> Additional Care for People with Metastatic Breast Cancer
Bone-strengthening therapy is part of the standard treatment for bone metastases. 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 a month 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 .
In some people, bisphosphonates and denosumab can cause bone, joint or muscle pain [29-30]. 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 health care provider if you should take supplements to keep your calcium levels up.
In rare cases, with either type of drug, a jawbone disorder called osteonecrosis of the jaw may occur [29-30]. 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.
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 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.
Nutrition and unwanted weight loss
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 advanced breast cancer and treatment. Your 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
- Eat small, frequent meals and snacks every few hours throughout the day.
- Try not to snack too close to meal times to avoid feeling too full for meals.
- Limit fluids at meals, but drink plenty of fluids in between.
- Take high calorie snacks with you when on the go.
- Eat your favorite foods more often.
- Increase the calorie content of meals and snacks by adding oils, olives, avocado, nuts, pesto and natural peanut or almond butter.
- Sip on homemade smoothies and prepared liquid supplement drinks (such as Ensure and Boost).
For tips on specific ways patients can improve diet and loss of appetite (including recipes), visit the National Cancer Institute’s website.
Nausea is a common side effect of breast cancer treatment. Your provider can prescribe medications to ease nausea caused by chemotherapy.
Tips to manage nausea
- Eat four to six small meals (instead of larger meals) each day.
- Try ginger tea, ginger ale or crystallized ginger, or add fresh ginger when you are cooking.
- Drink lemonade or lemon water.
- Eat bland, easy-to-digest foods that do not have an odor.
- Eat cool or frozen foods. These may have fewer odors than warmer foods.
- Avoid foods that are spicy, fried, very greasy or very sweet.
- Cook and freeze meals to reheat during times when you feel nauseous. Reheating causes fewer odors than cooking.
- Open the windows when possible to keep fresh air flowing. Use an overhead fan to decrease cooking odors.
- Take walks (when you are able) to get fresh air.
- Talk with your health care provider about integrative and complementary therapies that may help.
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. Fatigue can be caused by many things. Two common causes are depression and trouble sleeping . And, 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, one way to reduce fatigue is to exercise (if you are able). Findings from a small randomized controlled trial showed that even seated exercise helped manage fatigue in women with metastatic breast cancer .
If you feel overly tired or have trouble sleeping talk to your health care provider. Together, you and your provider can find the best ways to manage 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. 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 . Because these drugs increase the risk of blood clots and stroke, they are not recommended for the treatment of anemia once chemotherapy ends [35-38]. Safety analyses have raised questions about whether people with breast cancer should get erythropoietin (for more on these safety analyses, visit the FDA website).
Palliative care and pain control
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.
After breast cancer treatment ends
At some point, 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, 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 health care provider.
Learn more about support groups, hospice and other types of support.
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 type and amount of pain medication (especially opioids) they can prescribe. Although states need to ensure these drugs are not used for illegal purposes, overly restrictive policies can cause unnecessary suffering for people in pain.
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.
*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.