October is Breast Cancer Awareness Month. Many O&P facility staffs include caring, knowledgeable certified mastectomy fitters (CMFs), many of whom are themselves breast cancer survivors. They fit clients with forms and prostheses, often along with bras, swimsuits, and even turbans and wigs. But they frequently perform an even more valuable service: post-mastectomy education, along with a caring attitude and a listening ear, which helps their clients cross that "A Bridge Back to a Healthy World," as the article by Bebe Tamberg, CMF, describes it.
The O&P Edge Magazine
(Cutting edge information for the prosthetics, orthotics
and allied health care professions)
From The Editor
Miki Farley
I'm unable to recall the title of a 1930s movie in which a terminally ill young bride, with perhaps only a few months to live, put on such a brave face that her husband was unaware of the seriousness of her condition. While on their honeymoon, he remarked that their happiness suspended their lives in time, to which she somberly replied, "Yes, it's like living on the edge of eternity."
This exchange reminded me of the many conversations I've had with women facing life-threatening cancer diagnoses. They've often expressed the feeling that their lives were in a suspended state of existence while going through cancer therapies. The bodies they had before cancer had been replaced by bodies that were easily fatigued and sometimes nauseous from chemotherapy and radiation. And if that wasn't difficult enough, therapy side effects such as total body hair loss left them with an expressionless, zombie-like appearance. At some point during treatment, these patients took control of their healing by participating in support groups and seeking out solutions to improve their appearance.
Certified Mastectomy Fitters
Mastectomy fitters should be trained and certified by the Board for Orthotist/Prosthetist Certification (BOC) so that they can provide patients with experienced and specialized care, including patient education. Important information for the patient includes an explanation of why the proper fitting and wearing of a breast prosthesis is not only important for aesthetic reasons, but also as a therapeutic measure that replaces the weight of the removed breast. Patients also need to understand that lymphedema resulting from underarm lymph node removal can be an issue. A fitter can help by providing approved literature and appropriate referral options for this condition.
As a certified mastectomy fitter and image consultant at a leading California cancer center, I help women experiencing personal appearance side effects resulting from cancer therapies such as chemotherapy, radiation, and surgery.
My background as an image consultant and former fashion show producer and model agency owner was very beneficial when I started helping cancer patients. My first experience with cancer patients was as a hospice volunteer caring for the terminally ill. I began helping these patients with makeup and hair care and noticed their positive reactions. Very soon their caregivers, physicians, and hospice nurses started responding to them with approving and supportive comments.
Looking One's Best Aids Healing
Studies have proven that looking one's best plays an important role in the recovery process, because an individual's body image is what projects a patient's emotional health to the world. Presenting a positive outer image to others produces positive reactions. This positive feedback will often encourage a person undergoing therapy to continue daily routines at home, school, the workplace, and social engage-ments. Many women need to continue working during treatment, and it's important for them to look as normal and healthy as possible for many reasons not the least of which is job security. Family members (especially children), caregivers, and friends also benefit from seeing their loved ones dealing with their treatment in such an optimistic and hopeful way. It's a win-win for all!
Services Available
Personal appearance services are offered at some cancer centers and hospitals as part of their continuum of care. Because it is often difficult to locate these specialized services and products in the general retail world, I created the program at my cancer center to fill this need. Once physicians and nurses became aware of my onsite service, appearance consultation became a regular part of the pre-treatment education for their patients. All consultations are private and are offered free of charge.
In addition to post-mastectomy fittings, several other services are available, such as hair loss alternatives that include wigs, bangs, turbans and hats. Hair lost as a side effect of treatment does not usually start to grow back until therapy is completed, which may take three to six months. Skin care and makeup techniques include showing the patient how to correct unwelcome changes in skin appearance and how to camouflage eyebrow and eyelash hair loss to avoid the zombie-like appearance mentioned earlier.
Community Outreach
I created and continue to coordinate a breast health presentation for service clubs and organizations interested in educating members about the importance of early breast cancer detection. Joining me in these presentations are an oncologist, a nurse practitioner, and a breast cancer survivor. Our presentations have often resulted in saved lives because of our emphasis on the importance of proper breast self-examinations.
Health Insurance Coverage
It is very important to help patients with insurance coverage issues before fitting appointments. In doing so, a fitter avoids frustrating situations for the patient who cannot be fitted due to lack of proper insurance documentation or because the fitter is not an HMO-designated provider. It has been my experience that all private health insurance providers, Medicare, Medicaid, and HMOs are mandated by federal law to cover post-mastectomy breast prostheses and bras. For private insurance, Medicare, and Medicaid, an insurance card and prescription from a physician are necessary. In the case of HMO insurance, a prescription authorization needs to be requested by the primary physician.
Cranial Hair Prosthesis Insurance Coverage
Medicare, Medicaid and most HMO's do not cover hairpieces, turbans or hats. Private insurance policies often don't specify exclusion from coverage, so we recommend that patients read their policies carefully. For hair prostheses, we suggest obtaining a prescription from a physician stating: "Cranial hair prosthesis for medical purposes. Alopecia secondary to chemotherapy or radiation therapy." It might be helpful to include a letter from the physician with a photograph of the patient without hair to show that the wig prosthesis is for medical, not cosmetic, needs. And even if insurance coverage is denied, these items can probably be a tax-deductible medical expense.
As healthcare professionals, we are in a unique position to improve our patients' quality of life and help in their recovery by addressing the additional side effects resulting from cancer therapies. Consider offering your patients another bridge back to their healthy world.
