There are two primary goals for treating metastatic breast cancer: prolonging survival by keeping the cancer well under control and helping patients maintain the best quality of life possible. Treatment for a woman with metastatic breast cancer is pretty much continuous throughout her life, with short breaks, rather than one term of therapy, and then she is done. The goal is to stay ahead of the cancer, which may becomes resistant to one treatment but will often still respond to another.
Once you are diagnosed with metastatic disease, a major source of stress is having no clear idea of what to expect—how long you will live and how much you may suffer from pain and other problems. There are two important considerations here. One is dealing with your own emotions, through counseling, a support group, religion—whatever works best for you. The other is to get as much information as your doctor has about the likely probable progress of your illness and what it entails. Sometimes doctors deal with a patient’s fear by using every kind of therapy as rapidly and in as great a dose as possible, in an attempt to ward off the inevitable. Often the patient also goes along with this approach,. Bbut it’s as dangerous as the opposite extreme of shying away from any treatment at all.
No one knows how long someone with metastatic breast cancer will live. That’s why the second primary goal in treating metastatic breast cancer is keeping women feeling as good as they can for as long as they can. People often confuse palliative care and hospice care. They are not the same thing.
Palliative care is symptom management. It is provided by a palliative care team, which can include a doctor, nurse, social worker, chaplain, counselor, pharmacist, dietitian, rehabilitation specialist, physical therapist, music and art therapists, and home health aides.Their focus is reducing or eliminating your pain and other symptoms, addressing your emotional and spiritual concerns and, in general, improving your quality of life.
Learn more about palliative care in this ImPatient Science video.
There are many different types of treatments used to keep the cancer under control and reduce pain. These include hormone therapy, radiation, chemotherapy and targeted therapy. Studies are also exploring new immunotherapies. In addition there are new supportive therapies such as bisphosphonates (which treat bone metastasis), erythropoietin (which combats anemia), antinausea drugs, white blood cell growth factors (which prevent infection), and better pain medications.
During and after your treatment for metastatic disease you’ll be followed with the staging tests—bone scan, chest X-ray, and blood tests—as well as a few other tests such as CT scans, PET scans, or MRI. These can help determine if you’re indeed responding to treatment, although your symptoms are the best test of effectiveness.
Results from clinical trials often present information by describing the length of time a treatment keeps the cancer from progressing. It is important to remember when looking at these statistics that increased time to progression does not necessarily mean increased survival. It may simply mean that you have more symptom-free time before the cancer recurs. In this case, you would live comfortably for a longer time and spend less time actually ill.
It is important to let your doctors know if or when you are experiencing pain. If, for example, you’re in severe pain because of bone metastases, your doctor can put a catheter in the space along the spinal cord and dripping continuous low dose morphine to get rid of all the pain. Administered this way, it won’t affect your mind the way it would if administered systemically. This won’t cure you, but in your last three or four months of life, when systemic therapy is no longer working, it can give you quality time and reduce or eliminate suffering.
Anybody who has chronic pain because of metastatic cancer and isn’t getting relief should ask to be referred to a pain unit. Sometimes oncologists and people who work on cancer are so focused on treating and curing the disease that they forget about these ancillary things that can make an enormous difference in a patient’s life. So ask to see a pain specialist; even if it means having to travel to the local medical school, it can make a big difference to you.
Take Care of Yourself Emotionally
Women with metastatic disease often feel very isolated. Other survivors, finding their stories too scary, may not want to listen to them, and family and friends may not be able to deal with the seriousness of the situation. Luckily there are many women living with breast cancer recurrences and metastatic disease willing to help you at a click of a mouse. These resources include:
- BCMets.org: an online community of women and men living with advanced breast cancer.
- Advancedbreastcancer.org: Provides information and support for individuals with advanced breast cancer.
- Brainmetsbc.org: Provides information for women with breast cancer that has metastasized to the brain.
- METavivor.org: Provides funding for research and support for women with metastatic breast cancer.
- Metastatic Breast Cancer Network: Funds research on metastatic breast cancer.
- Metastatic Breast Cancer Alliance: an advocate-led alliance of organizations and individuals working together to transform and improve the lives of people living with metastatic breast cancer.
- AdvancedBC.org: Provides information and support for individuals living with advanced breast cancer.
- Young Survival Coalition: Offers a Metastatic Navigator guide for young women.
- Latinas Contra Cancer: Offers education and support for the Latino population.
- Sisters Network: A support organization for African-American women.