Bianca Fleming is Echuca’s first McGrath Foundation breast care nurse, after her appointment in April 2012. Based at Echuca Regional Health, Bianca provides support and education to women diagnosed with breast cancer to guide them through treatment and beyond.By Ivy Wise
What is your role as a breast care nurse?
Some of the things I do is provide education and the resources from the BCNA (Breast Cancer Network Australia) when you’re newly diagnosed, like the My Care Kit and My Journey Kit. I can provide the resources and education, go through pathology. Care co-ordination, as well, so if someone is newly diagnosed and they’ve got a surgeon and an oncologist and radiation oncologist and a GP, I can be one of those central people that can help with all those appointments.
How did your appointment come about?
Obviously there’s been a need. We put in an application and then going on our statistics, it showed there was a need for a breast care nurse. One of the things about the McGrath Foundation, is their goal, so Jane and Glenn’s (McGrath) goal when Jane had breast cancer was that everyone in Australia would have access to a breast care nurse. That’s about 150 breast care nurses, so we’ve got 85 breast care nurses at the moment around Australia.
How did you get into nursing?
I moved to Melbourne and studied nursing and worked at Peter MacCallum for eight years and specialised in medical oncology, so I’ve done a lot of cancer nursing. I’ve done a postgraduate certificate in cancer nursing and now I’ve specialised in breast cancer. I did practice development nursing. Then I had my first boy in Melbourne and Todd (husband) and I moved back here. Then I did some relief cancer nursing here (ERH) and then the McGrath position came up.
What made you get into oncology?
It was a little bit of pot luck. I have had no background in cancer family-wise. I’ve been very, very lucky. But when I started nursing and went out to all the hospitals, Peter MacCallum offered a fantastic graduate year with a lot of support and I liked the ongoing education and the things they had. And I went there and I loved it. I liked the continuity of care from when a patient was diagnosed to follow them through the treatments. You really get to know somebody and their families, so I enjoyed that part of cancer nursing, which you don’t often get if you’re an emergency nurse, where you see them and they’re gone. Whereas I see someone for years and years and I love that.
I can imagine you would get quite close to your patients. How do you avoid becoming too emotionally attached?
I think sometimes that’s hard and sometimes you do become emotionally attached and I think that’s part of being a good nurse. I know my professional boundaries, but obviously you are touched by somebody’s experience. What I find is, if I can help them, I get lots of satisfaction out of that. If I can help and make a difference and make their experience a little more easy, then I find I’ve done a good job.
It must be a very rewarding job?
It is very rewarding. Especially working for the McGrath Foundation. I’ve got all aspects, so I’m supported, I have lots of colleagues who support me, but I can go out and I’ve got lots of resources and support systems to provide a really good service. It is really rewarding to see people in our community are now actually having better cancer experiences, if you can, because we’ve got the support there. So I feel really privileged to be in the position to be able to do that.
How many women do you support?
I probably have around 85 active patients. I’ve probably discharged a lot of patients as well, who finished their treatments and are going really well and don’t need my service anymore. But they know they can always re-access me and it’s free. I’ve got lots of ladies that I run a support group for. Wild Orchids Support Group that’s run on the last Thursday of every month at the Harvest Hotel between 10am and noon. It’s fairly informal; coffee, tea, support and friendship for women with breast cancer. I organise guest speakers. Anyone is welcome. There’s around 15 to 20 women who access that service. I also do a newsletter that goes to about 150 women.
Have any of your patients died from breast cancer?
I have got women that the disease has progressed and that is hard. It’s hard for the families. Being in a small community, it’s difficult as well. I grew up here, I’ve got lots of family, lots of friends, I know lots of people, but that’s part of my role — to provide good care.
Does Echuca have a high rate of breast cancer?
No. I think breast cancer rates are high anyway, but not necessarily higher in Echuca.
What are the biggest concerns of women with breast cancer?
I think definitely the unknown is scary for women with cancer diagnosis in general. It also depends on where women are at in their lives. Some have got young families .
In your experience, how do women cope with things like hair loss and having a breast removed?
Everyone’s different. Everyone has their own experience. How they feel about that is very, very personal. Some women are absolutely devastated to lose their hair and it’s one of the biggest challenges that they have to face or losing a breast. There’s a grieving process that goes with that. And there’s support services that are really, really relevant at that time. And then I see some women who say it’s what they have to do. It’s part of their treatment plan, it’s a part of what they’ve been dealt and they have to deal with it and get on with it. And they deal with it the best way they think they can.
So you would have to treat each woman you see differently?
Absolutely. It’s all about the patient. It’s very, very patient focused. Everybody is different and all women are different. Some women come in and they’re just like ‘right, tell me what I’ve got to do. I need to have the best doctor, I need to know exactly what the days are going to bring for me’ and others are like ‘I’m just going to go with what’s happening here’. And I think that changes along the treatment and experience as well. From when they’re first diagnosed to having the chemotherapy and radiotherapy to survivorship is different as well.
We often here of women in their 20s and 30s being diagnosed with breast cancer, yet mammograms are only recommended to women over the age of 40. What is your view on that?
I understand why they can’t do mammograms for everybody because, financially, they just can’t do that. And we know the majority of women with breast cancer are between their 60s and 70s. Part of my role is to make all women breast aware, no matter how old you are. That’s one of the things that comes from the McGrath Foundation. Jane was only 31 when diagnosed, so they are very, very passionate about putting out into the community and the schools to be breast aware; how do you do a breast self-examination, when do I do a breast self-examination, what are the steps to do if I find a lump or a change or see something different. And that’s my job, to get it out into the community. Go to your GP because you can get a mammogram, you can get an ultrasound. Know your family history.
What have you learnt during your time as a breast care nurse?
I’ve learnt lots. I’ve learnt women are beautiful. I have lots of laughs, lots of moments where I feel sad for them and I can cry with them. But I’ve also learnt everybody is different, everybody goes through experiences differently and I value people and their families.
How do you go about supporting the partners?
That’s a difficult one because every relationship is different. A lot of the time it depends on how the man wants to cope. Through our life experiences, we all cope differently. It is very independent.
How does breast cancer affect a relationship?
A lot of the time, it brings relationships a lot closer. Obviously it’s a bit of shock to them (the partners). I provide support for families; husbands, families, children. These days (men) can talk to other men in similar situations. If they were struggling emotionally and cutting off, then I would provide support through the Cancer Council of Victoria.
It’s true that cancer not only affects the person with the disease, but their whole family?
That’s absolutely right. And that’s something I have to be aware of. A lot of the time it’s the woman bringing those discussions to me and saying you know ‘Peter’s not coping. He doesn’t want to go to the pub on a Friday night and that’s really strange. He’s too scared to let me go out’. Providing information to men and women, it’s a power.
When you’re diagnosed with any type of cancer, you’re left a little bit powerless to a certain degree because you didn’t ask for this and somebody’s telling you you’ve got to do this, you’ve got to do that and for many women and men, it’s the first time they’re being told what to do and they haven’t really got a say in much. They do like you to have an understanding and women do have a choice in types of treatment and surgery they have.
What do you love most about your job?
Sharing those experiences with women and their families. And being able to provide support and ongoing care through their cancer experience.
The free service covers Echuca-Moama, Rochester, Lockington, Leitchville, Cohuna, Tongala and Mathoura. Women can also self refer. The service also runs an eight-week exercise program twice a year for women who have had treatment and/or surgery for breast cancer. For information, contact Bianca on 5485
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