7 Things to Expect During Metastatic Breast Cancer Treatment
- Preparing for TreatmentTreating metastatic breast cancer can be different than treating early-stage breast cancer. Most patients I see with metastatic breast cancer were diagnosed with early-stage breast cancer and then experienced a recurrence, although a minority are diagnosed for the first time with metastatic cancer. I often tell my newly diagnosed patients that since metastatic breast cancer treatment is going to be a new experience for them, they’ll need to be comfortable relying on their support system and asking for help if they need it. Fortunately, thanks to recent treatment advances, many of my patients with late-stage breast cancers respond well to therapies and live longer lives, with a goal of tolerating the treatment they are receiving.
- 1. Today, treating metastatic breast cancer can be like treating a chronic disease.Treatment for metastatic breast cancer depends on the type of cancer, and each type has effective treatment options available. Most metastatic breast cancers are considered hormone receptor-positive (HR-positive); this means the cancer cells use hormones, like estrogen and/or progesterone, to grow. Knowing this, we can use therapies that block this growth process, including lowering hormone levels. With this strategy, we’ve seen excellent results—patients taking these drugs can live relatively normal lives. While their breast cancer isn’t cured, they can remain on their treatment plans for many years.
- 2. Typically, you’ll take a combination of medications.Hormone therapy, also known as endocrine therapy, is very effective in treating HR-positive breast cancer. We typically turn to a type of hormone therapy called aromatase inhibitors. Examples of aromatase inhibitors include anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin). While they can be very effective, after a while, cancer cells tend to outsmart these drugs and begin to grow again. But we have a new way to try to counteract this; we can combine hormone therapies with an exciting new class of drugs called CDK4/6 inhibitors. Studies show that combining these drugs early in the metastatic diagnosis with hormone therapy nearly triples how long it takes for the cancer to progress. Right now, two CDK4/6 inhibitors are available: palbociclib (Ibrance) and ribociclib (Kisqali), but another may be are coming down the pipeline soon, called abemaciclib.
- 3. Side effects can be challenging, but usually manageable.Aromatase inhibitors can cause menopausal symptoms, since they effectively lower the levels of reproductive hormones in the body—just like menopause does. Patients might experience hot flashes and vaginal dryness when taking aromatase inhibitors. They also might experience joint aches and pain. The main side effect of CDK4/6 inhibitors is a decrease in white blood cells that fight infection—we call that neutropenia. When we start a patient on these medicines, we follow their blood counts every two weeks for the first two months; if there is a significant decline in white blood cells, then we may need to bring down the dose. But infections due to neutropenia are still really rare for these patients. Other potential side effects include fatigue and nausea, as well as some hair thinning.
- 4. You may not need chemotherapy right away.Often, it takes my patients some time to wrap their minds around the fact that metastatic breast cancer treatment can be more like a marathon, as opposed to a sprint. We have a good number of treatments available that work, and we’ll keep patients on hormone therapy in combination with a CDK4/6 inhibitor, or other targeted medications like everolimus (afinitor), before we need to introduce chemotherapy.
- 5. It takes a village.I always stress to patients that it is important to have other specialists involved in their care. Psychologists, social workers, and palliative care doctors can be very helpful for managing the emotional component of the diagnosis and the stress of receiving treatment. Some patients see non-Western practitioners for complementary care; for example, I have patients with joint aches from aromatase inhibitors with whom I discuss acupuncture. However, it is important to tell your medical doctor everything you’re taking, even if it is a supplement, because they’ll want to make sure to avoid any negative drug interactions. The number one question that patients ask me is about their diet. Many of my patients have found it helpful to meet with a nutritionist—I recommend avoiding extreme diets and sticking to balanced meals, and nutritionists can help patients make these healthy changes.
- 6. Staying active can help fight fatigue.My goal for patients, especially with metastatic diseases, is for them to have a good quality of life and remain active. There are data supporting yoga as beneficial for cancer-related fatigue, and just taking a walk around the block can be helpful for patients. Exercising can also greatly improve your emotional health and help you maintain a positive outlook.
- 7. It is important to care for your mental health, also.After diagnosis, many patients see psychiatrists or psychologists to deal with the stress of this new change in their lives, but there is also something to be said about long-term emotional well-being. We commonly monitor patients with scans every couple months while they’re taking these medications, and it can be very anxiety provoking to anticipate these scans and wonder if the drugs are working or not. Having a way of handling this anxiety in a healthy way and ensuring that you are mentally prepared for this process is important. Talking to a professional, sharing with a support group, and getting enough rest or sleep are all crucial ways to stay on top of your mental health.
What to Expect During Breast Cancer Treatment