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Ann R Coll Surg Engl 2009; 91: 43-45 43Maguire et al. 1 were the first to show that a specialist nurse could reduce psychological morbidity following diagnosis of breast cancer, and the role of the breast care nurse (BCN) was developed in response. Further evaluation confirmed that the BCN can identify patients at risk of distress and provide effective emotional support.2-5 As a third or more of patients are clinically depressed or anxious immediately after diagnosis, 6-8 the BCN is now a key member of the breast multidisciplinary team 9,10 and often cited by patients as their most valuable contact. 11The role of the BCN has evolved and now includes many technical clinical roles such as seroma draining, patient follow-up and management of lymphoedema. ABSTRACT INTRODUCTION Due to their specialist training, breast care nurses (BCNs) should be able to detect emotional distress and offer support to breast cancer patients. However, patients who are most distressed after diagnosis generally experience least support from care staff. To test whether BCNs overcome this potential barrier, we compared the support experienced by depressed and non-depressed patients from their BCNs and the other main professionals involved in their care: surgeons and ward nurses. PATIENTS AND METHODS Women with primary breast cancer (n = 355) 2-4 days after mastectomy or wide local excision, selfreported perceived professional support and current depression. Analysis of variance compared support ratings of depressed and non-depressed patients across staff types. RESULTS There was evidence of depression in 31 (9%) patients. Depressed patients recorded less surgeon and ward nurse support than those who were not depressed but the support received by patients from the BCN was high, whether or not patients were depressed. CONCLUSIONS BCNs were able to provide as much support to depressed patients as to non-depressed patients, whereas depressed patients felt less supported by surgeons and ward nurses than did non-depressed patients. Future research should examine the basis of BCNs' ability to overcome barriers to support in depressed patients. Our findings confirm the importance of maintaining the special role of the BCN.

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