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Scenario You are a community nurse who regularly visits Mrs Jones, a 45 year old woman who has previously been treated for breast cancer which included mastectomy, removal of 10 of the axillary lymph nodes, radiotherapy and daily Tamoxifen* prescribed for 5 years. Due to the side effects of the Tamoxifen she stopped taking it after 1 year. Early this year, it was discovered that the cancer had re-occurred and metastasized to the lungs and spine. The doctor’s have predicted that she has approximately 6 months to live. Mrs Jones is married and has a 9 year old son and a 7 year old daughter. Due to her condition she is unable to work, which is putting a financial strain on the family. She has issues with back pain that is often hard to control, arm lymphoedema (related to lymph node removal during surgery), low mood, shortness of breath upon exertion and loss of appetite with accompanying weight loss. She has expressed that she does not know how to tell her children about her imminent death and that her husband does not seem to be handling the ‘situation’ (of her condition and it’s outcome) very well. They do not have other family members close by who could provide support. Mrs Jones has previously stated that her mother and aunty had died of breast cancer and that her grandmother had died of ovarian cancer. She has often asked whether there is some sort of link? Or whether the recurrence of the cancer was related to her stopping taking the Tamoxifen early? * Tamoxifen is an oral medication prescribed to women after initial treatment for breast cancer. Estrogen can stimulate the growth of certain types of breast cancer. Tamoxifen is a selective estrogen receptor modulator which binds to estrogen receptors, blocking the actions of estrogen. It’s common side effects include hot flushes and night sweats, vaginal discharge and weight loss or gain. Less common bet serious side effects include blood clots, bone loss, endometrial and uterine cancers, mood swings and/or depression.

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