Breast Cancer, Metastatic Or Recurrent: Treatment Overview

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Treatment Overview

Decisions about how to treat metastatic or recurrent breast cancer are based on a combination of factors that include specific information about the cancer, your preferences, and your health.

• Because breast cancer can now be discovered at a much earlier stage, most women will not have metastatic or recurrent disease.
• Although most metastatic breast cancer cannot be cured, you can live for several years with treatment that will improve the quality of your life.
• The type of treatment you receive depends on your general state of health and how active you are (performance status).

Initial treatment

The treatment you receive depends on your symptoms, the area of your body involved, and whether your breast cancer has spread. Treatment may include:

• Hormone therapy with medicines such as tamoxifen or an aromatase inhibitor. These medicines are used if your breast cancer has estrogen receptors. Aromatase inhibitors are only used if you have already completed menopause.
• Trastuzumab (Herceptin), for HER-2 breast cancer. It is used to stop the cancer from coming back and to control breast cancer that has spread.
• Chemotherapy with medicines such as doxorubicin, taxol, or cyclophosphamide.
• Bisphosphonates, to reduce bone pain, fractures, and spinal cord compression caused by metastatic disease in the bones.
• Radiation treatments, to destroy cancer cells that are causing problems in a specific area.
• Surgery for a local recurrence. For example, you might have a mastectomy if breast cancer has returned to your breast after you had breast-conserving surgery. Some studies have shown better survival rates for women who have the primary tumor removed even when the cancer has already spread.⁶
• Corticosteroids, to reduce inflammation and swelling caused by metastatic disease of the brain and spinal cord.

Clinical trials that test new medicines and new combinations of medicines are ongoing. Talk with your doctor about participating in a clinical trial.

The length of time between visits to your doctor depends on the type of treatment you are receiving and your response to the treatment.

Emotional needs

If you have recently been diagnosed with metastatic or recurrent breast cancer, you may experience a wide variety of emotions. There is no "normal" or "right" way to react. You may feel angry or frustrated and may second-guess your previous treatments. And you may lose hope. But recurrent or metastatic breast cancer can be treated successfully. Some women live for many years, managing their cancer like a long-term health problem. The treatment decisions you and your doctor made in the past were the right ones at that time. But now, new decisions must be made and treatment objectives must be explored.

Get the support you need. There are many different types of support programs, including individual or group counseling and support groups. Some groups are formal and focus on learning about cancer or dealing with feelings. Others are informal and social. All types of support help you explore your feelings and develop coping skills. Thanks to the Internet, it’s also possible to find women who are very willing to listen to you and share their own experiences through online support groups and chat rooms. Studies have found that people who take part in support groups have an improved quality of life, sleep better, and feel more like eating. Contact your local chapter of the American Cancer Society to help you find a support group. Talking with other people who may have had similar feelings can be very helpful.

Do not be afraid to ask for help. During times of emotional distress, it is important to allow other people to take over some of your responsibilities. Other people often feel the need to show you how much they care about you.

You may feel lonely and separate from other people. You may think that no one else can understand the depth of your feelings. Surrounding yourself with people that you love and talking about your feelings and concerns may help you feel less lonely and more connected with others.

Try alternative activities, such as meditation or guided imagery, to help you relax. Do not use alcohol or illegal drugs. Tell your doctor if you are using herbal preparations or other complementary treatments.

If the stress of having cancer is interfering with your ability to make decisions about your health, it is important to tell your doctor. Your cancer treatment center may offer psychological or financial services.

Staying hopeful when you have metastatic cancer

Living with cancer is one of the greatest challenges you will ever face. You may find it difficult to stay hopeful when you are fighting cancer for the second or third time. The following suggestions may help.

• Set goals and make every day special. Keeping a positive outlook can seem impossible at times. And, at times, it is okay to be frustrated and angry and to wonder, “Why me?” These are all normal and necessary emotions. But, they don't do anything to help you enjoy quality of life. Turn your attention to making every day special. Set a goal each day to do something special for yourself or someone else. Consider getting a new pet to care for, or try planting a garden. Support others who have cancer.
• Seek support. Surround yourself with people who encourage and motivate you. Sources of support may include:
  • Another cancer survivor.
  • Family and friends.
  • Health professionals. Keep in contact with your health professionals. Let them know if you are having difficulties with any area of your care or if something has changed in your health or lifestyle that may require an adjustment in your cancer treatment.
  • Clergy or a grief counselor.
  • An organized cancer support group. Look for opportunities to attend meetings or classes where you can receive new cancer information or simply receive reinforcement of concepts that are already familiar to you.
• Keep things in perspective. Remember that cancer is a part of your life, but it does not have to take over your life. Also, remember that you are not alone. Cancer is very common—many other people have cancer. Enjoy today. None of us can be sure how long we are going to live, but we can all make the conscious decision to enjoy each day.
• Think positive. Continually remind yourself that everything you are doing to treat your cancer is making a difference in the quality of your life now and well into the future. It may be helpful to make a list of the health benefits of properly treating your disease and keep the list close at hand. Include things on the list that are important to you.

Side effects

Breast cancer and the treatment for it can cause may side effects. There are many things you can do at home to help manage these side effects. Let your doctor know if you are having problems with side effects and what you are doing to manage them. Your doctor may be able to prescribe medicines or other treatments to improve your sense of well-being and your quality of life. Good communication with your doctor can help prevent problems.

Treatment if the condition gets worse

Although many women with locally recurrent breast cancer are cured, metastatic breast cancer is usually a progressive condition. But with newer treatment techniques, some women live for many years, managing their cancer like a long-term health problem.

Second-line treatments with different chemotherapy drugs are commonly used. New drugs continue to become available. And you can consider talking to your doctor about getting treatment through a clinical trial.

Your doctor can address questions or concerns about maintaining your comfort if treatment to control the progression of your breast cancer is no longer an option.

For more information, see the topic Cancer Pain.

Palliative care

As your cancer gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different than care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. Some people combine palliative care with curative care.

Palliative care can help you manage symptoms or side effects from treatment. It could also help you cope with your feelings about living with a long-term illness, make future plans around your medical care, or help your family better understand your illness and how to support you.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

End-of-life issues

A time may come when your goals or the goals of your loved ones may change from treating an illness to maintaining your comfort and dignity. Your oncologist will be able to address questions or concerns about maintaining your comfort when cure is no longer an option. Hospice health professionals can provide palliative care in the comfortable surroundings of your own home. For more information, see the topic Hospice Care.

You may wish to discuss with your doctor and your family the health care and other legal issues that arise near the end of life. It may be helpful and comforting to state your health care choices in writing (with an advance directive, such as a living will) while you are still able to make and communicate these decisions.

Think about your treatment options and which kind of treatment will be best for you. You may wish to choose a health care agent to make and carry out decisions about your care if you become unable to speak for yourself. For more information, see the topic Care at the End of Life.

Last updated:	August 31, 2007
Author:	Kathe Gallagher, MSW
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, Douglas A. Stewart, MD - Medical Oncology
Editors:	Cynthia Tank, Pat Truman, MATC