Breast Cancer in Palestine
Breast cancer is the most common cancer among Palestinian women, and the third cause of cancer deaths in Palestine. The past ten years have witnessed an increase of breast cancer incidence in Palestine, bringing with it an increased burden on women’s lives and their families.
Late diagnosis is one of the main characteristics of breast cancer care in Palestine. Data from Augusta Victoria Hospital (AVH) has shown that 60% of breast cancer cases were diagnosed late.
There are many determining factors for the late diagnosis. The most common ones include the lack of screening services, lack of awareness on self-examination techniques and the importance of routine mammography screening, lack of knowledge on available services, and delay in getting appointments. Personal or social factors include embarrassment of breast examination, and fear of being diagnosed with breast cancer, losing their breasts or dying. Others express their fear of the impact of breast cancer on their family relations and marriage.
Nurse Navigator Model
The Nurse Navigator Model is a program for improving prevention and treatment of cancer care through easier navigation of care. The role of patient navigator nurses goes beyond clinical case management; it includes a more holistic approach in prevention, information sharing, advocacy, and social work, among other roles. These non-clinical support services by nurse navigators help patients better cope with the disease on physical, psychological and social levels.
Evidence shows the positive impact of the Nurse Navigator Model on patients. It reduces uncertainty for patients and provides a clearer treatment route, from which the patient can make the right decision and feel supported. This model has been also shown to create a smoother transfer between different healthcare services, and has a positive impact on patients’ overall satisfaction. Hence, The Nurse Navigator Model helps to ensure a continuum of care, increased early detection rates, improved survival rates and overall quality of life for breast cancer patients and survivors.
Application in Palestine
A breast cancer Nurse Navigator study by the UNFPA and the Palestinian Medical Relief Society (PMRS) in October 2021. The study was generously funded by the Government of Japan to explore the possibility of introducing a Breast Cancer Nurse Navigator Model in Palestine, through assessing where the Model is being implemented and where it can be expanded.
Sabreen Abeedallah is a Project Coordinator at PMRS and has worked on exploring the Nurse Navigator Model in Palestine. She reflects on the initial need to conduct the Nurse Navigator study: “The breast cancer care in Palestine, including the UNFPA-supported project in collaboration with the Ministry of Health and multiple local partners has showed gaps in breast cancer care that required more investigation, including the need to explore the applicability of the Nurse Navigator Model.”
The study started with mapping services and explored how well current or previous breast cancer patients are aware of these services. It was shown that many do not know where to go for services and what the diagnosis and/or treatment process entails. Even for many of the ones who knew about processes, it was shown that their knowledge was more based on luck and coincidence, rather than targeted and systematic education within an awareness program.
The role of nurse navigators starts from promotion for early detection through diagnosis, treatment, and post-treatment services. Breast cancer care should be comprehensive, whereby collaborative services are being holistically provided, often from more than one place. Hence, it is important to have a nurse as a companion, supporting patients in each step, and giving them all the needed information and support.
Amaal is a nurse who works at the Augusta Victoria Hospital (AVH). She mentions how her role to promote early diagnosis starts with awareness at the community level, before the start of the screening phase. She mentions how she has to gain women’s trust in the first place, and reach them through trusted community members. The PMRS/AVH mobile clinic team coordinates with a trusted local entity in the village or area that the clinic visits for a certain duration (often one week). She adds: “You have to choose a safe space, and reach more women through key organisations such as councils, mosques, and women centres. Nine years ago, communities were not accepting of cancer screening and were scared of it. Many would refer to breast cancer as: ‘that disease’. Now we witness more acceptance and a more positive culture around breast cancer.”
Amaal goes on to mention what other roles she performs as a navigator: “We then follow up with all women through all steps of diagnosis. We work on coordinating permits for patients to enter Jerusalem when they require one. If a woman requires social, economic or legal support, we guide her where to go, who to speak with, and keep following up with her. These are aspects of breast cancer that transcend the clinical work and are often ignored, yet are essential for an effective treatment.”
Sabreen from PMRS emphasises the need for customised care for women, taking into consideration the different needs that women with breast cancer have: “For example, some may need psychological support more than others. We see many women facing violence or divorce, which sometimes require legal support. It is one collaborative program, and having a nurse who can contact each woman to hear about her specific needs is essential for an improved quality of life.”
The model is still in its inception phase in Palestine. There is ongoing work whereby nurses are supporting breast cancer patients and survivors in all steps of their journey. However, more capacity building and systemisation is required to nationalise the Model and fully implement it in all breast cancer services in Palestine. The Nurse Navigator Model for breast cancer can certainly improve women’s lives, and will hopefully achieve this in the near future for all women in Palestine.
