Breast Cancer - Metastatic: Palliative and Supportive Care

Aprobado por la Junta Editorial de Cancer.Net, 11/2022

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 physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to manage the cancer.

Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting you and your family with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative and supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative and supportive care in a separate section of this website.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments, such as chemotherapy, surgery, or radiation therapy, to improve symptoms.

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. The American Society of Clinical Oncology (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 drug depends on your overall health, your individual risk of side effects, your insurance coverage, and how you prefer to receive the drug.

  • Bisphophonates. Bisphosphonates, 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). This 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 an uncommon but serious condition that affects 1% to 2% of patients treated with these drugs. 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, radiation therapy, and/or surgery, which are commonly used to manage pain.

This information is based on ASCO's recommendations for bone modifying drugs for metastatic breast cancer. Please note that this link takes you to a separate ASCO website.

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 that you receive treatment with CSFs such as filgrastim 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 cancer treatment and focus on palliative and supportive 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 has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.

People who have metastatic breast cancer and who are expected to live less than 6 months may want to consider comfort care options, such as 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 your doctor or a member of your palliative 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

Family caregivers play 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. A caregiver's role can change 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 on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.