Breast Cancer - Metastatic: Palliative Care

Approved by the Cancer.Net Editorial Board, 05/2018

ON THIS PAGE: You will read about managing the symptoms and side effects of metastatic breast cancer and its treatment. Use the menu to see other pages.

Cancer and its treatment cause symptoms and side effects. In addition to treatments intended to slow or stop the cancer’s growth, an important part of metastatic breast cancer care is relieving a person’s symptoms and side effects. This approach is called supportive or palliative care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer at the same time that they receive treatment to ease side effects. In fact, people who receive both at the same time often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medications, nutritional support, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to manage the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each option in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of the specific treatment and palliative care options. During and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

The following options may be used to manage the symptoms and side effects of metastatic breast cancer.

Bone modifying drugs

If cancer has spread to the bone, medications that help to strengthen the bones can be used to lower the risk of bone pain, fracture, and the need for radiation therapy to the bone. ASCO recommends bone-modifying drugs for people with breast cancer when scans show there are metastases in the bone.

There are 2 different classes of bone-modifying drugs and both help stop the bone from breaking down. Both classes of drugs help reduce the risk of bone problems from metastatic cancer. The choice of drugs depends on your overall health, your individual risk of side effects, your insurance coverage, and how you prefer to receive the drug.

  • Bisphophonates, such as zoledronic acid (Zometa) and pamidronate (Aredia), block the cells that dissolve bone, called osteoclasts. Zoledronic acid is given by IV for at least 15 minutes every 3 to 4 weeks or every 12 weeks. Pamidronate is given by IV every 3 to 4 weeks for at least 2 hours. Side effects may include flu-like symptoms and kidney problems. If you are taking pamidronate or zoledronic acid, you should have a blood test to check how well the kidneys are working before each time you receive the drug.

  • Denosumab (Xgeva) is an osteoclast-targeted therapy called a RANK ligand inhibitor. Denosumab is given as an injection under the skin (called a subcutaneous injection) every 4 weeks. Denosumab may cause low calcium levels in the blood, so you may need blood tests to monitor your blood calcium levels. You may also have tests to check kidney function.

A possible condition associated with bone-modifying drugs is osteonecrosis of the jaw. It is uncommon, about 1% to 2% of patients develop it, but it can be a serious condition. The symptoms of osteonecrosis of the jaw may include pain, swelling, and infection of the jaw; loose teeth; and exposed bone. It is recommended that you have a thorough dental examination, and any invasive procedures to the jaw bone or treatments for mouth infections should be done before starting these drugs. While receiving bone-modifying drugs, you should take good care of your teeth, mouth, and gums and avoid having any unnecessary invasive dental work done, such as elective dental surgery. Following these recommendations may help lower the risk of osteonecrosis of the jaw.

Although bone-modifying drugs may help reduce or lessen pain over the long term, they should not replace other treatments to reduce pain. Patients who experience bone pain should receive other medications and/or radiation therapy and/or surgery that are commonly used to manage the pain.

This information is based on ASCO's recommendations for bone modifying drugs for metastatic breast cancer.

White blood cell growth factors

White blood cell growth factors are proteins that help the body produce white blood cells. They are also called hematopoietic, meaning blood-forming, colony-stimulating factors (CSFs). White blood cells help fight infection and can be destroyed during some types of cancer treatment. Your doctor may recommend CSFs to help you avoid infections.

When treatment stops working

At some point, options for metastatic breast cancer treatment become very limited and the cancer will become difficult to control. When this happens, patients may choose to stop treatment and focus on palliative care.

It is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

People who have metastatic breast cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable and preferable option for many families. Learn more about advanced cancer care planning.

Changing role of caregivers

A family caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

And, the caregiver's role often changes throughout treatment, often becoming more intensive if the cancer worsens.

Eventually, the need for caregiving related to the cancer diagnosis will come to an end. After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.