> Additional Care for People with Metastatic Breast Cancer
Bone Strengthening Therapy
Bone strengthening therapy helps lower the risk of fractures related to bone metastases, and can help reduce pain caused by bone metastases. Acting as bone stabilizers, a group of drugs called bisphosphonates are now part of standard treatment for bone metastases. Intravenous use of the bisphosphonates pamidronate (Aredia) or zoledronic acid (Zometa) once per month has been shown to decrease the rate of fractures and pain, as well as the need for radiation therapy and surgery. Though rare, severe bone, joint and/or muscle pain may occur in some people who take bisphosphonates [52]. Any of these side effects should be reported to a health care provider right away. In very few cases, a jawbone disorder called osteonecrosis also may occur. Treating dental infections prior to treatment with bisphosphonates may reduce the risk of osteonecrosis [29].
Counseling for People with Metastatic Cancer
Mental well-being is important for people in all stages of cancer. For those with metastatic cancer, counseling, especially in a group setting, can improve quality of life. These sessions can help you improve communication with family members, face fears about death and dying and help control pain and other symptoms.
One important benefit of participating in group therapy is social support. The group can provide a place to belong and express feelings. Many people feel an intense bond with other group members and a sense of acceptance through sharing a common experience. Social support from the group can counter some of the feelings of social isolation that can separate you from well-meaning but anxious friends and family. For more on social support, see Support.
Maintaining Nutrition and Countering Loss of Appetite
Loss of appetite is a common problem for those with metastatic breast cancer. It can be the result of cancer treatment or the cancer itself. Stress, depression, nausea and change in ability to taste are all factors that can cause appetite loss. Light exercise before mealtime (if physically able) or use of a prescription drug such as Megace may help increase appetite. Though some health care providers recommend not drinking alcohol during chemotherapy, some find that a drink at mealtime helps stimulate appetite [93].
Although it may be difficult because of loss of appetite, it's best to eat a balanced diet. A well-nourished body is stronger than a poorly nourished one and will likely be better able to deal with the stresses of advanced cancer and its treatment. A good diet has enough calories and is rich in fruits and vegetables. Your provider can help you decide how many calories you need each day.
If nausea is a problem, try eating small, frequent meals instead of larger ones. Eating cool foods such as ice cream or fruit ice may also help, as cool foods tend to have fewer odors than warmer ones. Spicy foods, very sweet foods, greasy foods and hot liquids are usually harder to tolerate when you feel sick. Your provider can prescribe medicine to ease nausea caused by chemotherapy [93].
Liquid supplements, such as Ensure and Boost, may also help. These drinks have calories and beneficial nutrients. Such supplements may also be recommended if weight loss cannot be controlled. For most people with metastatic breast cancer, major weight loss is not a problem until the breast cancer is very advanced.
Managing Fatigue
Fatigue is one of the most common complaints among people living with cancer and can greatly impact quality of life. For some, there's a treatable cause of this complaint: anemia (a drop in red blood cells). Because chemotherapy destroys the red blood cells in the body, it sometimes leads to anemia and then fatigue. Severe anemia can be treated with a blood transfusion. Growth factors, such as erythropoietin (Procrit, Epogen and Aranesp) or similar drugs can increase the number of red cells [94,95]. These drugs, however, increase the risk of blood clots and are not recommended for the treatment of anemia after chemotherapy is completed [95]. And, recent safety analyses have raised questions about whether people with breast cancer should get erythropoietin (for more on these safety analyses, visit the FDA website).
Physical activity, if it can be tolerated, is also often recommended for fatigue.
Pain Control and Palliation
Actively controlling pain and other adverse symptoms should be a standard part of treatment for all people with breast cancer. For those with metastatic breast cancer, it is very important and may include painkillers and treatment for specific organs.
Although metastatic cancer cannot be cured, treatment can prolong life. However, the side effects of some therapies can affect quality of life. At some point during the process, treatment to control the cancer may be stopped. This can happen when treatment stops showing any benefit or when it greatly affects quality of life. For information on managing of pain, see Management of Pain Related to Metastatic Breast Cancer.
Once treatment is stopped, reducing any symptoms related to the cancer (called palliative care) becomes the main focus, rather than just a part of the treatment regimen. This can be a very difficult time. Your health care provider or hospital can arrange for counseling or a support group to help address and manage the feelings and emotions related to this stage of cancer care. For more on support groups, hospice and other types of support, see the Support section.
Access to optimal pain management varies from state to state. In states with highly restrictive or vague policies governing the distribution of pain medications, health care providers are often limited as to the types and amounts of pain treatment, especially opioids, they can prescribe. Although states need to ensure that these drugs are not used for illegal purposes, overly restrictive policies can cause unnecessary suffering for people with pain. Susan G. Komen for the Cure® supports efforts to reduce policy barriers and promote effective state policies that ensure adequate pain management for people living with cancer. Along with the American Cancer Society and the Lance Armstrong Foundation, Komen for the Cure funded a report, "Achieving Balance in State Pain Policy: A Progress Report Card (Third Edition)," prepared by the University of Wisconsin Pain & Policy Studies Group. The good news is that many states are adopting policies that improve access to pain management for people living with cancer, and steady progress continues towards these efforts.
Updated 08/25/09
