The moment a woman finds out she has breast cancer is a particularly shocking and confusing one. It marks the beginning of a long journey, comprised of surgeries and treatments that bring with them a slew of side effects before the woman can achieve a long-awaited recovery and return to normal life.
To help patients get through this emotional journey, at Hadassah Hospital Ein Kerem and Hadassah Hospital Mount Scopus, the women receive personal guidance from a nurse coordinator who specializes in breast cancer. These coordinators provide “Medicine with a Soul,” becoming an anchor of knowledge and stability for the patients as they move through the medical bureaucracy. “Medicine with a Soul” is a unique project, initiated by the Hadassah Medical Organization Board of Directors, headed by Dalia Itzik.
Each breast cancer patient is treated by a multidisciplinary team, comprised of radiologists, surgeons, oncologists, pathologists, nurses, psychologists, social workers and, as needed, fertility preservation specialists, plastic surgeons and geneticists. The ultimate goal is to provide optimal care while minimizing risks of complications and reducing the need for hospitalizations, thereby improving the patients’ quality-of-life.
In addition, Prof. Tanir Allweis, director of Hadassah’s Breast Complex and the Breast Surgery Department, notes, “Treatment is always personalized and depends on completely individual parameters.”
There is also a dedicated nurse coordinator for young women, who understands their unique needs and works alongside a team of dedicated psychologists at the breast complex.
The nurse coordinator is a “compass” that leads the way. As Hadassah Ein Kerem nurse coordinator Smadar Daniel-Gadsi explains, “I accompany the patient from diagnosis to treatment and follow-up. I assist in scheduling and coordinating tests and treatments, helping the patient to manage side effects, strengthening and supporting her with empathy.”
Dr. Shani Paluch-Shimon, director of Hadassah’s Breast Oncology Unit, notes, “Often when the patient comes to the oncologist for the first time and receives a treatment plan that includes an explanation of side effects, she is emotionally overwhelmed, frightened, and often leaves the session without remembering everything she was told.”
She adds, “The patient needs time to digest the information and collect her questions. Then the nurse coordinator sits with her and provides guidance. When the patient sees that she has someone available for consultation, to answer the questions that were bothering her in the middle of the night, she finds it very reassuring.”
Daniel-Gadsi points out that women who receive an initial diagnosis of cancer undergo a number of tests before they even have that appointment with an oncologist or surgeon. This can take several days in which their stress levels intensify, as they begin reading about breast cancer online, taking in information that is not necessarily relevant to their situation.
“They run scary scripts in their heads,” she says, “which can make the pressure worse. Many times, when they come to me for initial guidance, at best they are confused and often discouraged; at worst, they feel completely lost.”
Daniel-Gadsi gives them a realistic picture of their situation, offering empathy and hope. “It is important for me to cultivate a sense of security within them that they are in a safe place, and that the breast system at Hadassah is built to support them throughout their journey.”
Liza Monas, a surgical breast nurse at Hadassah Ein Kerem, adds, “Breast cancer appears in a very feminine organ, which every woman wants to preserve. The women are very afraid of losing their femininity, sexuality and intimacy. She explains that when she assures them that their breast can be reconstructed with great results, they relax.
According to Monas, “Breast cancer recovery rates are relatively good, and this gives patients a lot of optimism about the future.” In many cases, however, the emotional crisis comes when treatments end, when it is time to return to normal life.
Dr. Paluch-Shimon explains, “Up to that point, the patient is constantly busy with tests and procedures. Suddenly she now has time to process everything she's been through. Even at this stage, the nurse continues to be a point of contact and support, to calm her very understandable anxieties, to decide whether it is necessary to involve doctors, the psychosocial staff or to refer her to a family doctor.”
A Look to the Future
In looking ahead toward breast cancer care in the future, nurse coordinator Daniel-Gadsi comments, “We as a society need to change the military terminology that we use in talking about cancer. It is not a war that needs to be won. After all, there are no winners or losers here. A patient may feel that she has not done enough if the treatment does not work, G-d forbid, or may feel she failed if she can no longer tolerate the side effects. Cancer is a disease that behaves according to its own rules, and it does not always respond as expected. Therefore, the treatment of cancer is not a battle, but a journey, and we go through this journey hand-in-hand with our patients.”