telephone consultations to talk about how people are doing or how well they are tolerating their therapy. But online, of course, you can’t do a physical exam, so you can’t check the breast and palpate the lymph nodes, which is essential, especially in breast cancer follow-up.
4. the trilingual campaign “I do it for me” offers online workshops to provide patients with a way out of social isolation. What is your assessment of this?
Dr. Ebner: I think that is something very important, because not only the body, but also the mind belong to health. Immediately after the completed treatment, i.e. when the patient has regained her purely physical health, it is essential to take care of her mental recovery as well. During therapy, sufferers often isolate themselves for a while and many thoughts revolve around the disease. Of course, this causes fear and this does not disappear so quickly. Often those affected have lost confidence in their health and this must first be regained. That’s why I think it’s good that there are offers that bring patients back into everyday life and enable them to make contact with people who have experienced similar things. This is how quality of life can be regained.
Dr. Vetter: The problem of social isolation exists not only at the time of diagnosis, but also during the entire follow-up. More often, patients can fall into a “black hole” and then need an “anchor” to eventually get out. The side effects of the treatment are often then compounded. Here, our support is needed, but also that of other disciplines, in order to create an improved situation for the patients. I believe that digital offerings such as those in the “I do it for me” campaign should also be used for this purpose.
Dr. Ebner: In an online setting, it’s also easier to find access. You don’t have to go somewhere to meet people you’ve never met before. That takes overcoming. Instead, you can just sit down at your computer. That would be the first step, on which you can certainly build well.
5. the campaign focuses on issues such as nutrition, sports and stress. The goal is to empower patients to reduce physical discomfort and increase well-being. In your experience, what is the impact of these issues on patients’ daily lives?
Dr. Ebner: In most patients, the stress level is relatively high and this continues throughout the follow-up. This is, of course, a great burden for those affected. Offers that counteract this therefore certainly have a good impact. Sometimes it just takes the right start to make a positive change. And with a healthy diet and regular exercise, not only can body weight be normalized and sleep improved, but well-being can be enhanced and possible side effects of adjuvant therapy counteracted.
Dr. Vetter: In the meantime, there are some data that show that exercise and a healthy diet make sense. For example, the risk of breast cancer recurrence can be significantly reduced by exercise in some cases. It was also shown that fatty diets should be avoided. But for me, women’s body image also plays an important role. This is where psycho-oncology and plastic surgery come in. The topic of sexuality should also not be neglected during the discussions.
Dr. Ebner: This in particular would be something that could be discussed well in an online setting. Some people may find it easier to talk about sexuality and any difficulties associated with it in this somewhat more anonymous setting than in the consultation, where this is often still a taboo subject – especially among older women.
Further reading (interviewee’s note): https://www.rosenfluh.ch/media/gynaekologie/2021/01/Aerztliches-Management-bei-Tumorpatientinnen-waehrend-der-Pandemie.pdf
With financial support from Pfizer AG, Zurich.
PP-ONC-CHE-0304 Nov 2021
Article online since 22.12.2021