Bone-strengthening therapy is part of standard treatment for bone metastases. Two types of drugs that can help strengthen bones are:
Use of bisphosphonates or denosumab can lower the risk of fractures related to bone metastases and can help reduce pain caused by bone metastases. These drugs can also reduce the need for radiation therapy and surgery related to bone fractures and bone pain .
Bisphosphonates are usually given once a month through an IV. After taking bisphosphonates for a year or two, the frequency of treatment may be reduced to once every three months.
Denosumab is given once a month as an injection (not an IV).
In some people, bisphosphonates and denosumab can cause bone, joint or muscle pain [28-30]. Any of these side effects should be reported to a health care provider right away.
Some people taking bisphosphonates need to increase their intake of vitamin D and calcium. If you develop muscle twitching or increased anxiety, ask your provider if you should take supplements to keep your vitamin D and calcium levels up.
In rare cases, with either type of drug, a jawbone disorder called osteonecrosis of the jaw may occur [28-30]. Having a full dental exam before starting treatment with bisphosphonates or denosumab may reduce the risk of osteonecrosis of the jaw . Talk with your oncologist before getting any dental procedure while you are being treated with bisphosphonates or denosumab.
Loss of appetite is a common problem for those with metastatic breast cancer. It can be caused by treatment or the cancer itself. Stress, depression, nausea, constipation and changes in your sense of taste or smell can also affect appetite.
Light exercise before mealtime (if you are able) may help increase appetite.
Although a loss of appetite can make it hard to eat, it’s important to get enough calories, protein and nutrients to keep you going throughout the day. Eating helps you strengthen your body so you are able to deal with the stress of metastatic breast cancer and treatment. Your health care provider can help you decide how many calories you need each day.
For most people with metastatic breast cancer, major weight loss is not a problem until the cancer is very advanced.
Tips to prevent unwanted weight loss
For more tips on improving nutrition and loss of appetite (including recipes), visit the National Cancer Institute’s website.
Browse over 600 healthy recipes. These recipes are meant to encourage healthy food choices.
Nausea is a common side effect of breast cancer treatment. Your health care provider will prescribe medications to ease nausea caused by chemotherapy.
Tips to manage nausea
Fatigue is common with metastatic breast cancer and can greatly impact quality of life. When fatigued, people feel tired and lack energy all of the time. Sometimes, getting enough rest doesn’t help.
Your health care provider should check you for signs of fatigue at each visit. He or she can help you find ways to manage fatigue.
Fatigue can be caused by many things. Two common causes are depression and trouble sleeping . For some people, fatigue is caused by anemia (a drop in red blood cells). Learn more about depression or anemia.
Although it may seem hard, exercise (if you are able) may help reduce fatigue. Even exercises done while sitting down have been shown to help reduce fatigue in women with metastatic breast cancer .
If you feel overly tired or have trouble sleeping talk with your provider. Together, you can find the best ways to manage fatigue.
Because chemotherapy destroys red blood cells in the body, it sometimes leads to anemia and then, fatigue. Sometimes, anemia can be treated by increasing iron or folate in the diet. Severe anemia can be treated with a blood transfusion.
Erythropoietin (Procrit, Epogen and Aranesp) or similar growth factor drugs can increase the number of red cells and reduce the need for blood transfusions. Some studies suggest these drugs can improve quality of life .
However, these drugs increase the risk of blood clots and stroke, and appear to shorten survival [34-37]. So, they are not recommended for the treatment of anemia once chemotherapy ends [34-37]. Safety studies have raised questions about whether people with breast cancer should get erythropoietin (for more on these safety analyses, visit the FDA website).
Although metastatic cancer cannot be cured, treatment may extend life. The side effects of some therapies, however, can affect quality of life. Reducing any cancer-related symptoms (called palliative care) should always be a part of breast cancer treatment. Pain control is an important part of palliative care.
Actively controlling pain and other symptoms should be part of standard care for everyone with breast cancer, but especially for those with metastatic breast cancer. Treatment may include painkillers and may target specific organs.
Learn more about managing pain related to metastatic breast cancer.
At some point, you may decide to stop treatments to control the cancer. This can happen when treatment stops showing any benefit or when it greatly affects quality of life.
Once treatment is stopped, palliative care becomes the main focus, rather than just a part of treatment. This can be a very difficult time. Your health care provider or hospital can arrange for counseling or a support group to help you address and manage your feelings and emotions at this stage of cancer care. The National Institutes of Health (NIH) website has information on end-of-life planning and care, including questions to ask your provider.
Learn more about support groups, hospice and other types of support.
Learn More | Current Article
Komen Support Resources
*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time.
1-877 GO KOMEN(1-877-465-6636)
What would you tell someone about living with stage IV breast cancer?