Living With Metastatic Breast Cancer: 5 Things to Know

Kate M. O'Rourke

Disclosures

August 15, 2019

4. Maintaining Life Balance Is Challenging

MBC causes changes in function, alters relationships, and adversely affects self-image.[26] Patients with MBC use a variety of strategies to live well with MBC, including attempting to reestablish a sense of normality and reprioritizing their lives.[27]

In addition to the physical and psychological effects of treatment, oncologists should understand that many different factors affect the treatment decisions of patients with MBC. These include treatment logistics and convenience; participation in personal and family responsibilities, work, and daily activities; and the ability to pursue life goals.[28] Individuals living with a metastatic diagnosis welcome guidance on routine prevention and screening for other medical conditions, and sometimes struggle with making decisions, even simple ones, such as stocking light bulbs and other household supplies.[29]

5. Bone Is Among the Most Common Sites of Metastatic Spread

Between 40% and 75% of patients with MBC have metastases to the bone upon initial presentation; between 44% and 71% have bone metastases upon autopsy.[30] Patients with bone metastases often suffer from pain, as well as hypercalcemia, pathologic fracture, and loss of mobility.[30] Bone metastases can cause chronic pain, which results directly from expanding lesions, pathologic fracture, or damage to adjacent structures.[30] Spinal cord compression occurring from bone metastases is a medical emergency requiring urgent treatment and is present in up to 20% of patients with MBC at autopsy.[30] Patients with MBC who are experiencing back pain should be evaluated for impending cord compression, because bone metastases are present in 95% of these cases.[30] Patient prognosis is generally poor once symptomatic leptomeningeal metastases develop in patients with MBC, and tumor cells may reach leptomeninges by various methods, including direct extension from bone-based metastases.[31]

Treatment options for neuropathic pain related to bone metastases include adjuvant analgesics, such as antidepressants and anticonvulsants, in conjunction with opioids; topical anesthetics; and psychological support.[30] For bone pain not associated with spinal cord compression or fracture, nonsteroidal anti-inflammatory drugs and acetaminophen in combination with opioids are recommended.[30] For diffuse bone pain from metastases, bisphosphonates, glucocorticoids, or systemic administration of radioisotopes are options.[30] Interventional procedures, such as regional infusions with the insertion of an infusion pump, percutaneous kyphoplasty or vertebroplasty, and radiofrequency ablation, are potential treatments for refractory pain from bone metastases.[30]

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