Case Study

Rebekah Shim
Azusa Pacific University
UNRS 367 Pathophysiology
Professor Joy David
November 30, 2016
 Breast Cancer with
Metastasis to the Brain
and Lungs

Presented by Rebekah Shim

 PATIENTS
MEDICAL/SURGICAL HISTORY:
Caesarean Section 2008
Tubal Ligation 2008
Breast Cancer with Modified Radical
Mastectomy of Left Breast 2011
Name: G. T.
Multiple Brain Metastases 2014
Age: 40
Gender: Female Whole Brain Radiotherapy 2014
Ethnicity: Hispanic Metastasis to Brain and Bilateral
Reason For Seeking
Lungs 2016
Care: Confusion,
Weakness
Diagnoses: Urinary
Tract Infection, Altered
Mental Status,
Metastatic Breast
Cancer
 PATHOPHYSIOLOGY
Pathophysiology:
Breast cancer occurs when tumor cells invade local tissue and grow and mutate at rapid rates.
Cancer cells can migrate and colonize in distant sites Metastasis
Metastasis occurs when tumor cells escape basement membrane of tissue, move across
extracellular space, enter into the blood or lymphatic circulation, and then gain access to other
organs (Copstead & Banasik, 2013).
According to a study, the brain is usually the first site of metastasis in patients with breast
cancer (Rostami, Mittal, Rostami, Tavassoli, & Jabbari, 2016).
Signs and Symptoms: Headache, behavioral changes, fatigue, altered mental
status.
Significant Labs:
Elevated glucose levels due to use of corticosteroids.
Decreased Hemoglobin, Hematocrit, RBC, and Platelets due to bone marrow suppression from
chemotherapy.
Elevated WBC due to UTI.

Significant Diagnostic Tests:

MRI of brain Metastasis to brain and cerebral edema.
CT of brain Bilateral metastases and vasogenic edema.
Chest X-Ray Vague pulmonary nodules bilaterally with metastasis in both lobes of the lung.
 TREATMENT AND DISCHARGE INSTRUCTIONS
Care Provided for the Patient:
Encouraged adequate hydration due to UTI
Administered antibiotics as ordered
Kept patients head elevated and in midline to prevent increase in ICP
Provided wound care using sterile technique
Monitored neurological status frequently
Provided patient with spiritual resources (Chaplain)

Patient Education & Discharge Instructions:

Teach patient about possible side effects of corticosteroid use such as weight gain,
anxiety, and peptic ulcers.
Provide patient with information regarding hospice and palliative care.
Refer patient to a social worker that can provide information and support for her
children.
Teach patient to monitor possible symptoms of brain and lung metastasis such as
shortness of breath, wheezing, confusion, visual changes, and seizures.
 EVIDENCE BASED RESEARCH TOPICS
Article 1: Sense of Coherence (SOC) and how it relates to a breast cancer
patients quality of life
Sense of Coherence 3 Main Categories
Comprehensibility is the belief that things happening in life are understandable.
Manageability is the belief that people have the ability to take care of things.
Meaningfulness is the belief that what happens in life is worthwhile.
A questionnaire of 13 items is used and patients indicate whether they agree or
disagree.
Evidence shows that a higher SOC serves as a protective factor for patients who are
diagnosed with breast cancer
How can this evidence help patients?
Help the patient discuss the things in life that are important and meaningful
Physicians and nurses can use the SOC questionnaire to determine the patients level of
SOC and use that to determine how patients are coping, and what specific needs they
may have.
Health care workers can help reduce patients stress and focus on interventions to
strengthen the patients degree of SOC.

(Rohani, Abedi, Sundberg, & Langius-Eklof, 2015).

 EVIDENCE BASED RESEARCH TOPICS
Article 2: Retrospective Evaluation of Palliative Care and Hospice Utilization
in Hospitalized Patients with Metastatic Breast Cancer
Only a minority of patients with metastatic breast cancer receive outpatient palliative
care or are referred to hospice during their last hospitalization prior to death.
Clinicians should recognize hospitalization as a trigger to discuss end-of-life care goals
and preferences with their patients and a signal to consider whether a patient and
family may benefit from a palliative care referral or hospice services.
Patients with cancer who die in the hospital experience more physical and emotional
distress and lower quality of life at the end of life compared to patients who die at home
under hospice.
Caregivers experience high rates of PTSD and prolonged grief disorder when their loved
ones die in the hospital.
Why arent more patients with metastatic breast cancer referred to hospice?
Most patients who are hospitalized are seen by physicians they have never met who
are unfamiliar with their personal values and wishes.
This evidence can encourage clinicians to bring up conversations about EOL
preferences before the patient is discharged during any acute hospitalization.

(Shin et. al, 2016)

 REFERENCES
Copstead, L. C., & Banasik, J. L. (2013). Pathophysiology (5th ed.). St. Louis, MO: Elsevier.
Rohani, C., Heidar-Ali, A., Sundberg, K., & Langius-Eklof, A. (2015). Sense of coherence as a
mediator of health-related quality of life dimensions in patients with breast cancer:
A longitudinal study with prospective design. Health and Quality of Life Outcomes,
1-9. doi: 10.1186/s12955-015-0392-4
Rostami, R., Mittal, S., Rostami, P., Tavassoli, F., & Jabbari, B. (2016). Brain metastasis in
breast cancer: A comprehensive literature review. Journal Of Neuro-Oncology,
127(3), 407-414. doi:10.1007/s11060-016-2075-3
Shin, J. A., Parkes, A., El-Jawahri, A., Traeger, L., Knight, H., Gallagher, E. R., & Temel, J. S.
(2016). Retrospective evaluation of palliative care and hospice utilization in
hospitalized patients with metastatic breast cancer. Palliative Medicine, 30(9),
854-861. doi: 10.1177/0269216316637238
https://youtu.be/q_JDp-VePAs