Counseling For Cancer Patients
You do not need to face the physical and mental distress caused by the disease and its treatment on your own. Coming to terms with the shock of the , dealing with fear of the future and existential questions concerning life and death is anything but easy. Accepting help can allow you to save your strength and make it easier to find ways to be able to live as good a life as possible with your disease.
Nowadays, counseling is an important part of good cancer treatment. Psycho-oncologists are specially trained psychological experts, medical experts and/or social workers. If you wish, they can support you and your family in coping with the emotional and social aspects of the disease.
In the hospital, psycho-oncological support is mainly provided by doctors and nurses. They may work together with other providers of specialized psychological support for cancer patients. Special psychological support is also offered as part of rehabilitation. Outpatient support is available for people who are at home . This kind of support is offered by the following specialists and facilities:
Outpatient psycho-oncology departments of hospitals and certified centers
- Practices specialized in oncology
- Practice-based psychotherapists
How Common Is It
About 155,000 women in the United States live with metastatic breast cancer. Men can have metastatic breast cancer too, but it’s rare.
Only 6% to 10% of women with breast cancer are diagnosed at stage IV. About 20% to 30% of women are diagnosed with an early-stage breast cancer, and then the cancer spreads.
What Should The Initial Definitive Therapy For The Cancer Be
Treatment decisions are guided by the hormone receptor and HER2 status of the tumor, as well as the presence of symptomatic or life-threatening disease. The patientâs previous therapies, performance status, comorbid conditions, and organ function should also be taken into consideration.
As a general rule, metastatic breast cancer is not curable. Treatment has been proven to improve survival, but treatments with tolerable side effects are preferred in order to maintain quality of life. Goals of therapy should be palliation of symptoms associated with the disease and prolongation of life.
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Metastases In Internal Organs And The Skin
Metastases in skin or internal organs for instance, in the lungs or the liver can be specifically treated if
- there are no other metastases in the body,
- metastases are only found in one lung or in one lobe of the liver ,
- the tumor has not grown back in the same place ,
- there is no second tumor, and
- there was more than one year between the first treatment and the occurrence of the metastases.
Surgery is an option for lung metastases if there is only one single metastatic tumor or if the metastases are found in only one lung. The operation is usually followed by treatment with medication.
Metastases that only occur in one lobe of the liver can also be surgically removed. Radiofrequency ablation is an alternative to surgery. In this procedure, a probe is used to increase the temperature of the metastatic tissue and damage it so much that it can no longer grow. Both surgery and RFA are usually followed by treatment with medication.
Metastases sometimes arise in a part of the lungs called the pulmonary pleura too. This can lead to the build-up of fluid in the pleural cavity . The medical term for this is pleural effusion. Built-up fluid can cause breathing difficulties and pain. Surgery can be done or medication can be taken to seal up this space and prevent fluid from building up there.
Radiotherapy can sometimes also be used in other parts of the body such as the lungs and liver, in order to relieve symptoms and temporarily slow down or stop tumor growth.
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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Metastatic Breast Cancer: Treatments And Possible Consequences
When breast cancer is diagnosed, the aim of treatment is usually to remove all of the tumor. But this is no longer possible if it has spread to other parts of the body. Then the aim of treatment is to keep your overall health and quality of life as good as possible for as long as possible.
The goal of treatment for metastatic breast cancer is to stop or slow down the growth of the tumor. It is also possible to reduce the symptoms and possible side effects of treatment and to treat associated medical conditions. Cancer-related pain can be treated with well-managed pain relief therapy. If treatment is carefully planned and tailored to a person’s specific situation, and if their overall health is good, it is often possible to keep the disease under control for years, even if they have metastatic tumors, and have a good quality of life despite the symptoms.
How To Make A Treatment Plan For Metastatic Breast Cancer
After a diagnosis of metastatic breast cancer, its helpful to take the time you need to gather as much information as possible. Once you are ready, you can make plans and informed decisions about your care, treatment, and quality of life.
You may already have a medical oncologist if this is a recurrence of a previous breast cancer diagnosis. If appropriate, your oncologist can recommend other specialists who can join your medical team. Together, you will develop a metastatic breast cancer treatment plan.
If metastatic breast cancer is your first breast cancer diagnosis , you probably dont have a medical oncologist. Your primary care physician can recommend an oncologist and other specialists to you so you can put together your medical team.
The doctors on your medical team may be involved in your care at the same time or at different points throughout your care. Either way, everyone on your medical team needs to communicate with one another about your tests and treatments.
Your breast cancer medical team may include a number of specialists:
You may meet with some of these specialists in person, while others will consult only with your medical oncologist.
If youve been diagnosed with metastatic breast cancer, its important to communicate with your medical team to ensure youre getting the support you need.
Some questions you may want to ask include:
-
Do you plan to do a biopsy of the metastatic cancer? Why or why not?
Learn more about Genetic Testing.
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Moffitt’s Treatment Approach To Metastatic Breast Cancer
At Moffitt Cancer Center, we take a comprehensive approach to treating metastatic breast cancer. Every patient is provided with an individualized treatment plan that takes into account his or her specific diagnosis, medical history and personal preferences. Patients with stage 4 breast cancer typically receive different treatment plans than patients with earlier-stage malignancies, as metastatic cancer treatment is designed to target cells throughout the entire body rather than in only one particular part of a breast. Every metastatic breast cancer treatment plan is developed by a multispecialty team that comprises surgeons, medical oncologists, radiation oncologists and other experts.
In Moffitts Don & Erika Wallace Comprehensive Breast Program, systemic treatments such as chemotherapy are most commonly used for treating metastatic breast cancer, although surgery is recommended in some instances as well. Additionally, patients who turn to Moffitt for metastatic breast cancer treatment may also qualify to participate in clinical trials, through which they can gain access to immunotherapies, hormone therapies and other advanced targeted treatments that arent yet available in other settings. We are committed to helping each patient achieve not only the best possible survival outcome, but also a high quality of life.
What Should I Ask My Healthcare Provider About Metastatic Breast Cancer
If youve been diagnosed with metastatic breast cancer, ask your provider:
- What are my treatment options?
- What is my prognosis?
- What side effects can I expect?
- Will complementary therapy help me feel better?
- What if I want to stop treatment?
- How can I feel my best during treatment?
A note from Cleveland Clinic
Metastatic breast cancer is advanced breast cancer. Providers classify it as stage 4 breast cancer. It happens when cancer cells, often left behind after previous breast cancer treatment, start to spread to other parts of the body. While there is no cure for metastatic breast cancer, treatment can prolong your life and help you feel better. There are many medications available, so if one treatment isnt working, your care team can try a different approach. If you notice any symptoms or dont feel your best, especially if youve undergone breast cancer treatment in the past, talk to your healthcare provider.
Last reviewed by a Cleveland Clinic medical professional on 04/14/2021.
References
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Quick Guide On Skin And Nail Changes For Metastatic Breast Cancer Survivors
This video covers the side effects of nail changes, skin rashes, and sensitivities and hand foot mouth syndrome that patients living with Metastatic Breast Cancer may experience. It explains nail changes, skin rashes, and sensitivities, as well as hand foot mouth syndrome, and includes tips for coping with each symptom.
Symptoms Of Metastatic Breast Cancer
The symptoms of stage 4 breast cancer depend on the location of the cancer and where it has spread in your body.
- If breast cancer has spread to your bones, you may notice a sudden new bone pain. Breast cancer most commonly spreads to your ribs, spine, pelvis, or arm and leg bones.
- If it has spread to your brain, you may experience headaches, vision or speech changes, or memory problems.
- Breast cancer that has spread to your lungs or liver usually causes no symptoms.
The main treatments for stage 4 breast cancer are targeted drug therapies that destroy cancer cells wherever they are in your body.
These treatments may include:
- hormone therapy, which stops or slows the growth of tumors by preventing your body from producing hormones or interfering with the effect of hormones on breast cancer cells
- chemotherapy, where drugs given orally or through an IV travel through your bloodstream to fight cancer cells
- immunotherapy, which uses drugs that stimulate your immune system to destroy cancer cells
- a combination of these therapies
In some cases, surgery or radiation therapy may be used to treat stage 4 breast cancer.
The following are the common treatment options for different types of stage 4 breast cancer.
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Her2 Status And Genetics
Human epidermal growth factor receptor 2 is a gene that promotes cancer metastasis. The HER2 gene is a mutation, and it is not inherited. HER2 is a protein that promotes cancer cell growth because acts as a fertilizer, helping the cancer cells to rapidly reproduce. Approximately 20%30% of women with breast cancer have extra copies of this protein.
Having extra HER2 enables a persons breast cancer to be classified as HER2 positive. The primary significance of this is that a specific type of drug can work to block the HER2 receptor in the body. Therefore, knowing the HER2 status can guide therapeutic choices.
Myth #: If An Earlier
Ninety percent of MBC diagnoses occur in people who have already been treated for an earlier-stage breast cancer. Many people are under the impression that remaining cancer-free for five years means that a metastatic recurrence cant happen. However, distant recurrences can occur several years or even decades after initial diagnosis. Factors such as original tumor size and the number of lymph nodes involved can help predict the risk of recurrence.
For example, a 2017 survey of 88 studies involving nearly 63,000 women diagnosed with early-stage, hormone-receptor-positive breast cancer found that the risk of distant recurrence within 20 years ranged from 13% to 41%, depending on tumor size and lymph node involvement.
As KatyK of Idaho comments: that you are cured if you are cancer-free five years after initial diagnosis. I fell for that one myself. When I was diagnosed with MBC 12 years after initial diagnosis I was shocked. I thought I was cured, which to me means all better. Nope! Not even sure medically what cured means.
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When Can Metastatic Breast Cancer Occur
Some people have metastatic breast cancer when they are first diagnosed with breast cancer . This is called de novo metastatic breast cancer.
Most often, metastatic breast cancer arises years after a person has completed treatment for early or locally advanced breast cancer. This may be called a distant recurrence.
A diagnosis of metastatic breast cancer is not your fault. You did nothing to cause the cancer to spread.
Metastatic breast cancers come from breast cancer cells that remained in the body after treatment for early breast cancer. The breast cancer cells were always there but were dormant and could not be detected. For some unknown reason, the cancer cells began to grow again. This process is not well-understood.
Treatment Options For Metastatic Breast Cancer
Treatment for metastatic breast cancer often is based on systemic therapies, which use drugs rather than surgery or radiation. Metastases treatments are designed to shrink tumors and slow their growth, help ease symptoms and improve quality of life. Treatment may change, such as when one therapy stops working, or the side effects become too uncomfortable. Rather than having only one treatment, most patients undergo several treatments combined to help fight the cancer.
The four broad categories of drug-based treatments are:
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Integrative Therapies For Metastatic Breast Cancer
You may find it beneficial to add integrative therapies to your treatment plan. There are many evidence-informed integrative modalities to boost the mind and body. Practices like gentle yoga, meditation, massage and music therapy may feel enjoyable and reduce stress and anxiety levels.
To help our patients maintain quality of life after a metastatic breast cancer diagnosis, our team of breast cancer experts may offer supportive care services to help manage side effects of the disease and its treatments. These may include:
Expanded Access And Right To Try: Alternative Paths To Experimental Treatments For Metastatic Breast Cancer
If you would like to find out whether theres an experimental drug that could be beneficial for you, talk to your medical team. Make sure that youve thoroughly researched whether there are any clinical trials you can join. In most cases, you wont be eligible to request an experimental drug through Expanded Access or Right to Try unless participating in a clinical trial is not possible for you.
Doctors recommend enrolling in a clinical trial if youre eligible since your participation helps advance treatments for breast cancer and, by participating, you receive extra medical attention and monitoring of side effects during the trial.
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Triple Negative Breast Cancer
With this type of breast cancer, the breast cancer cells dont have ER+ or PR+ receptors. They dont overproduce the HER2 protein, so hormone therapy isnt very effective.
Instead, triple negative stage 4 breast cancer is usually treated with chemotherapy. Radiation therapy may also be an option, depending on the site of metastasis.
Working After A Metastatic Breast Cancer Diagnosis
The effect of a diagnosis of metastatic breast cancer on work life is different for every person. You may have an understanding supervisor, a flexible schedule, and an encouraging team to support you. Or you may have questions about how best to manage treatment and work. Some women may wonder if they should be working at all. Others may feel the need to work because theyre concerned about paying for treatment.
In working with people living with stage IV disease, theres a constant conversation and struggle about whether to work or not, says Rosalind Kleban, licensed clinical social worker who serves as administrative supervisor for psychosocial programs and Memorial Sloan-Kettering Evelyn H. Lauder Breast Center in New York City. Part of the discussion that leans toward working is that it very often acts as a distraction, a way to be involved in things and people outside of the illness. I think that both sides of the equation should be looked at very seriously because work has some value for all of us including people with an illness.
Ultimately you have to do what is right for you, your lifestyle, and your family. There is no one best way to manage the emotional, physical, and legal aspects of balancing your job and your treatment.
Learn more general information about breast cancer and your job.
Read more specific information about working with metastatic breast cancer:
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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.