Advanced breast cancer can be treated even if it cannot be cured. In fact, scientists estimate that approximately 150,000 women are living with advanced breast cancer in the U.S., a third of them living for 5 years or longer with the diagnosis.1
If you’ve recently received a diagnosis of advanced, or metastatic, breast cancer, you’ll soon learn that the treatments suggested and how your disease is managed can be quite different from those of early-stage breast cancer.
The biggest change you’ll notice is that your doctor’s goal becomes to stop or slow progression of the disease to prolong your life, reduce your symptoms, and limit the side effects you experience. It’s quite distinct from the more aggressive nature of stage 1 treatment goals to find a cure and prevent recurrence.
With advanced breast cancer, the objective becomes focused on making sure you feel as good as possible for as long as possible.
Why is treatment different?
Any radiation, chemotherapy, surgery and other drugs you receive tend to emphasize managing the disease over the long-term rather than getting rid of the cancer.2
For instance, rather than operating to remove a tumor, your doctor may advise radiation to shrink the tumor in order to relieve pain or other distressing symptoms or counteract the tumor encroaching on vital organs.
These treatments may seem more conservative than those you experienced with early-stage breast cancer. That’s largely because long-term treatments need to take the quality of life issues into account to a greater degree. For example, there are many side effects, such as vomiting, that are tolerable for six weeks but not for six years.
It’s also important to note that your cancer cells may have built a resistance to medicines you used in the past, or that past treatments are too toxic to use more than once. Often, chemotherapy that may have helped you in the past is no longer an option.3
Balancing benefit versus burden
As of December 2018, there are 290 clinical trials available in the U.S. to patients with advanced breast cancer.4
How you and your doctor decide to treat your cancer and manage the side effects can be a tricky balance of personal wishes, health risks, toxicity, finances, comorbidities, and age. Doctors refer to this analysis as the benefits versus burden judgment.5
Your decision-making process will require you to weigh things like:
What’s an acceptable level of risk for debilitating side effects?
Is there a life-event, such as a child’s wedding, that I want to attend?
How much do I want any pain to be controlled versus being able to perform daily tasks like driving?
Will any side effects or financial burden outweigh the extra time I’ll gain?
What have other patients experienced on this treatment and what were their results?
As you and your health team weigh benefits versus burdens, you may find that your treatments change more frequently than happened with early-stage breast cancer. That may be because your cancer builds a resistance to the medicine, the side effects become too severe, or the medicine shows no sign of slowing your disease.2
Defining your goals
Your doctor will probably have many suggestions for managing your disease and its symptoms. The treatments you decide to accept will be as individual as you are. Regardless of what you choose, you should know that people with advanced breast cancer are living longer with their disease than ever before.1
For instance, participating in a clinical trial interests some people as a way to help improve medical care for future patients. Others may decide the burdens of further treatment outweigh the potential benefits. The right answer is what’s right for you and your family.
This stage of your disease will require open, honest dialogue with your health care team about what you want to happen so that they can build a treatment plan around you. Ultimately, any therapies you choose must meet your unique wishes and expectations for treatment.
Mariotto AB, Etzioni R, Hurlbert M, PenberthyL, Mayer M. Estimation of the number of women living with metastatic breast cancer in the United States. Cancer Epidemiol Biomarkers Prev. 26(6):809-815, 2017. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28522448. Accessed 12/14/18.
Chunga CT, Carlson RW. Goals and Objectives in the Management of Metastatic Breast Cancer. The Oncologist. Available at: http://theoncologist.alphamedpress.org/content/8/6/514.full. Accessed 12/14/18.
https://www.lbbc.org/learn/types-breast-cancer/metastatic-breast-cancer/treatments-and-research-metastatic-breast-cance-5 Accessed 12/14/18.
BreastCancerTrials.org. Available at: https://www.breastcancertrials.org/bct_nation/browse_trials.seam?categoryString=METASTATIC&pageRecord=0. Accessed 12/14/18.
Kaur J, Mohanti BK. Transition from Curative to Palliative Care in Cancer. Indian J Palliat Care. 2011 Jan-Apr; 17(1): 1–5. doi:10.4103/0973-1075.78442. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3098537/. Accessed 12/14/18.