How Do Nurse Case Managers Care for Older Women With Breast Cancer?

Andrea Jennings-Sanders

Yong-Fang Kuo

Elizabeth T. Anderson

Jean L. Freeman

James S. Goodwin

ONF 2005, 32(3), 625-632. DOI: 10.1188/05.ONF.625-632

Purpose/Objectives: To describe how nurse case managers care for older women with breast cancer.

Design: A randomized, prospective trial.

Setting: Thirteen community hospitals and two public hospitals in southeastern Texas.

Sample: 335 older women aged 60-89 years newly diagnosed with breast cancer and being cared for by 60 surgeons. Most participants were Caucasian. A total of 166 women were in the control group, and 159 were in the intervention nurse case management group.

Methods: The nurses implemented multiple nursing interventions in each nursing process phase over a period of 12 months.

Main Research Variables: Independent variables were participants' demographic characteristics, depressive symptomatology, and cognitive impairment. Nurse case management contact was a dependent variable.

Findings: In each nursing phase, a greater number of nurse case management contacts were made in the first quarter. Bivariate analysis illustrated statistical differences among race, income, education, and living alone with respect to the mean amount of nurse case management. Multivariate analysis revealed that age, income, living alone, and stage of cancer predicted more nurse case management contact.

Conclusions: Nurse case managers may play a role in helping older women with breast cancer achieve positive health outcomes.

Implications for Nursing: Based on the findings of this study, nurses can develop specific nursing interventions to meet the needs of older women with breast cancer. Nurses can use the Model of Nurse Case Management to plan and manage care for older women with breast cancer.

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    Anderson, E.T., Raines, A.P., & Goodwin, J.S. (1994). Nurse case management: A community-based model for older breast cancer patients. Paper presented at the Gerontological Society of America Meetings, Atlanta, GA.

    Bradley, C.J., Given, C.W., & Roberts, C. (2002). Race, socioeconomic status, and breast cancer treatment and survival. Journal of the National Cancer Institute, 94, 490-496.

    Brooten, D., & Naylor, M.D. (1995). Nurses' effect on changing patient outcomes. Image: The Journal of Nursing Scholarship, 27, 95-99.

    Cameron, S., & Horsburgh, M.E. (1998). Comparing issues faced by younger and older women with breast cancer. Canadian Oncology Nursing Journal, 8(1), 40-44.

    Compas, B.E., Stoll, M.F., Thomsen, A.H., Oppedisano, G., Epping-Jordan, J.E., & Krag, D.N. (1999). Adjustment to breast cancer: Age-related differences in coping and emotional distress. Breast Cancer Research and Treatment, 54, 195-203.

    Craddock, R.B., Adams, P.F., Usui, W.M., & Mitchell, L. (1999). An intervention to increase use and effectiveness of self-care measures for breast cancer chemotherapy patients. Cancer Nursing, 22, 312-319.

    Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). "Mini-Mental State." A practical method for grading the cognitive state of patient for the clinician. Journal of Psychiatric Research, 12, 189-198.

    Goodwin, J.S., Satish, S., Anderson, E.T., Nattinger, A.B., & Freeman, J.L. (2003). Effect of nurse case management on the treatment of older women with breast cancer. Journal of the American Geriatric Society, 51, 1252-1259.

    Heimann, R., Ferguson, D., Powers, C., Suri, D., Werchselbaum, R.R., & Hellman, S. (1997). Race and clinical outcome in breast cancer in a series with long-term follow-up evaluation. Journal of Clinical Oncology, 15, 2329-2337.

    Hughes, L.C., Robinson, L.A., Cooley, M.E., Nuamah, I., Grobe, S.J., & McCorkle, R. (2002). Describing an episode of home nursing care for elderly postsurgical cancer patients. Nursing Research, 51, 110-118.

    Jennings-Sanders, A., & Anderson, E.T. (2003). Older women with breast cancer: Perceptions of the effectiveness of nurse case managers. Nursing Outlook, 51, 108-114.

    National Cancer Institute. (2005). Cancer facts and figures. Retrieved March 25, 2005, from

    Palsson, M.B., & Norberg, A. (1995). Breast cancer patients' experiences of nursing care with the focus on emotional support: The implementation of a nursing intervention. Journal of Advanced Nursing, 21, 277-285.

    Perkins, P., Cooksley, C.D., & Cox, J.D. (1996). Breast cancer: Is ethnicity an independent prognostic factor for survival? Cancer, 78, 1241-1247.

    Pistrang, N., & Barker, C. (1995). The partner relationship in psychological response to breast cancer. Social Science and Medicine, 40, 789-797.

    Radloff, L. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.

    Ritz, L.J., Nissen, M.J., Swenson, K.K., Farrell, J.B., Sperduto, P.W., Sladek, M.L., et al. (2000). Effects of advanced nursing care on quality of life and cost outcomes of women diagnosed with breast cancer. Oncology Nursing Forum, 27, 923-932.

    Rustoen, T., & Begnum, S. (2000). Quality of life in women with breast cancer: A review of the literature and implications for nursing practice. Cancer Nursing, 23, 416-421.

    Satariano, W.A., & Ragland, D.R. (1994). The effect of comorbidity on 3-year survival of women with primary breast cancer. Annals of Internal Medicine, 120, 104-110.

    Spiegel, D., Bloom, J.R., Kraemer, H.C., & Gottheil, E. (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet, 2, 888-891.

    Thijs-Boer, F.M., de Kruif, A.T., & van de Wiel, H.B. (1999). Supportive nursing care around breast cancer surgery: An evaluation of the 1997 status in the Netherlands. Cancer Nursing, 22, 172-175.

    Yancik, R., Wesley, M.N., Ries, L.A., Havlik, R.J., Edwards, B.K., & Yates, J.W. (2001). Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA, 285, 885-892.

    Zander, K. (2002). Nursing case management in the 21st century: Intervening where margin meets mission. Nursing Administration Quarterly, 26(5), 58-67.