> Additional Care for People with Metastatic Breast Cancer
Bone strengthening therapy
Part of standard treatment for bone metastases is bone strengthening therapy. Two types of drugs that can help strengthen bones are:
- Bisphosphonates (zoledronic acid (Zometa) or pamidronate (Aredia))
- RANK ligand (RANKL) inhibitor (denosumab (Xgeva))
Use of bisphosphonates or denosumab once per month can lower the risk of fractures related to bone metastases and can help reduce pain caused by bone metastases. It can also reduce the need for radiation therapy and surgery related to bone fractures and bone pain.
In some people, bisphosphonates and denosumab can cause severe bone, joint or muscle pain [63,165]. Any of these side effects should be reported to a health care provider right away.
In rare cases, with either type of drug, a jawbone disorder called osteonecrosis may occur [63,165]. Treating dental infections before treatment with bisphosphonates or denosumab may reduce the risk of osteonecrosis [37].
Counseling, social support and support groups
For those with metastatic cancer, counseling (especially in a group setting) can improve mental well-being and quality of life. These sessions may help improve communication with family members and face fears about death and dying. They can also help control pain and other symptoms through the sessions themselves or by encouraging those who need more pain or symptom control to seek help from their providers.
Social support is an important benefit of group therapy. 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 ease some of the feelings of social isolation that can separate you from well-meaning but anxious friends and family.
Learn more about social support and support groups.
Nutrition and help with loss of appetite
Loss of appetite
Loss of appetite is a common problem for those with metastatic breast cancer. It can be the result of treatment or the cancer itself. Stress, depression, nausea and change in ability to taste can cause loss of appetite.
Light exercise before mealtime (if you are able) or use of medicines (such as Megace) may help increase appetite. Though some health care providers recommend not drinking alcohol during chemotherapy, some people find that a drink at mealtime helps increase appetite [113].
Nutrition
Although loss of appetite can make it hard, 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 plenty of calories and is rich in fruits and vegetables. Your provider can help you decide how many calories you need each day.
Liquid supplements, such as Ensure and Boost, can help you get calories and useful nutrients. They 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 cancer is very advanced.
Nausea
If nausea is a problem, try eating small, frequent meals instead of larger ones. Eating cool or frozen foods such as ice cream may also help. Cool foods tend to have fewer odors than warmer ones. Hot liquids and foods that are spicy, very sweet or greasy can be harder to tolerate when you are nauseous [113]. Your provider can prescribe medicine to ease nausea caused by chemotherapy.
For tips on ways to improve diet and loss of appetite (including recipes), visit the National Cancer Institute’s website.
Managing fatigue
Fatigue is common with metastatic breast cancer and can greatly impact quality of life.
For some, there's a treatable cause of fatigue: anemia (a drop in red blood cells). Because chemotherapy destroys 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 and reduce the need for blood transfusions. Some studies suggest these drugs can improve quality of life [114]. Because these drugs increase the risk of blood clots, they are not recommended for the treatment of anemia once chemotherapy ends [115-117]. 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).
Exercise (if you are able) can also reduce fatigue.
Pain control and palliation
Pain control
Actively controlling pain and other symptoms should be part of standard care for everyone with breast cancer, especially those with metastatic cancer. Treatment may include painkillers and may target specific organs.
Learn more about managing pain related to metastatic breast cancer.
Palliative care
Although metastatic cancer cannot be cured, treatment can extend life. The side effects of some therapies, however, 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. Once treatment is stopped, reducing any cancer-related symptoms (called 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.
Learn more about support groups, hospice and other types of support.
Read our perspective on the role of palliative care and hospice in end-of-life decision-making.
Access to pain management
Access to pain management varies from state to state. Some states have highly restrictive or vague policies on the distribution of pain medications. In these states, 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 (Fourth Edition)", prepared by the University of Wisconsin Pain & Policy Studies Group. The good news is many states are adopting policies that improve access to pain management for people living with cancer, and steady progress continues towards these efforts.
Updated 09/29/11
