Conversation with Marisa Stevens, Oncology nurse practitioner

30 Nov 1999

My name is Marisa Stevens and I work as an Oncology nurse practitioner at St Vincent’s private in East Melbourne. I have worked in oncology for over 20 years now, both interstate and overseas on inpatient wards and in day oncology units.

I work with patients across the breast cancer setting: women diagnosed with early breast cancer (curative) and those with advanced (incurable) breast cancer. My role includes meeting with patients and their support person prior to starting treatment to ensure they understand their diagnosis and the goal of their treatment plan. We discuss potential side effects from treatment and look at prevention and management strategies to help patients have a good game plan moving forward.

This does not merely focus on the physical effects, but the potential impact on the emotional, financial, practical and social components of a patient’s life. This is why we have a team approach; our patients routinely see the exercise physiotherapist and nutritionist and we also need to ensure that we refer patients as needed to support groups, the social worker or psychologist when necessary.

Whilst there has been a lot of advancements in anti-cancer treatments (targeted therapies, oral therapies and immunotherapies) the main treatment for a lot of women with early breast cancer in 2021 is still chemotherapy. It is important for patients to understand that there are numerous chemotherapy drugs and different combinations of these medications and what combination they are prescribed will depend upon their diagnosis: each of these treatments has specific side effects and my role is to prepare and support patients throughout this process. I call patients a few days following their initial treatment and patients are able to call me if they have side effects or concerns. I am there to intervene early and escalate quickly when required.

It is important to note that we understand this process is daunting and can be incredibly overwhelming so we don’t expect patients to understand everything after one consultation. We are seeing patients often and understanding diagnosis/treatment is an ongoing conversation. For this reason it is a good idea for patients to come prepared when they see their specialists with 2-3 questions that have been playing on their mind.

In relation to how to get through chemotherapy, patients need to be invested, proactive and try to keep normality going as best they can. Keeping a diary of side effects from treatment is really important as it allows us to make changes specifically to the individual to make it as bearable as possible! It also includes having a daily routine such an exercise, a work plan and even a social plan. Regulating social media and “googling” is really important as there is a lot of misinformation out there and it can become incredible confusing for patients. Good advice is to keep it as simple as possible.

Indeed setting goals and having purpose is not limited to the time during chemotherapy, but extends to life after treatment. Post chemotherapy patients need to be realistic with their recovery and give themselves time. A lot of patients say that it may take them a full 12 months from diagnosis to recover from all the various treatments. The most frustrating side effects for most women are often fatigue, cognition and menopausal effects – all of which are minimised by keeping up regular exercise.

Breast cancer is an individual journey; every patient brings something different to the table, every treatment has different side effects and everyone reacts differently so it is important for us to tailor our care to each person that comes through the door.