Episode 378: Considerations for Adolescent and Young Adult Patients With Metastatic Breast Cancer

“She’s triple negative and has a very, very aggressive tumor. Instead of going on spring break that year, she sat in our chemo room and got chemo. Her friends from college are good to try to keep her involved and try to surround her and encourage her, but they’re right now in very, very different spots in their lives. She’s fighting for her life; her friends are fighting for the grade they get in a class—and that’s different,” ONS member Kristi Orbaugh, MSN, NP, AOCN^®, AOCNP^®, nurse practitioner at Community Hospital North Cancer Center in Indianapolis, IN, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS^®, manager of oncology nursing practice at ONS, during a conversation about metastatic breast cancer in adolescent and young adult patients.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

This podcast is sponsored by Lilly and is not eligible for NCPD contact hours. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications.

Episode Notes

• This episode is not eligible for NCPD.
• ONS Podcast™ episodes:
  • Episode 368: Best Practices for Challenging Patient Conversations in Metastatic Breast Cancer
  • Episode 354: Breast Cancer Survivorship Considerations for Nurses
  • Episode 350: Breast Cancer Treatment Considerations for Nurses
  • Episode 345: Breast Cancer Screening, Detection, and Disparities
  • Episode 307: AYAs With Cancer: Financial Toxicity
  • Episode 300: AYAs With Cancer: End-of-Life Care Planning
• ONS Voice articles:
  • ‘Cancer Ghosting’ May Add Another Layer of Emotional Burden for Patients
  • Discoveries in Race-Related Breast Cancer Biomarkers May Improve Precision Treatments
  • What Is HER-2-Low Breast Cancer?
  • What Oncology Nurses Need to Know About Supporting AYAs With Cancer
• ONS books: Guide to Breast Cancer for Oncology Nurses
• Oncology Nursing Forum articles:
  • An Integrative Review of the Role of Nurses in Fertility Preservation for Adolescents and Young Adults With Cancer
  • Impact of Race and Area Deprivation on Triple-Negative Metastatic Breast Cancer Outcomes
  • Relations of Mindfulness and Illness Acceptance With Psychosocial Functioning in Patients With Metastatic Breast Cancer and Caregivers
• ONS huddle cards:
  • Altered Body Image
  • Fertility Preservation
  • Sexuality
• Other ONS resources:
  • Breast Cancer Learning Library
  • Fertility Preservation in Individuals With Cancer
  • ONS Biomarker Database
• American Cancer Society’s breast cancer resources
• American Society of Clinical Oncology continuing education resources
• Elephants and Tea
• Life, Interrupted
• Livestrong
• National Cancer Institute’s breast cancer resources
• Stupid Cancer
• Young Survival Coalition

To discuss the information in this episode with other oncology nurses, visit the ONS Communities. 

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [email protected].

Highlights From This Episode

“When we use ‘adolescent and young adult,’ we’re really talking about age 19–35. Some groups will say 15–39, but right around that age. When we think about that age, think about what all could be going on during those ages. Late teenagers, they may be going off to college, they may be graduating high school, trying to set up their own life, trying to become independent from mom and dad. If you’re talking about early to mid 30s, you could be talking about young parents, young career folks. So, just setting that into place makes you realize this can be a very tumultuous time for folks.” TS 2:06

“Unfortunately, this group tends to have more aggressive subtypes. We see more triple-negative in this group. We see more hormone-negative, HER2-positive in this group. Normal breast cancer cells should be stimulated by hormone. They are stimulated by hormones. So when you have a breast cancer cell that is not driven by hormones, it’s much more difficult to treat. We tend to see more aggressiveness in these tumors. We also see a higher incidence in non-Caucasian folks in this age group compared to the older age groups.” TS 4:53

“I think we have gotten much better about understanding the importance of fertility preservation and getting reproductive endocrinologists in, sooner rather than later. If we have earlier-stage cancers and we have patients that want to try to preserve eggs, preserve fertility, sperm banking. … If you have that time to talk to them—maybe a 21-year-old—the primary thing on her mind is not how many children she wants to have one day. Maybe she’s not even thought about having kids yet. It’s still a question you need to [ask]. Do you want to try to preserve fertility? Do you want to try to harvest some eggs? That’s a conversation that needs to be had and is very, very important for that age group.” TS 10:35

“One thing that helps is if you can get them [into] reputable support groups with people their own age that are going through what they're going through. Someone else that doesn't have hair, someone else that isn't going to make it to the big board meeting or isn’t going to get the promotion this year because they've had to take a medical leave. Someone else that understands it differently.” TS 16:47

“In breast cancer, many of those biomarkers just get reflexed. And what I mean by reflexed is a breast cancer pathology comes through, or a breast cancer specimen comes through, and it just automatically gets tested for X, Y, Z. HER2 and of course ER/PR. Now we understand that we don’t just need to know whether they're HER2 positive or HER2 negative. We need to know: What is the IHC score? And even if the IHC score is zero, is there any membrane staining? And then we need to know what’s their ESR1, their PTEN, their AKT, their PIK3CA. Those are so important to know.” TS 18:11

“I think it’s important to try to remember what our priorities were when we were in our 20s—what our priorities were when we were starting out as young mothers or starting out our career. Because that’s where these folks are. … I can’t imagine in the midst of college, when I’m trying to be independent, to suddenly have to be at home and rely on my mom to take me to my chemo appointment. … So I think one really important bias is to remember where they are in the developmental stages of life. They’re not 40-something. They haven’t lived X amount of life, and we need to take a step back and try to remember when we were their age, what was important to us? Where were our priorities at that point? And then hear them when they’re telling us what’s important to them.” TS 29:22

“From a female standpoint … we frequently throw these patients into menopause or have early menopausal symptoms, and I think we forget how devastating that can be. … They now are at higher risk for osteopenia or osteoporosis. … And then we tell people, ‘Be as normal as possible, get back and do those normal things.’ Well, they’re in a relationship, and they want to be intimate [but] suddenly having sexual intercourse is incredibly painful. Or if it’s not painful, sometimes they’ve just lost pure interest in that. They don’t feel confident about their body. All of those things need to be addressed because patients are trying to live each day as normally as possible.” TS 31:55