With a nursing career that spans over 40 years, half of which has been spent working alongside patients with cancer, Metastatic McGrath Breast Care Clinical Nurse Consultant Peta Brydon is an advocate, ally and expert for those who have progressed to a metastatic or received a de novo metastatic breast cancer diagnosis. Based at The Kinghorn Cancer Centre at St Vincent's Hospital in Sydney, Peta has shared her wisdom, experience, and wealth of knowledge in this article for those traversing this complex and confusing time in their lives.
What to expect
"Patient Care [for metastatic patients] is collaborative and focused on improving outcomes in people with cancer. Optimal cancer care pathways ensure consistent, safe, high-quality, evidence-based care for our patients. These pathways are endorsed by Cancer Australia, all states and territories and the Cancer Council of Australia. " Peta Brydon
As with early breast cancer care, those with a metastatic diagnosis can expect a multi-disciplinary team to support them in the planning and delivery of treatment and care. This team approach ensures that patient care is planned and delivered according to each patient's individual needs and preferences across the treatment setting and stages of disease. Along with a specialist cancer care nurse such as Peta, others you might meet during treatment and care:
- Medical Oncologists
- Radiation Oncologists
- Clinical Psychologists
- Radiologists
- Palliative Care Specialists
- Allied Health
- Genetics
- Social Worker
- GP
Read more about who you might expect to meet and their roles on your metastatic cancer journey.
You will be treated and seen as an individual on this journey, and no two metastatic cancer journeys will be alike; therefore, the people involved in your care will be tailored to your individual case.
At the Kinghorn Cancer Centre, Peta is with her metastatic cancer patients for every visit with the medical oncologist. This provides them with psychosocial support and an advocate and someone to help translate the information provided and navigate the healthcare system in which they now find themselves.
For many patients, understanding the medical information given to them can be a challenge, especially when receiving such an overwhelming diagnosis.
If you have been given a metastatic diagnosis, your own cancer nurse is often the first point of contact for any questions or queries you have surrounding any of your medical information.
From Peta's perspective, what is essential is that you access the right psychosocial support for you and your family from the moment of diagnosis and throughout your treatment. Doing this can help you live well and traverse the thoughts and feelings of a metastatic cancer diagnosis with the support of those who understand.
Your cancer nurse specialist can help refer you to a psychologist who supports those with cancer and allied health supports where necessary.
If you are unsure of where to find the support you need, your cancer nurse specialist can help with:
- Explaining and helping you understand treatment options that have been discussed by your specialist
- Referring you to support services
- Coordinating, navigating, and translating your treatment plan
- Advocating for your choices and needs.
- Assessing and treating symptoms of disease and treatment side effects
For those needing the support of a specialist breast cancer nurse like Peta, the McGrath Foundation provides free access to their specialist breast cancer nurses across Australia. You can find the one closest to you by typing "Find a McGrath Breast Care Nurse "followed by your postcode into Google or via their website.
Traversing your diagnosis
"There is no "normal" when it comes to how a metastatic diagnosis is received, so we do as much as we can to provide psychosocial and emotional support to patients and their families from the very beginning, whatever that looks like for them." Peta Brydon
If the years of experience have taught Peta one thing, it is that a metastatic diagnosis is received differently from person to person and that there is no right way to feel or react to the news that your cancer has advanced and spread.
Feelings can range from disbelief and grief to a quiet, contemplative acceptance of being told you have stage 4 cancer. You are not expected to feel one way or another; all feelings are valid.
Given there is so much individuality to each patient's life circumstances: age, family status, culture, spirituality, health, work, and current life stage, it is not surprising that it can be normal to feel everything on the spectrum at different times and stages and to revisit each of these emotions at different times. It might be difficult ever to accept your diagnosis, which is also completely okay.
Where to now.
"While we cannot cure metastatic cancer, we can treat it." Peta Brydon
If your treating team suspects a metastatic diagnosis, you will have imaging such as a CTCAP (CT scan of your chest, abdomen and pelvis), WBBS (Whole Body Bone scan) or PETCT scan to confirm the spread of your disease and a biopsy where possible to confirm the receptor status of the cancer.
Breast cancer is a heterogeneous disease. Heterogeneity in the expression of established prognostic and predictive biomarkers, hormone receptors (ER/PR), and human epidermal growth factor receptor two oncoprotein (HER2) forms the basis for targeted treatment. Therefore, collecting as much information on your metastatic disease is the first step. Treatment will depend greatly on this information about the cancer, a patient's overall health and age, and current treatments, including clinical trials.
Treatment decisions for every patient are not made in isolation; the multidisciplinary team (MDT) involved in your care will provide advice based on current best practice (best available evidence, consistent with local policies and clinical practice guidelines). MDT's objectives are to focus on improving outcomes for people with cancer.
“Clinical trials are part of the treatment paradigm for all cancer patients." Peta Brydon
With an ever-changing gamut of treatment options and novel treatments becoming available all the time, your treating team will keep you informed of clinical trials and new treatments that might be suited to your particular type of cancer.
Access to genomic testing can help guide your treatment by identifying mutations in your cancer. Some new treatments may be available for breast cancer patients with a particular
mutation or clinical trials may be available with treatment targeting your cancer presentation. It is best to discuss what clinical trials are available and whether you are eligible for any with your treating team.
In a hyper-connected world, accessing information and articles on new and experimental treatments is very easy. It is important to remember that not all types of cancer respond to all types of treatment. It is also prudent to know that some more experimental treatments can interact with or inhibit chemotherapy and other medical treatments. But don’t be afraid to discuss these with your treating team; they are the experts who can guide you and let you know if the treatment you are interested in pursuing is contraindicated with your current chemotherapy or treatment
Not all cancer treatments are funded by the Pharmaceutical Benefits Scheme (PBS) but your treating team will let you know all the other options that are available, including those through self-funding. Your treating team will recommend your best treatment option for your current stage of disease.
Peta's approach to supporting patients with metastatic cancer is to guide them toward the best evidence-based treatment and hold their hands should they have other ideas about their treatment and care without judging.
Support Services
"Metastatic cancer can be a very isolating disease.” Peta Brydon
It can be very distressing to receive a stage 4 cancer diagnosis; therefore, getting the right support is vital. One thing that Peta says brings hope to patients with metastatic breast cancer is that while it is not curable, metastatic cancer is treatable. She also describes a wealth of services and support available for these patients. While this is a disease where only you alone ride the symptoms, treatment effects, and prognosis, you never need to feel alone during what can be a scary or confusing time.
Whether you decide that medical treatment is for you or some experimental treatment, it gives you hope and makes you feel like you have done what you can. Peta describes how she supports patients no matter what their decision. This doesn't mean she refuses to advocate for the best evidence-based treatment for her patients but provides unwavering support to those with metastatic breast cancer no matter where the journey takes them.
Beyond your multidisciplinary team, so many support services are available for those with metastatic cancer.
There is support out there for you, whatever your circumstance and prognosis. Here are some of the metastatic breast cancer resources Peta recommends investigating
The Otis Foundation provides retreat accommodation across Australia to anyone dealing with breast cancer at no cost.
The Nelune Foundation provides psychological and practical support, assistance and care for public hospitals and underprivileged cancer patients in the NSW community.
McGrath Breast Care Nurse Telephone Support Line:
The McGrath Breast Care Nurse Telephone Support Line is open Monday to Friday, 9 a.m.-5 p.m., for anyone experiencing breast cancer and looking for support. You can call their Breast care Support Nurses for FREE on 1800 183 338
Kinghorn Cancer Centre, Sydney, Breast Cancer Information Sessions
For all Breast Cancer patients, there are monthly information sessions with a guest speaker followed by discussions. For further information and to register, please contact Rosemary Arias, Social Worker, 02 8382 4275 or rosemary.arias@svha.org.au
Breast Cancer Network Australia (BCNA)
BCNA has a wealth of information and support services available.
Kinghorn Cancer Centre Nurse Led Metastatic Breast Cancer Support Group
For patients of the Kinghorn Cancer Centre, Peta runs a face-to-face monthly support group that welcomes women living with metastatic breast cancer. Patients from other hospitals will be accepted into the group where appropriate. You can request to join the group by getting in touch with Peta via email: peta.brydon@svha.org.au
The Cancer Council is a nationwide support and information service for all Australians affected by cancer. They have numerous support services listed, and you can contact them on 13 11 20 to find out about services in your area.
Above all else, Peta wants all patients and their families with metastatic cancer to know they are not alone. If you are unsure where to turn or who to ask for advice and support, use your cancer nurse as the first port of call and as an advocate.
Remember, those with metastatic breast cancer who would like to access a specialised Breast Care Nurse head over to the McGrath website, where you can find one for FREE close to you.
