Metastatic breast cancer is cancer that has spread beyond the breast, underarm and internal mammary lymph nodes to other parts of the body near to or distant from the breast. When a patient is diagnosed with metastatic breast cancer, their care team must include medical oncology and surgical oncology, BUT mind-body, naturopathic medicine, registered dietitians, pastoral care and physical therapy are each involved in the total treatment of any patient with breast cancer. In addition, we should remember the important role that primary care doctors, radiologists (mammography and breast MRI), and pathology physicians (tissue analysis) play in establishing the diagnosis for a treatment team. Understanding the unique role that each of these experts plays can help patients to be active participants in their care.
John McKnight, MD, MBA
Medical Oncologist at Cancer Treatment Centers of America® (CTCA) in Newnan, Georgia
Q. If a woman is diagnosed with metastatic breast cancer, what does that mean?
A. The cancer has spread outside of the breast and its nearby tissues. Therefore, cancer can be detected in distant organs such as the lungs, liver or bones.
Q. As a medical oncologist, what is your role as part of the care team for women diagnosed with metastatic breast cancer?
A. Medical oncology is officially a subspecialty of internal medicine. As a result, the medical oncologist plays a central role in the diagnosis, treatment and day-to-day care of adult patients with cancer. Our internal medicine background is a key to our approach in caring for the whole person. My opening question in each new consultation is, “Tell me what’s in your heart and what you would like for me to do for you today?”. This is my way of setting a tone in which it is clear that each individual’s wants, needs and hopes for how their cancer care will proceed become central to the care plan.
Practically speaking, the medical oncologist diagnoses metastatic cancer and recognizes complications from cancer, hopefully before significant symptoms affect the patient. For example, the medical oncologist would like to diagnose cancer spread to the thigh bone (femur) prior to progression to painful fracture. In addition, the medical oncologist is responsible for supervising and administering medicines such as chemotherapy in the treatment of cancer.
Q. What do you think is most essential for woman diagnosed with metastatic breast cancer to know about their diagnosis and treatment?
A. While the word “metastatic” often makes patients feel hopeless, it is very important for each patient to carefully discuss their individual situation with the oncologist. For example, a woman with only a few metastatic areas in her bony skeleton is very different from the woman who has many metastases in her liver and lungs. Within these two examples, treatment options and predicted survivals are very different. In addition, we now know each individual breast cancer has its own profile and characteristics. Therefore, treatment decisions and predictions about how well or poorly a patient with metastases will or will not do, must be individualized. Many women with metastatic disease are not only living longer but, more importantly, living better with today’s individualized approaches.
Q. Are there any advances in the treatment of metastatic breast cancer that you find especially exciting right now?
A. There are many exciting treatment developments. One important development addresses one of the most challenging aspects of treating metastatic breast cancer—the tendency for cancer cells to develop resistance to chemotherapy. This resistance allows cancer to then grow rapidly and spread widely. Recently new combinations of oral hormonal-based therapies have been developed to overcome resistance, This is an incredibly exciting advance for patients with metastatic cancer.
Lanceford Chong, MD, MPH
Medical Director of Radiation Oncology at CTCA® in Goodyear, Arizona
Q. What role does radiation oncology play in the treatment of metastatic breast cancer, and what should patients know about how radiation will factor in their overall treatment plan?
A. While breast cancer can metastasize to multiple and various sites in the body, the most frequently encountered regions seen for consultation in radiation oncology include the brain and bones. The goal of palliative radiation therapy is to ease symptoms related to the metastatic lesion or to prevent anticipated problems related to the lesion if it were left to progress.
With brain metastasis, the number of lesions, anatomic location, size of the lesion and presence of edema around the lesion must be assessed. The two primary radiation therapy treatments for brain metastasis include whole-brain radiation therapy or stereotactic radiosurgery (SRS). Whole-brain radiation therapy is given to patients who have one or more brain lesions; the beams of radiation are directed to the right and left side of the entire head. Stereotactic radiosurgery, an advance in radiation oncology, is administered to patients with one-to-three brain lesions; multiple radiation beams pinpoint the exact tumor site through several different angles, while delivering a very high dose of radiation.
Bone metastases are evaluated based on the number of lesions, location, size, presence (or extent) of erosion in the bone, weight and pain. For symptomatic, non-complicated bone metastases, external beam radiation would be used. Stereotactic body radiation therapy (SBRT), another advance in radiation oncology, is used with patients who have an oligometastic disease and for irradiation of a spinal lesion.
It is important that patients diagnosed with metastatic breast cancer be aware of the role that radiation oncology might play as part of their overall treatment plan. In most cases, treatment is used for systemic management and pain control when indicated. However, an appropriate and reasonable consultation may be needed with a radiation oncologist because timing of treatment is crucial for best results in symptom control and quality-of-life. The importance of finding a clinically astute and therapeutically knowledgeable radiation oncologist with a top team and state-of-the-art technology cannot be overestimated or overstated during treatment.
Diane Schaab, MS, LPC
Mind-Body Therapist at CTCA in Newnan, Georgia
Q. What are some of the emotional challenges that women with a diagnosis of metastatic breast cancer might face?
A. Our goal when counseling a metastatic breast cancer patient is to assist women in adjusting to their illness and to the impact cancer has made on their lives. We work to impart a sense of empowerment to help women move forward.
When diagnosed with metastatic breast cancer, women may go through a variety of emotions, including anger, sadness, shock, fear, hopelessness, being overwhelmed and, sometimes, a feeling of seclusion. Often times, women struggle with some of the emotions they are experiencing. There is no right or wrong answer as to how any one person responds emotionally.
Life can be an emotional roller coaster. It is essential for women to have the tools to navigate through the challenges of their cancer journey in order to cope with their emotions, relationships, body image, decision-making and stress. Providing psychosocial support can provide women a sense of relief. By embracing their emotions as they experience them and processing those emotions in a way that allows them to move forward, they can proceed with a sense of hope.
Q. As a mind-body therapist, what are some of the ways you work with patients diagnosed with metastatic disease?
A. Our focus in mind-body medicine is to help women find the inner strength they need to develop and enhance their coping skills so they are able to embrace life while they are managing cancer. Our therapists provide individual, couples or family counseling to patients and their loved ones as they navigate their cancer journey.
Many patients see mind-body therapists for the management of non-cancer related stressors as well, including: work-related, financial, relationship and other life changes. We provide patients with problem-solving skills and strategies for coping, and we help patients work through their emotions. In addition to counseling, we offer support groups and other wellness support such as music therapy, art expression classes and guided imagery/meditation sessions.
Q. Are there any specific resources or tools that you would want women living with metastatic breast cancer to be aware of?
A. Some of the best tools for managing stress are free and right at your fingertips! Deep belly breathing is a wonderful way to lower anxiety levels. Can’t fall asleep? Try progressive muscle relaxation followed by guided imagery. The use of mindfulness techniques can bring peace and tranquility to your inner being. Calm thoughts, living one day at a time and prayer can all be our allies while healing.source