Bone-strengthening therapy is a standard part of treatment for bone metastases.
The 2 types of drugs that can help strengthen bones are:
Use of bisphosphonates or denosumab can :
Bisphosphonates are given once a month or every 3 months by vein (through an IV).
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 [38-39]. Any of these side effects should be reported to a health care provider right away.
Some people who take 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 disorder called osteonecrosis of the jaw may occur [38-39]. Before you start treatment with bisphosphonates, it’s a good idea to have a dental exam .
Talk with your oncologist before getting any dental procedure while you are being treated with bisphosphonates or denosumab.
Learn about bisphosphonates in early breast cancer treatment.
Loss of appetite is a common problem for people 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. Eating helps strengthen your body.
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 isn't 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.
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
Some older studies show marijuana may be helpful for nausea and vomiting . However, medical marijuana is not legal in every state.
The National Comprehensive Cancer Network (NCCN) has a booklet with more information on preventing and coping with nausea and vomiting.
Some chemotherapy and targeted therapy drugs can cause diarrhea. Bowel movements may become more frequent and/or looser and you may also have cramping and gas.
Some ways to manage diarrhea are listed below. Talk with your provider about which over-the-counter diarrhea medication to take (and take it as prescribed) or if you need prescription medicine.
Keep track of the number of bowel movements you are having. If you are having more than 4 loose bowel movements a day or the diarrhea does not improve after 2 days, let your provider know [41-42]. These are signs the diarrhea is serious and you need medical care.
If the diarrhea improves after a day or 2, you may begin eating small, regular meals again .
Ways to manage diarrhea
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, even getting enough rest doesn’t help.
Your health care provider should check for signs of fatigue at each visit. He or she can help you find ways to manage it.
Many breast cancer treatments cause fatigue. Depression and trouble sleeping are other common causes of fatigue .
For some people, fatigue is caused by anemia (a drop in red blood cells).
Although it may seem hard during treatment for metastatic breast cancer, getting some physical activity may help reduce fatigue. Family and friends often want to help, but don't know how. For example, you may want to ask someone to be a walking partner.
Even doing exercises while sitting down may help .
If you feel overly tired or have trouble sleeping talk with your provider. Together, you can find the best ways to manage fatigue.
Chemotherapy destroys red blood cells in the body. This can cause anemia, which can cause fatigue.
Sometimes, anemia can be treated by increasing iron or folate in the diet. Severe anemia can be treated with a blood transfusion.
Growth factors, such as erythropoietin (Procrit, Epogen and Aranesp), can increase red blood cell count and reduce the need for blood transfusions. However, safety studies have raised questions about whether people with breast cancer should take these drugs (for more on these studies, visit the FDA website).
These drugs increase the risk of blood clots and stroke, and may shorten survival [45-48]. So, they aren’t recommended for the treatment of anemia after chemotherapy ends [45-48].
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.
Controlling pain and other symptoms should be part of standard care for everyone with breast cancer. It’s especially important for those with metastatic breast cancer.
Treatment may include pain medications and may target specific parts of the body.
Learn more about managing pain related to metastatic breast cancer.
At some point, you may decide to stop treatments for 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.
Hospice can make this later stage of care as comfortable as possible.
The National Institutes of Health (NIH) website has information on end-of-life planning and care, including questions to ask your provider.
The American Society for Clinical Oncology (ASCO) has a guide for patients and their families to help make decisions on end-of-life care.
Learn more about support groups, hospice and other types of support.
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Learn more about what Komen is doing for people with metastatic breast cancer.
*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.
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