My treatment

My treatment

Choosing a treatment can be daunting, and there are a lot of questions to ask your oncologist about your available options. You want to choose a treatment that is effective for your metastatic breast cancer, but it is also important to understand the possible side effects and consider how a treatment may affect your lifestyle. Talk to your oncologist about which treatment may be right for you.

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Remember:

  • Treatment for metastatic breast cancer is long term and you may have to take different treatments over time1,2.
  • The goals of treatment are to prevent your cancer from spreading further (progressing), relieve the symptoms and ensure you have the best possible quality of life1,2.
  • Always tell your oncologist about any treatment side effects you experienced – there are things they can do to help1.

What are the types of treatment for metastatic breast cancer?

The treatment you will receive for your metastatic breast cancer will largely depend on the type and location of your cancer. You may be given a combination of therapies or you may receive only one therapy at a time2.

The three main types of drug therapy that you can be offered to control your cancer are chemotherapy, anti-hormonal therapy (also called endocrine therapy) and targeted therapy1,2Radiotherapy, and rarely surgery, may also be used when necessary for disease or symptom control2.

In addition, you may be given treatments to help relieve the symptoms of the cancer or of the metastases in your body. Among the most important of these treatments are bone stabilizing agents such as bisphosphonates or anti-RANKL monoclonal antibody which are given to help strengthen your bones, particularly if you have bone metastases3,4.

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  • Chemotherapy
  • Radiotherapy
  • Anti-hormonal drug therapy
  • Targeted therapies
  • Bone stabilizing agents
  • Surgery
  • Chemotherapy

    Chemotherapy drugs are substances that kill cancer cells5. However, they can harm normal cells too and this can cause side effects5. Some chemotherapy drugs are given as a pill that you can take at home1. Others are given by intravenous infusion and you may have to go to hospitals to receive them1.

    Whether you receive chemotherapy will depend on your health, what medicines you have taken before and the type of cancer you have. There are many different types of chemotherapies1. If you have too many side effects with one kind, please consult your oncologist.

  • Radiotherapy

    Radiotherapy is the use of high-energy radiation that kills cancer cells5. Radiotherapy may be given to control your cancer. It can also be used to relieve bone pain if cancer drug therapy does not relieve it fast enough. It is common to radiate metastases in the bone that are causing pain2.

    Radiotherapy treatment is individualized based on discussions between the patient and her doctor3.

  • Anti-hormonal drug therapy

    Anti-hormonal therapies (or endocrine therapies) are used to treat breast cancer that is sensitive to hormones, particularly estrogen. Some types of breast cancer are stimulated to grow by hormones, such as estrogen6. Anti-hormonal therapies work by blocking the actions of particular hormones in the body – by suppressing the production of the hormones estrogen and progesterone or by blocking the receptors for these hormones2,6.

    There are several different hormone-based therapy drugs that work in different ways. Anti-hormonal therapies are usually given as pills, but some are given as injections. You may take them with or without chemotherapy2,6.

    Whether you are given anti-hormonal therapy, and what type, will depend on whether you have gone through the menopause, how much time has passed since your diagnosis and what kind of treatment you took for your initial breast cancer (if you were diagnosed and treated previously for early breast cancer)2,6. If you have had anti-hormonal therapy in the past, you may still take it again7.

  • Targeted drug therapy

    Targeted therapies work on specific types of breast cancer by blocking specific pathways that breast cancer cells use to multiply. To determine if any targeted therapies are right for you, your oncologist will have to determine what type of cancer you have2.

    There are therapies which are used in the treatment of HR-positive breast cancer that specifically target the signaling pathways that are activated by hormones, such as estrogen8.

    There are also several therapies that target HER2 receptors8. These drugs work in people with high levels of HER2 in the cancer cells, but they do not work in cancers that do not have this protein.

  • Bone stabilizing agents

    These are drugs that are often used when there are metastases in the bone. They work by helping to strengthen your bones and help reduce bone loss3,7.

    They can help relieve bone pain and reduce the long-term risk of bone breaks3,7. They are taken as pills or injections3,7.

  • Surgery

    Surgery is rarely used in metastatic breast cancer2. But, it may help some women by lessening symptoms or controlling disease in specific body parts. Surgery is often utilized when cancer has metastasized to the bones, lung or brain, and occasionally the liver2.


What are the treatments for specific metastatic breast cancer types?

Treatment options can vary depending on the type of metastatic breast cancer you have1. For example, your oncologist may recommend a combination of an anti-hormonal treatment and a targeted therapy if your cancer is HR-positive, or a HER2-targeted therapy for HER2-positive cancer7. Consult with your oncologist to understand which treatment is best for you.

WHAT TREATMENT IS
BEST FOR ME?

There is no single ‘best’ treatment for metastatic breast cancer, and what works for one person may not necessarily work for you7.

There are many different factors that affect which cancer treatment is best for you. These factors include the biology of the tumor (the type of breast cancer), the sites of metastases in your body, any prior treatments you have received for breast cancer and any treatments you are currently taking for other diseases7.

Expect to change treatments over time because your cancer can develop resistance to a given treatment7. You may need to switch to another treatment to which your cancer is more likely to respond. Your oncologist may stop your treatment for other reasons. You should consult your oncologist if you are experiencing too many side effects.

HOW DO I KNOW IF MY TREATMENT IS WORKING?

People react differently to different cancer treatments, so it is difficult to predict if your cancer will respond to a treatment or not. Your oncologist will conduct a variety of tests over time to find out if your treatment is working. These may include looking at:

The size of your tumor/metastases

Your oncologist may use imaging procedures to see if your tumor or metastases are growing, shrinking or staying the same size – to determine the effectiveness of the treatment8. This may involve repeating some of the scans that were used to diagnose the cancer initially such as computed tomography (CT) or magnetic resonance imaging (MRI) scans8.

The level of tumor markers

Tumor markers are proteins or other substances that are often, but not always, found in the blood when tumors are active in the body9.

The levels of tumor markers over time can be used by your oncologist to monitor the efficacy of your treatment9.

The level of circulating tumor cells

Circulating tumor cells (CTCs) are cancer cells that have detached from the primary tumor and are circulating in the bloodstream9.

High levels of CTCs may indicate the cancer is growing9. Your oncologist may monitor the level of CTCs in your blood to see how well you are responding to treatment9.

Development of new metastases

Your oncologist will want to make sure that cancer cells have not spread to other parts of the body. For this, imaging procedures such as computed tomography (CT) or magnetic resonance imaging (MRI) scans can be used10.

For how long do I take treatment?

Treatment for metastatic breast cancer is long term. This is because ongoing treatment is needed to control your cancer and prevent it from getting worse, and to help control symptoms of metastases. Your treatment may change over time and you may be given the same treatment several times, alternated with other treatments11.

There is no single best way to treat metastatic breast cancer and each person’s situation is different1.

You may be tempted to stop treatment once you feel better or if it makes you feel sick. However, as much as possible, it is critical to keep taking your treatment for as long as it is prescribed. Talk to your oncologist if you are thinking about stopping your treatment. There are things that can be done to help reduce side effects.

WHAT TREATMENT SIDE
EFFECTS CAN I EXPECT?

The side effects you experience will depend on the type of treatment, the dose you are receiving and your reaction from one therapy cycle until the next12. Also, everyone reacts differently to treatment. The side effects you have may be very different to those of another person on the same treatment12.

If you experience side effects from chemotherapy, these usually start during the first few weeks of therapy and intensify with each treatment cycle12. It is a good idea to plan for this until you know how you will feel. In general, these side effects subside once treatment is halted and the normal cells in the body recover (chemotherapy affects both the normal and cancer cells in the body)12.

Not everyone experiences side effects with treatment. If you do not experience any side effects, it does not mean that your cancer treatment is not working12.

Always tell your oncologist or nurse about any side effects you experience. There are supplemental treatments that can help with the side effects or in some cases your cancer treatment may be adjusted. Also, what feels like a side effect could be a sign of the cancer growing.

Common side effects and how to manage them

Some of the most common side effects of breast cancer treatment include fatigue, pain, nausea and vomiting, diarrhea, hair loss, low white blood cell count, and weight gain or weight loss13.

Pain

If you are having pain, it is important to let your oncologist or nurse know. They can give you drugs to help and recommend pain relief methods3.

It might help to keep a record of the frequency and the severity of your pain – does the pain get worse at night, or when doing specific things? Relieving your pain effectively will have a large impact on the way you feel – it can help reduce fatigue, anxiety and depression, and improve your sleep and overall well-being.

Cancer pain is usually treated with medicine and complementary therapies3. Therapies such as acupuncture, massage therapy and relaxation techniques can help you to control your pain14. Exercise can also help.

Fatigue

Fatigue is one of the most common side effects during treatment for metastatic breast cancer. Fatigue is so much more than feeling tired: it is complete exhaustion. It may be related to the physical effect of the cancer itself or be a side effect of treatment. Or it may be related to changes in your sleeping patterns and added stress and anxiety15.

Tips for dealing with fatigue13,15:

  • Eat regularly and eat healthy foods
  • Do regular gentle exercise
  • Plan your day and only do what is most important to you
  • Ask for help from friends and family
  • Take short breaks or naps
  • Tell your oncologist or nurse – your fatigue could be related to a low level of red blood cells, a condition known as anaemia, and this can be treated12

Nausea and vomiting

Untreated nausea and vomiting can make you feel very tired and can also lead to more serious problems. Tell your oncologist or nurse if you experience nausea or vomiting during your treatment for metastatic breast cancer – there are medicines available to help you control them for the duration of your therapy.

Tips to reduce nausea and vomiting12,13,16:

  • Gentle exercise and fresh air
  • Avoid spicy, greasy or very sweet foods – try bland and easy-to-digest foods
  • Take small sips of fluid during the day, if you don’t like the taste of water, consider ginger or syrup flavourings
  • Eat regular small meals

Sleeping problems and insomnia

Numerous factors can prevent you from having a good night’s sleep, including pain, stress, side effects of the treatment, anxiety, and depression. You may feel like you can’t sleep, wake up frequently in the night, or wake up very early.

This can affect your ability to function on a daily basis17. Tell your oncologist if you experience sleeping problems – there are medications that may help17.

Tips to help you sleep12,17:

  • Try to maintain your usual sleeping pattern
  • Reduce noise and light in your room
  • Try relaxation techniques, meditation or mindfulness
  • Have a warm drink before bedtime (but avoid caffeine)

Lack of concentration and cognitive changes

Experiencing a lack of concentration or even cognitive changes are not unusual side effects you can experience during your metastatic breast cancer treatment therapy. These side effects can be caused by physical or emotional changes that may or may not be related to your treatment12,18. It is important you report any problems with concentration to your oncologist or nurse. 

Hair loss

If you are receiving chemotherapy as a part of your treatment for metastatic breast cancer, you may experience thinning or drying-out of your hair, or hair-loss19. Many people worry about this but it depends on the kinds of drugs you are precscribed12.

For some, but not all chemotherapies, scalp cooling may be an effective way to prevent hair loss20. Ask your oncologist whether this may help your specific treatment and whether scalp cooling is offered at your clinic.

Having your hair fall out can be very upsetting, and it might be a good idea to cut your hair short if you know you are going to lose it13. This can help you regain some control of the situation, rather than waiting for your hair to fall out. Do what feels right for you.

References
  1. National Breast Cancer Foundation Australia (2020). Treatment. Retrieved from https://nbcf.org.au/about-breast-cancer/treatment. Accessed 10 December, 2020.
  2. Australia Government (October 2020). Treatment options for metastatic breast cancer. Retrieved from https://www.canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/treatment/metastatic-breast-cancer. Accessed 10 December, 2020.
  3. National Cancer Institute (2020). Breast Cancer Treatment -Patient Version. Retrieved from https://www.cancer.gov/about-cancer/treatment/side-effects/pain/pain-pdq Accessed 13 October, 2020.
  4. National Cancer Institute (2020). NCI Dictionary of Cancer Terms. Retrieved from https://www.cancer.gov/publications/dictionaries/cancer-terms Accessed 13 October, 2020.
  5. National Cancer Institute (2020). Types of cancer treatment. Retrieved from https://www.cancer.gov/about-cancer/treatment/types. Accessed 13 October, 2020.
  6. National Cancer Institute (2020). Hormone Therapy for Breast Cancer. Retrieved from https://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet Accessed 13 October, 2020.
  7. NCCN Clinical Practice Guidelines in Oncology Breast Cancer, Version 6. 2020- September 8, 2020. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 13 October, 2020.
  8. National Cancer Institute (2020). Breast Cancer Treatment – Patient Version. Retrieved from https://www.cancer.gov/types/breast/patient/breast-treatment-pdq#section/all. Accessed 13 October, 2020.
  9. Breastcancer.org (2020) Blood Marker Tests. Retrieved from https://www.breastcancer.org/symptoms/testing/types/blood_marker. Accessed 13 October, 2020.
  10. Australian Government Cancer Australia (October 2020). Diagnosis when breast cancer has spread. Retrieved from https://www.canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/diagnosis/diagnosis-when-breast-cancer-spreads. Accessed 13 October, 2020.
  11. American Cancer Society (April 2020). Treatment of Stage IV (metastatic) breast cancer. Retrieved from https://www.cancer.org/cancer/breast-cancer/treatment/treatment-of-breast-cancer-by-stage/treatment-of-stage-iv-advanced-breast-cancer.html. Accessed 10 December, 2020.
  12. Cancer Council Victoria (2020) Chemotherapy: Side effects of chemotherapy. Retrieved from: https://www.cancervic.org.au/cancer-information/treatments/treatments-types/chemotherapy/side_effects_of_chemotherapy.html. Accessed 13 October, 2020.
  13. Australian Government Cancer Australia (October 2020). Side effects. Retrieved from https://www.canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/treatment/chemotherapy/side-effects#. Accessed 13 October, 2020.
  14. National Cancer Institute (2020) Side Effects: Pain. Retrieved from https://www.cancer.gov/about-cancer/treatment/side-effects/pain. Accessed 13 October, 2020.
  15. National Cancer Institute (2020). Fatigue and Cancer Treatment. Retrieved from https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue. Accessed 13 October, 2020.
  16. Cancer Care Ontario (2019). How to manage your nausea and vomiting. Retrieved from https://www.uhn.ca/PatientsFamilies/Health_Information/Health_Topics/Documents/How_to_Manage_Nausea_Vomiting_cco.pdf. Accessed 10 December, 2020.
  17. Macmillan cancer support (2020). Trouble sleeping (Insomnia). Retrieved from https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/trouble-sleeping. Accessed 10 December, 2020.
  18. National Cancer Institute (2020). Memory or Concentration Problems and Cancer Treatment. Retrieved from https://www.cancer.gov/about-cancer/treatment/side-effects/memory. Accessed 13 October, 2020.
  19. National Cancer Institute (2020). Memory or Concentration Problems and Cancer Treatment. Retrieved from https://www.cancer.gov/about-cancer/treatment/side-effects/hair-loss. Accessed 13 October, 2020.
  20. Macmillan Cancer Support (2020) Scalp cooling. Retrieved from: https://www.macmillan.org.uk/information-and-support/coping/side-effects-and-symptoms/hair-loss/scalp-cooling.html. Accessed 13 October, 2020.

 

Disclaimer

This health information is provided for reference only and is not intended to replace discussions with a healthcare provider.

All decisions regarding patient care must be made with a healthcare provider.