Living With Metastatic Breast Cancer: 5 Things to Know

Kate M. O'Rourke

Disclosures

August 15, 2019

2. A Palliative Care Plan Is Essential

Supportive and palliative care should be considered from the point of an MBC diagnosis.[2] Clinicians should develop a comprehensive care plan for every patient with MBC that includes symptom management and addresses both patient and family issues, including psychosocial concerns and adequacy of support.[3] Clinicians can use several validated pain and symptom assessment instruments for patients with advanced breast cancer and should ascertain the patient's understanding of their illness as well as their expectations for outcome.[3,14] Patients with MBC frequently experience pain, including back pain, epidural compression, and iatrogenic chronic pain; dyspnea; fatigue; and delirium and confusion.[3] Anxiety, depression, and existential suffering are common psychological symptoms.[3] Supportive therapies include pharmacology; physical therapy; behavioral counseling; spiritual support; diet management; and complementary therapies, such as yoga, acupuncture, meditation, and massage.[2,3,15,16,17]

Managing pain requires an integrated approach that includes hormonal therapies, chemotherapy, biologic therapy, radiation therapy, surgery, analgesic therapy, rehabilitation, and psychological care.[3] Nonpharmacologic and pharmacologic measures can be used to manage dyspnea.[3] Clinicians should address fatigue by first addressing underlying reversible factors, and then turning to nonpharmacologic and pharmacologic approaches.[3]

3. Exercise and Mindfulness-Based Stress Reduction Are Key Coping Strategies for Anxiety

Exercise and mindfulness-based therapies are excellent approaches to cope with the anxiety and depressive symptoms that are commonly associated with an MBC diagnosis.[18,19,20,21,22,23,24] Exercising during treatment, such as radiation, chemotherapy, or hormone therapy, can ease side effects, and exercise after treatment can boost quality of life and even improve survival.[19] Yoga and moderate-intensity progressive walking with resistance training can reduce anxiety, depression, and fatigue in women with MBC.[19,20,21,22] Mindfulness-based stress reduction helps with emotional regulation, increasing self-kindness, and decreasing negative rumination. Studies have shown that in patients with MBC, mindfulness reduces anxiety and distress and improves sleep.[23,24,25]

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