Considering Palliative Care When You Have Metastatic Breast Cancer

Hearing the word palliative care may cause you to catch your breath. Isn’t that the same thing as hospice? Does this mean there aren’t more treatments I can try? The truth is that palliative care can be used right alongside treatments for cancer and has significantly improved the quality of life for many people with any stage of cancer.

Palliative care isn’t really a distinct type of care. It's more of a philosophy. The aim of palliative care is to take care of the whole person: mind, body, and spirit. Before you get worried that this sounds like some new age fad, it is not. On the contrary, it is the kind of comprehensive care we would hope every person with cancer could receive.

If you think about your cancer care, you’ll realize that much of the care we currently devote to people with cancer comes down to figuring out how to outwit cancer, how to most effectively remove cancer cells from the body with the fewest number of side effects.

At the same time, issues such as pain, fatigue, insomnia, and treatment side effects have often taken the back seat. It’s simply expected that you won’t feel all that good while receiving cancer treatment. Since metastatic breast cancer usually means ongoing treatments for most of the rest of your life, this approach is no longer acceptable. This is where palliative care can make a difference.

A palliative care team is usually made up of several people, but the particular specialists may vary from hospital to hospital. The team is often led by a physician who specializes in palliative care (yes, this is a specialty, and a growing one). Also included is a palliative care nurse along with healthcare professionals ranging from physical therapists to counselors, nutritionists, chaplains, and more.

Some people think of palliative care playing more of a psychosocial role, but the management of your physical symptoms can sometimes be immensely improved with this type of care. In palliative care, oncologists are freed up to do what they do best—choosing treatments that best keep your cancer in check.

While palliative care has been shown to be helpful for people with all stages of cancer, it can be particularly helpful for those with metastatic disease.

Studies are showing us that people who see a palliative care team often have a better quality of life during metastatic cancer treatment than those who do not receive palliative care. It’s important to note again that palliative care is not hospice care. Hospice care is only one type of palliative care. In fact, one study found that stage 4 cancer patients who received palliative care lived significantly longer than those who did not receive this care.

The roles that palliative care plays vary at different cancer centers. Some cancer centers strongly recommend palliative care for most of their patients, while fewer options for this care may be available to others. The best thing to do is talk to your oncologist and ask if she believes you might benefit from this care.

If your oncologist has not mentioned palliative care, it does not mean she doesn’t consider it helpful. The fact that many people confuse palliative care with hospice care can lead to hesitation on the part of oncologists to broach this subject.

Palliative care, unlike much of medical care, is designed to address the overall well-being and comfort of a person coping with cancer rather than specific symptoms, so it is somewhat hard to define as it will be different for each person. Some of the symptoms, however, that palliative care addresses for those with metastatic breast cancer include:

• Pain management
• Shortness of breath (with lung metastases or pleural effusion)
• Fatigue
• Musculoskeletal symptoms (pain, stiffness, and fracture prevention)
• Peripheral neuropathy
• Nausea
• Itching (this is common with liver metastases)
• Loss of appetite
• Weight loss
• Symptoms related to skin and chest wall metastases
• Anxiety
• Depression
• Grief (including anticipatory grief)
• Family relationships
• Spiritual concerns

As noted earlier, palliative care may be used even for someone who has an early stage curable cancer. Palliative care does not replace the conventional treatment of cancer, in contrast, it may help you stay as healthy as possible so you can tolerate these treatments.

A picture is worth a thousand words, so a specific example may be helpful. Consider a person with bone metastases related to breast cancer. In this setting your oncologists will work with your medications, deciding whether hormonal treatments, HER2 therapies, or chemotherapy would be best. She will consider whether bone-modifying agents may be of benefit as well. You may see a radiation oncologist to consider whether radiation therapy is needed.

Your symptoms, however, include much more. Palliative care specialists are experts in pain management and can help you find the right balance between pain relief and side effects from pain-relieving drugs. If more pain relief is needed, they can look at ways of helping alleviate these side effects.

Physical and occupational therapists on the team may help you increase your mobility after a fracture, or help you know what to do to decrease your chances of a fracture. Other members of your palliative care team may recommend alternative therapies to help you with both the pain and anxiety of metastatic cancer. A counselor on the team may be able to help both you and your family cope with what having metastases means, and the team is available to address your spiritual concerns as well.

In short, a good palliative care team can do wonders to assist you by not just treating your cancer, but helping you to live with your cancer.