Breast Care Course

- by Lieske Wegelin

May 2019 marked the beginning of the Breast Care Course through Stellenbosch University. 10 students from various organisations including Eerste River Hospital, Rondebosch Cancercare, Worcester Hospital, Wits Health Consortium, Addington Hospital, a Netcare patient navigator and 2 nurses in private practice joined for the course.

The Breast Care Course was borne as a result of needing a higher level education course similar to the Breast Course for Nurses but specifically for Registered Nurses (RN) working in a breast clinic. The purpose of the course is to enable the RN to confidently assess patients with breast problems in a breast clinic / unit.

The course is run over 6 months with 1 theoretical week at the beginning and the remainder of the time being used for practical hours and online / self study. By the end of the course, the learners will be able to:
- Perform a comprehensive clinical assessment, including a clinical breast examination.
- Have the basic understanding of fine needle aspiration biopsy and core biopsy technique to assist a trained professional.
- Categorise a patient as having a malignant, benign or indeterminate breast lesion.
- Appropriately refer a patient for further investigation.
- Be able to categorise a patient as needing referral for genetic testing.
- Interpret basic investigation results related to breast pathology.
- Have a basic understanding of breast cancer treatment and the management of side effects of treatment.
- Be able to advise patients on follow up procedure.

The 1 week theoretical part of the course was packed with lectures and practical sessions.

Day 1 focused on the normal breast, clinical breast examination and history taking. The afternoon was spent discussing staging and metastatic screening. Dr Edge, Dr de Villiers and I presented on this day.

Day 2 started off with a presentation on cytology and histology and was followed by a practical session about biopsy techniques. The students each got a chance to see how difficult obtaining a good specimen can be. Thank you to Lancet Laboratories (Carol van der Velde and Dr Dittrich) and BARD (Paula Nieuwoudt) for sponsoring this session. The next sessions were about interpreting these investigations and this was done by making use of case studies presented by Dr Van Staden, a medical officer in the Tygerberg Breast Clinic. Dr Riaan Duvenhage came all the way from Worcester Hospital to present his excellent work on electronic notes and data collection. They have a very comprehensive and up to date data set due to the electronic nature of their notes. The day ended with a brilliant interactive session on genetics presented by Mardelle Schoeman.

Day 3 started with radiological investigations of the breast. Dr Retha Hattingh presented this important session. Dr Karin Baatjes then used case studies to assist the students with differentiating between normal and abnormal imaging. We were then joined by Dr Francios Malherbe and Sr Galiema Fish from the Groote Schuur Breast Clinic. They presented the process that patients follow in the breast clinic at Groote Schuur. After lunch, I went through benign changes of the breast and then the group got to do peer evaluations on the topic of clinical breast examination.

Day 4 was all to do with the management of breast cancer. Dr Ilna Conradie (surgeon at TBH) spoke about surgery for breast cancer. Dr Pieter Barnardt (oncologist at TBH) discussed chemotherapy and it's side effects. Dr Magda Heunis (radiation oncologist at TBH) spoke about radiotherapy. The day ended with Dr Irene Boeddinghaus (oncologist from Vincent Pallotti Oncology) speaking about endocrine therapy. During the middle of the day, Dr Carien Otto, a medical officer from the Tygerberg Breast Clinic came to be part of a discussion about running a breast clinic and the administration thereof.

The last day, Day 5, started with a brief session on lymphoedema. This was followed by Ann Steyn and Carla Lind from Reach for Recovery speaking about volunteers and their role in the patients management and journey. Linda Greeff (a social worker with many years of experience), then discussed the psychosocial aspects of a breast cancer diagnosis, a topic that is often not discussed or mentioned when a patient is newly diagnosed.

The last part of the theory week allowed for practical assessment of the students. We all went over to the Tygerberg breast clinic where the students were fortunate enough to examine and take a history from a few patients that were in the ward waiting to be operated on the following day. It is always a very different experience when one is faced with a real patient as opposed to practicing on colleagues or mannequins. We were very fortunate to have such lovely patients willing to assist.

The next Breast Care Course will commence in May 2020. If you are interested in attending, please send me an email (lieskewegelin@gmail.com) so that I can keep you on the mailing list and keep an eye on the Stellenbosch University short course website (https://shortcourses.sun.ac.za/)

Talitha, Lettie, Elna, Jenny, Hayley, Lieske, Jenna, Nontokozo, Danine, Claudia, Patricia, Margaret, Liesel and Ebenecia

Thank you to the University of Stellenbosch Department of Nursing and Midwifery, all the lecturers,  sponsors of the students and the patients.

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