Amanda is a 34 year woman, 8 weeks post–partum. She has a history of malignant melanoma. She was admitted for assessment and supportive care with the hope of receiving immun therapy or targeted therapies. She was initially diagnosed at 25 years old, and had surgical excision of a lesion on her left calf with a skin graft.
She had a sentinel node biopsy that did indicate lymph node spread at the time. She has further completion lymphadenectomy. She remained well until the early stages of her recent pregnancy when she noticed a new lesion on her abdomen and a swelling under her left axilla.
She had a scan which indicated recurrent systematic disseminated malignant melanoma. She did not consent to any treatment that could affect the foetus and after the birth of her baby she continued with significant side effects
including, Lymphoedema of her left leg affecting her mobility.Severe pain in her lower back, weight loss and acute fatigue.
She has recently separated from her partner and they have a 7 year old son as well as the new–born. Her son was asking what was happening to his mum. Amanda was aware that the prognosis was poor and was particularly concerned about the well–being of her children.
She had a hostile relationship with her ex– partner and she had custody of the children. She has 2 very close sisters, one of which was looking after her oldest son. Her father was close to and her mother that died suddenly 2 years ago. One of Amanda’s
concerns was whether the cancer had crossed the placenta and had passed to her baby. She wished to go home as soon as she could.
SUMMATIVE REFLECTION
1. Imagine the range of emotions you might feel if you found yourself in this scenario? (300 words)
2. What are the pressing issues in this scenario (400 words)
a. In how the family could support and communicate with her son.
b. In overcoming barriers, which could exist in getting her home (her preferred place of care).
3. Consider a minimum of 2 journal articles that will inform further understanding of this scenario (400
words)
4. Having reflected on this scenario how might your learning here influence your future practice? (400
words)
