Phase : Downward Phase
The downward phase of illness was characterised by episodes of illness and crisis of increasing frequency. Acute episodes were often a result of chemotherapy side effects, physical deterioration, uncontrolled symptoms, such as breathlessness and cerebral symptoms. Five of the women attended an accident and emergency department during this phase.
Crisis events marked the final downward phase for four of the women. All were admitted to hospital via an accident and emergency department two for uncontrolled pain and two for neutropenic sepsis associated with chemotherapy.
What Does It Mean To Have Metastatic Or Stage 4 Breast Cancer
After hearing a diagnosis of metastatic breast cancer, a rush of questions emerges. But often, its not until long after leaving the doctors office.
Metastatic means the cancer has spread beyond the breast and immediate lymph nodes to other organs or tissues in the body, most often the bones, brain, lungs or liver. Its considered stage 4 breast cancer, which means the cancer has progressed to its most advanced stage.
But even though its moved to other organs, it still behaves like breast cancer and is treated with breast cancer therapies.
More than 154,000 U.S. women are estimated to have metastatic breast cancer, according to the Susan G. Komen organization. Men can have metastatic breast cancer too, but its rare.
To help patients fill in information gaps, N. Lynn Henry, M.D., Ph.D., the breast oncology disease lead for the University of Michigan Rogel Cancer Center, explains the nuances of stage 4 metastatic breast cancer.
How To Handle Emotions
Coping with the many symptoms that can occur with stage 4 breast cancer can be frustrating and discouraging, and people sometimes wonder if they will have to feel poorly the rest of their lives. Anxiety and depression are also severe for some people with advanced disease.
Fortunately, palliative care team consults are now offered at many cancer centers. While hospice is a form of palliative care, palliative care can be helpful even with early, curable tumors. Working with a palliative care team to address physical and emotional issues frees you up to work with your oncologist on issues that treat your cancer specifically.
While the research is also young, it appears that those people who receive palliative care consults not only have a better quality of life with advanced cancer, but they may actually live longer, too.
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Phase : The Pretrajectory Phase Of Metastatic Breast Cancer
Women’s narratives began by describing events before metastatic disease was diagnosed. This included life before their diagnosis of primary disease, and life after completing treatment for early stage disease. Reflecting back, women tried to identify the cause of their disease progressing, a common theme was to attribute this to previous life stress or lifestyle women felt personal responsibility for their disease progression.
I just kind of thought I had to be superwoman…and that was a really stupid thing to do and I had three different jobs and I was doing between 5060hours a weekI just couldn’t see the bigger picture and I do think that contributed to, to sort of the speed up of my condition I am sure. Dawn
Women identified other life events which they feared as possible causes of progressive disease, such as marital breakdown.
Emotional And Spiritual Care
End-of-life care also includes emotional, mental, and spiritual therapy. A personâs healthcare team may include social workers, counselors, mental health professionals, and religious or spiritual advisors.
According to the Anxiety and Depression Association of America, up to 40 percent of people with cancer experience serious mental distress. This may include anxiety, depression, panic attacks, and post-traumatic stress disorder .
Medications, therapy, religious or spiritual rituals, and support groups can help a person cope with mental health issues and stress during this difficult time.
Caregivers may also need help with stress, anxiety, and depression. The palliative care team can usually also provide support and advice to caregivers for their emotional needs.
The Breast Cancer Healthline app provides people with access to an online breast cancer community, where users can connect with others and gain advice and support through group discussions.
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When Should You Ask For Hospice Care
Very often we hear people say they wish they had opted for hospice care earlier on, so how can you know when it is time?
In order to receive hospice care, you usually need a physicians note saying that you are expected to live six months or less. If you live longer, that’s not a problem and there’s no penalty. Your care can either be renewed for another six months or discontinued. You can also change your mind at any time if you decide you would rather pursue treatments designed to treat your cancer.
Why Does Metastatic Breast Cancer Happen
Most often, metastatic cancer occurs because treatment didnt destroy all the cancer cells. Sometimes, a few cells remain dormant, or are hidden and undetectable. Then, for reasons providers dont fully understand, the cells begin to grow and spread again.
De novo metastatic breast cancer means that at the time of initial diagnosis, the breast cancer has already spread to other parts of the body. In the absence of treatment, the cancer spreads.
There is nothing you can do to keep breast cancer from metastasizing. And metastatic breast cancer doesnt happen because of something you did.
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Conventional Stages Of Breast Cancer Progression: 0 Through Iv
As mentioned, there are five basic stages of breast cancer with a couple of sub-categories.
Stage 0
This is a bit of an unclear term which specialists use to describe the development of abnormal cells that are not yet invasive breast cancer. Indeed physicians consider Ductal Carcinoma in situ, or DCIS, stage 0 breast cancer.
Here the malignant cancer cells are present in the lining of the breast d uct but have not yet invaded the surrounding breast tissue or spread beyond the duct. Almost 100% of DCIS is curable, but it obviously, does need treatment.
Early-stage breast cancer Stage 1
Stage 1 breast cancer is an early stage breast cancer. There is a considerable difference in medical opinion as to what exactly constitutes early stag e breast cancer. Also, how aggressive the treatment for Stage I breast cancer is another area of debate.
The standard definition of a stage 1 breast tumor is that a certain amount of breast cancer cells invade tissues and structures beyond the duct lining. However, no cancer cells have spread beyond the breast.
Furthermore, the tumor size is less than 2 cm in diameter. If physicians can detect and treat breast cancer before it grows beyond 2cm, the prognosis is very very good.
The average age of diagnosis of a stage 1 breast tumor is about 52 years old. In over 90% of cases, treatment tends to involve breast conservation surgery, followed by radiation therapy.
Chance of stage 1 cancer recurrence or spreading.
Defining The Illness Trajectory Of Metastatic Breast Cancer
The concept of illness trajectory has been described extensively in relation to chronic illness and to the process of dying., It refers to the events over the course of illness which are shaped by the individual’s response to illness, interactions with those around them and interventions. Glaser and Strauss refer to the events that unfold for an individual who is dying as having two elementstime and shape, and chart the relationship between expectations of when death may occur by professionals, family members and the individual. The concept of trajectory introduced by Strauss et al encompasses not only the physiological unfolding of a patient’s disease but the total organisation of work done over the course of illness and the impact on those involved with that work and its organization and despite the passage of time is still considered relevant today. There has been considerable interest in charting the course of different dying trajectories as a means of tailoring palliative care services prior to death, most recently exploring the experience of patients living through the trajectories of specific cancers, such as glioma. Strauss et al described a Chronic Illness Trajectory Framework where the pattern of illness is characterised by a cycle of decline-reprieve-decline-reprieve-decline to death, which renders expectations uncertain and arrangements and plans unpredictable.
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Treatment Of Stage Iv Breast Cancer
Stage IV cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. When breast cancer spreads, it most commonly goes to the bones, liver, and lungs. It may also spread to the brain or other organs.
For women with stage IV breast cancer, systemic drug therapies are the main treatments. These may include:
- Some combination of these
Surgery and/or radiation therapy may be useful in certain situations .
Treatment can often shrink tumors , improve symptoms, and help some women live longer. These cancers are considered incurable.
Palliative Care For Metastatic Breast Cancer
Palliative care describes treatments that reduce pain and other symptoms but dont fight the disease. Palliative care works to help a person feel as comfortable as possible. You can receive these treatments at home or in the hospital. Palliative care can be used at any time during any phase of cancer treatment early-stage, recurrent or locally advanced-stage, or metastatic. The goal is to reduce pain and discomfort and increase quality of life.
Below are some of the most common symptoms and side effects that people might experience because of metastatic breast cancer and its treatment. You may have one or more of these symptoms and side effects or you may have none:
-
help with daily tasks such as bathing and dressing
When youre in hospice care, nurses and home health aides visit you as often as needed. They become your main source of direct medical care. Your doctor usually still oversees your care and provides advice and prescriptions as needed.
Hospice helps many families move through several stages from urgently searching for answers, to medical care, to the acceptance of what has been and what is coming. It can help you and your family find peace and comfort, not only with death but also with life as you have lived it.
Questions to ask when choosing a hospice:
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The Decision To Discontinue Disease
Chemotherapy
A significant proportion of patients with advanced cancer continue to receive chemotherapy toward the end of life , including a small number who receive their last dose of chemotherapy within 14 days of death. Chemotherapy administered until the EOL is associated with significant adverse effects, resulting in prolonged hospitalization or increased likelihood of dying in an intensive care unit . Thus, the lack of definite or meaningful improvement in survival leads many clinicians to advise patients to discontinue chemotherapy on the basis of an increasingly unfavorable ratio of benefit to risk.
Ultimately, the decision to initiate, continue, or forgo chemotherapy should be made collaboratively and is ideally consistent with the expected risks and benefits of treatment within the context of the patient’s goals of care. However, the following reasons independent of the risks and benefits may lead a patient to prefer chemotherapy and are potentially worth exploring:
Immunotherapy
Data on immune checkpoint inhibitor use at the EOL are limited, but three single-institution, retrospective studies show that immunotherapy use in the last 30 days of life is associated with lower rates of hospice enrollment and a higher risk of dying in the hospital, as well as financial toxicity and minimal clinical benefit.
Alternative And Complementary Therapies
Some patients with metastatic breast cancer opt to try alternative therapies that are claimed to achieve healing effects similar to scientifically-tested medical approaches, but lack scientific evidence to support those claims. Approaches that are considered alternative therapies when applied to cancer treatment include vitamin therapies, homeopathic treatments, extreme diets, chiropractic treatment and acupuncture.
Some alternative treatments are harmful or even life-threatening. Amygdalin, an extract derived from apricot kernels, exposes the patient to cyanide. Bee venom can cause a life-threatening allergic reaction. Severe dietary restrictions such as Macrobiotic diets can disrupt the bodyâs metabolism and cause dangerous weight loss. People should be aware that foods, vitamins, and other treatments may interfere with the effectiveness of surgery, chemotherapy or radiation. It is essential that patients work with their doctors and openly discuss possible effects of any treatment they are considering. Alternative and complementary therapies are not regulated by the U.S. federal government and may lack quality controls.
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Treatment Of Stage Iii Breast Cancers
Sometimes large breast cancers invade into muscles or attach to major arteries, veins or nerve trunks, which makes them impossible to surgically remove completely.
So, for these patients, the treatment usually starts with radiation or chemo to try to shrink it first, before surgery. But even a large tumor that has not attached itself onto muscle can, sometimes, be completely removed. There is no direct relationship between tumor size and whether or not it may be treated surgically or not.
Obviously, Stage 3 breast cancers that surgeons can completely remove do tend to have a significantly better prognosis than inoperable stage 3 breast cancers. However, some breast tumors, particularly those that are ER-positive, respond very well to chemotherapy. So well, in fact, that they actually downstage.
So, it is difficult to predict the overall prognosis for stage 3 breast cancer, as it will vary from individual to individual. If the response to chemotherapy is favorable, the overall survival rate is around 72%.
Some Patients Live Years With Advanced Disease When Should End
byLeah Lawrence, Contributing Writer, MedPage Today September 30, 2021
Breast cancer remains the second leading cause of cancer death among women in the U.S. Although treatments for metastatic breast cancer — whether a new diagnosis or recurrent disease — have improved in recent years, metastatic disease remains incurable, explained Dawn L. Hershman, MD, MS, director of breast oncology at the Herbert Irving Comprehensive Cancer Center at Columbia University in New York City.
“There are a lot of treatments for many types of metastatic breast cancer, but the natural history is such that when we give treatment, the cancer can sometimes shrink or even disappear, but eventually it will come back and progress,” Hershman said. “As the cancer progresses from one treatment to the next, it often becomes more and more resistant.”
One of the most challenging aspects of treating metastatic breast cancer is prognostication of the disease course, said Molly E. Collins, MD, director of medical education, supportive oncology and palliative care program at Fox Chase Cancer Center in Philadelphia.
The current 5-year survival estimates in metastatic breast cancer are 28% for women and 22% for men. However, survival rates vary by disease subtype, Hershman said.
These variations in survival make knowing when during a patient’s disease course to stop active treatment and initiate conversations about end-of-life care particularly challenging.
Optimism With Realism
Disclosures
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Stages Of Breast Cancer: Stage Iiic
Stage IIIc breast cancers basically involve tumors of any size with significant metastases to:-
- the lymph nodes behind the sternum
- lymph nodes under the arm
- the lymph nodes above or below the collarbone
The extent and depth of lymph node involvement make these patients unsuitable candidates for surgical treatment as a primary mode of therapy. Chemotherapy is the treatment of choice for women with stage IIIb and IIIc breast cancers.
However, up to 70% of patients with stage III breast cancers who have chemotherapy remain alive and disease-free after 7 years.
The Stages Of Breast Cancer
NOTE: Although a lot of this information is still valid, The American Joint Committee on Cancer has recently updated their classifications for staging breast tumors.
We will be updating all our articles on staging in the near future. In the meantime, please click HERE for a brief summary of the major changes in January 2018.
If a breast biopsy confirms that breast cancer is indeed the diagnosis, the staging process begins.
The stages of breast cancer are really the extent of breast cancer. So, in order to choose and begin the best treatment, it is necessary to stage breast cancer. The staging process shows the progression of breast cancer.
Breast cancer progresses in relatively predictable and consistent ways, so it is possible to categorize breast cancer in terms of stages.
There are basically five stages of breast cancer, with some subcategories .
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Knowing What To Expect In The Final Days Or Hours Helps Comfort The Family
Most people don’t know the signs that show death is near. Knowing what to expect can help them get ready for the death of their loved one and make this time less stressful and confusing. Healthcare providers can give family members information about the changes they may see in their loved one in the final hours and how they may help their loved one through this.
Wait What Men Get Breast Cancer Too
It came as a heavy jolt when Michael Kovarikwas first diagnosed in 2007.
“I remember just like, sitting down and going, wait a minute, wait a minute. Women get breast cancer. Men don’t get breast cancer. So, it was very much a shock,” he told me when we first spoke. “There were people that didn’t quite believe it at first. And so, it was a way of educating people a lot at the beginning. But I think that made it more real to me.”
He had a recurrence in 2010 and was diagnosed with metastatic disease in 2015.
“The fatigue is unreal,” Kovarik said. “I’m struggling right now, but hopefully things will get better.”
He became active in the Male Breast Cancer Coalition and MBC Alliance and, like Jamil Rivers, in Metavivor. Metastatic disease is the primary lethal form of breast cancer, yet only 7% of breast cancer research is devoted to curing it.
“We get answers to stopping this disease,” Kovarik said when we last spoke in August.Michael Kovarik died from MBC on Sept. 22, 2021.He is survived by his long-time partner, Tim Watkins.
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