Research nurse brings women to leading edge of breast cancer care

By AMY ADAMS

Christine Schurman has two jobs. First, she coordinates breast cancer clinical trials at the School of Medicine, organizing the trials that tell doctors which new treatments work and which don’t. But the key ingredient to a successful clinical trial is finding patients who are willing to enroll.

That’s where Schurman’s second job as a research nurse at Stanford Hospital comes into play, and it has led her on a Bay Area odyssey both searching for eligible women and educating all interested women on breast cancer.

Schurman’s recruitment efforts have taken her to health fairs, churches and corporate-sponsored health events throughout the region. Although recruitment is her goal, education ends up being the primary outcome.

Christine Schurman does more than simply recruit women into Stanford breast cancer clinical trials. The research nurse also travels throughout the Bay Area educating women about the disease and its risk factors. "Most healthy women just want to know that they aren’t at imminent risk of breast cancer," she says. Photo: Amy Adams

"A lot of people with cancer want to know more about their treatment," she said. "People don’t understand how chemotherapy works and are sometimes more comfortable asking questions of a nurse than of their doctors."

Women who attend these events are often cancer patients themselves or have family members going through breast cancer treatment. They want to understand the whys and wherefores of their own cancer or that of a friend or family member.

"Most healthy women just want to know that they aren’t at imminent risk of breast cancer," Schurman said. She added that many women overestimate their own risk of the disease.

The Stanford breast cancer study most accessible to the general population is a multicenter trial comparing two drugs, tamoxifen and raloxifene, in their ability to prevent breast cancer in women who are at high risk of the disease. A previous trial found that women at high risk who took tamoxifen had half the risk of developing breast cancer compared with high-risk women who did not take the drug. However, tamoxifen has side effects that include an increased risk of uterine cancer.

The trial, called the Study of Tamoxifen and Raloxifene or STAR trial, could help post-menopausal, high-risk women identify which drug is most likely to lower their risk of breast cancer with the fewest side effects. High-risk women are those with a mutation known to increase breast cancer risk, have a mother, sister or daughter with breast cancer or have a history of breast biopsies.

Schurman admits that these requirements limit the number of people she is able to recruit. "Most people aren’t eligible," she said. "These talks are mainly a way to educate people and hopefully find those who are appropriate and interested in the study."

Among the things most women want to understand is their own risk of breast cancer. The models that have been developed for calculating risk take into account a woman’s family history of the disease, her age and other factors. Schurman said these statistical models are complicated and may or may not be relevant for any one woman.

"I explain that the models are based on data from thousands of women, but can’t take into account every variable that affects an individual’s risk," she said. She also pointed out that factors such as history of taking hormone replacement therapy, body weight and smoking can also alter a woman’s risk of developing breast cancer.

One thing she can do is help women learn how to lower their risk. "I try to suggest alternative treatments for women who are on HRT," Schurman said. She said that for each of the symptoms that HRT treats, such as osteoporosis or hot flashes, other drugs can be as effective.

Another set of questions Schurman faces involves treatment options. One problem, Schurman said, is that a lot of information available online is outdated or from inaccurate sources such as personal Web pages or other non-medical sites, making it hard for women to understand why doctors may choose one treatment over another.

Each cancer is different, Schurman said, "That’s why it’s so difficult to pick one therapy that works for everyone." Depending on many factors such as how large the tumor is, its cellular makeup and whether it has spread, a doctor will make a set of treatment recommendations that may include a combination of surgery, chemotherapy, radiation or anti-hormone drugs. With so many factors to take into account, Schurman said it’s hard for women to understand why one treatment may be recommended over another.

Although explaining cancer risk or treatment options to women may not bring many more people into clinical trials, Schurman said it’s a good opportunity to help educate women about breast cancer. "There is clearly a need for patients and families to have access to information in an interactive setting outside the pressures of a doctor’s office," she said.

Researchers test dramatically shortened therapy approach for breast cancer (8/6/03)

Psychiatric research builds link between sleep, stress, cancer progression (10/8/03)