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Coming to Terms with the Reality of Metastatic Breast Cancer

by Michele Cepeda, RN

Breast Cancer image

Individuals diagnosed with metastatic breast cancer – breast cancer that has spread to different parts of the body, most commonly, bones, the lungs, or the liver – often are faced with lifelong treatments. Treatment for metastatic breast cancer focuses on controlling – not curing – the disease while providing a good quality of life.

Today, many more treatment options that can effectively control the cancer are available than ever before. This means people are living longer with metastatic breast cancer. Treatments are more individualized, and management of the disease is long term. When one medication is no longer effective, another medication is used. And when that medications stops working, another is chosen, and so on. If a medication change is needed, the treatment decision will be determined by several factors:

  • types of previous breast cancer treatment;
  • site of the metastasis;
  • your age and general health status;
  • certain features of the tumor cells; and
  • current symptoms from previous chemotherapy.

Today, many more treatment options are available than ever before. This means people are living longer with metastatic breast cancer.

You should discuss the benefits, risks, and potential side effects of each treatment with your oncologist to help determine the best option for you. Side effects vary from treatment to treatment, and it is important to speak with your doctor or oncology nurse if the medications are interfering with daily life. It is best to do this at the onset of undesirable symptoms and not wait until your next visit. For example, tell your doctor if you are not sleeping at night due to treatment-related hot flashes or unable to walk because of bone pain caused by your current breast cancer treatment.

Along with your oncologist and oncology nurse, various supportive services are available that can provide excellent resources for coping with metastatic breast cancer. These may include social workers, psychiatrists, nutritionists, pain specialists, spiritual counselors, and financial counselors. In addition, private counseling and support groups can help you communicate and deal with your feelings, such as those of isolation, which are often pushed aside during treatment.

Those diagnosed with metastatic breast cancer not only cope with the challenges of their diagnosis and the side effects of treatment, but they also need to juggle life, full-time jobs, parenthood, being caregivers to their parents or spouses, and sometimes being their own healthcare advocates, having to fight with insurance companies to cover procedures or medications. Coping with metastatic disease means that you always need to be ready for change. There may be setbacks, but the reality is you try to push ahead and continue to do the things that you do.

A patient once described metastatic breast cancer as a tiger crouching five miles away. You know soon it may be coming toward you, but it’s not here yet, so you wait in your garden with the tiger close by. In that garden, there is hope and the belief you can live well. There you find all the little tricks that get you through the day, that help you to meet the challenges of keeping the tiger away from your peaceful garden.

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Michele Cepeda is an oncology nurse at the New York University Langone Outpatient Cancer Center. She works with individuals with metastatic breast cancer, as well as the newly diagnosed.

This article was published in Coping® with Cancer magazine, January/February 2010.