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These included markers on participants’ quality of life, anxiety, depression and satisfaction.</p><p id="par5005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Data collection and analysis:</span> The quality of the evidence was assessed using the GRADE approach. A structured narrative description of results was made.</p><p id="par6005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Results:</span> 14 RCTs with 2905 women were carried out, most of whom had been diagnosed with primary breast cancer, except one study which focused on women with advanced breast cancer. Mean age ranged between 48 and 64 years and different psychosocial interventions developed by specialised oncology nurses were evaluated and in some cases were compared with a different type of support intervention or with standard care. In general, women stated their satisfaction was the same or higher with the care received, although it remained unclear as to what optimum duration of interventions would be, which ranged from between 9 weeks to 18 months, with low or very low level of evidence. Studies which focus on the evaluation of telephone follow-up programmes were also identified, with a variable duration of between 12–60 months, and the results of which were globally more satisfactory, with emphasis also that the quality of evidence was higher compared with the previously mentioned studies.</p><p id="par6505" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Conclusions:</span> Evidence suggests that psychosocial interventions made by nurses specialising in women with primary breast cancer may improve or may be at least as effective as standard care and other support interventions, during diagnosis, treatment and the follow-up period. Telephone follow-up interventions managed by nurses were as effective as the standard care for women with primary breast cancer.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Comment</span><p id="par0010" class="elsevierStylePara elsevierViewall">In general terms, cancer diagnosis has a major impact on the psychosocial health of the person and their environment, which necessitates a comprehensive approach. To do this, guarantee of follow-up by a multidisciplinary team is essential from a holistic perspective. What must be taken into consideration is the importance of the decision-making process, the uncertainty of prognosis, the expectations of each individual, and that there is a response to specific needs on a physical, psychological, social and spiritual level. For this to be achieved, new care models must be designed, new competences and professional roles developed and the portfolio of services redefined so as to achieve a rapid, efficient, sustainable and good quality healthcare, adapted to new demands.</p><p id="par0015" class="elsevierStylePara elsevierViewall">During recent years, the prevalence of breast cancer has risen, greatly due to increasingly higher survival thanks to early detection programmes and the efficaciousness of treatments, which means that special emphasis should be placed on the follow-up of the women after completing treatment and interventions must be adapted to provide appropriate ways of coping and optimum quality of life.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The systematic review by Brown, Cruickshank and Noblet therefore offers an updating and summary of the available scientific evidence relating to the role of nurses specialising in care of women with breast cancer. For this, a systematic review of the literature was undertaken, analysing the impact of interventions created by specialized nurses comparing them within four groups: psychosocial interventions compared with standard care for women with primary breast cancer; psychosocial interventions compared with other support interventions for women with primary breast cancer; telephone follow-up interventions compared with regular care received by women with primary breast cancer and psychosocial interventions compared with regular care in women with advanced breast cancer. This structure facilitates classification and analysis of the effectiveness of the different interventions regarding level of satisfaction, control of anxiety levels and depression, quality of life and control of symptoms in the cases of advanced cancer.</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is of note that most of the articles analysed were from an English context, since this environment is where most oncology advanced practice nurses are. It is therefore of particular interest to examine what experience existed in other countries and to assess the usefulness of implementing these profiles and interventions in Spain. Here, despite the fact that the figure of the oncology advanced practice nurse exists in several regions such as Andalusia and Catalonia, their presence and capacity for intervention is incipient, albeit with great potential.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this review, as in other experiences where specific interventions have been developed by the oncology advanced practice nurses, this figure was highly positively valued, considered ideal for developing interventions and care in the follow-up of women with breast cancer. Specifically, several studies showed that telephone interventions managed by nurses for breast cancer follow-up are viable and are associated with an improvement in the patient’s quality of life.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The progressively increasing introduction of the advanced practice nurse for follow-up of patients with chronic diseases and specifically the oncology APN stands out within the framework of existing competence optimisation, new competences development and the implementation of new professional roles nationally and internationally. These nurses with their advanced training and competences and with outstanding clinical leadership and autonomy of complex decision-making based on the application of scientific evidence in clinical practice are the key to optimisation of patient care and the healthcare system sustainability due to their four essential roles: expert clinician, consultant, teacher and researcher.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The excellent results from the introduction of the oncology APN mean that they are positively valued within the multidisciplinary teams, with an improvement being observed in accessibility, reduction of waiting times and high patient satisfaction.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The introduction of this figure as a reference in tumour committee teams or functional units is an example of the advance in this field, while their potentiality will lead to improvement in coordination and follow-up of the different oncology care processes where attention is still focused on diagnosis and treatment stages, leaving other aspects as secondary, that in the mid to long term will condition the patient’s quality of life.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Here, a review by Mokhatri-Hesari and Montazeri<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> reveals that quality of life relating to health in breast cancer patients has generally improved during the last decade. However, problems relating to worry, fear, uncertainty, treatment side effects and future perspectives, especially in young patients, deserve better and more attention.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Interventions made by specialised nurses may be effective in reducing the use of resources, preventing unnecessary hospitalizations, re-admittance to hospital and even reduction in hospital stay with its associated costs,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> as well as reducing the impact of the disease on their quality of life.</p><p id="par0055" class="elsevierStylePara elsevierViewall">It is vital that this figure be fully developed in Spain, given the good results in other contexts. Its impact in women with breast cancer and other oncology processes may thus be assessed, leading to better coordination in teams and enhanced patient follow-up.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec1005" "titulo" => "Summary" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Comment" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-06-07" "fechaAceptado" => "2021-06-10" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Díaz-Periánez C. Aportaciones de las Enfermeras de Práctica Avanzada Oncológicas en el cuidado de las mujeres con cáncer de mama. Enferm Clin. 2021;31:254–256.</p>" ] ] "multimedia" => array:1 [ 0 => array:5 [ "identificador" => "tb0005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "<span class="elsevierStyleSections"><p id="par9010" class="elsevierStylePara elsevierViewall">Brown T, Cruickshank S, Noblet M. Specialist breast care nurses for support of women with breast cancer. Cochrane Database of Systematic Reviews 2021, Issue 1. Art. No.: CD005634. DOI: 10.1002/14651858.CD005634.pub3.</p></span>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A feasibility study of the Mini-AFTER Telephone Intervention for the management of fear of recurrence in breast cancer survivors: a mixed-methods study protocol" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Cruickshank" 1 => "E. Steal" 2 => "D. Fenlon" 3 => "J. Armes" 4 => "B. Scanlon" 5 => "E. Banks" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s40814-017-0161-8" "Revista" => array:4 [ "tituloSerie" => "Pilot Feseability Stud." "fecha" => "2017" "volumen" => "4" "paginaInicial" => "22" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Health-related quality of life in breast cancer patients: review of reviews from 2008 to 2018" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Mokhatri-Hesari" 1 => "A. Montazeri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12955-020-01591-x" "Revista" => array:5 [ "tituloSerie" => "Health Qual Life Outcomes." "fecha" => "2020" "volumen" => "18" "paginaInicial" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33046106" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The costs, resource use and cost-effectiveness of Clinical Nurse Specialist-led interventions for patients with palliative care needs: a systematic review of international evidence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Salamanca-Balen" 1 => "J. Seymour" 2 => "G. Caswell" 3 => "D. Whynes" 4 => "A. Tod" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0269216317711570" "Revista" => array:6 [ "tituloSerie" => "Palliat Med." 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Journal Information
Vol. 31. Issue 4.
Pages 254-256 (July - August 2021)
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Vol. 31. Issue 4.
Pages 254-256 (July - August 2021)
Evidence-based nursing
Contributions of Oncology Advanced Practice Nurses in the care of women with breast cancer
Aportaciones de las Enfermeras de Práctica Avanzada Oncológicas en el cuidado de las mujeres con cáncer de mama
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Cristina Díaz-Periánez
Departamento de Enfermería, Universidad de Huelva, Huelva, Spain
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