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A diagnosis of metastatic, or stage 4, breast cancer is made when cancer has spread from the breast to other parts of the body. Because tumors affect multiple organs, removing them surgically is usually not possible. In most cases, it means this cancer can’t be cured, presenting a serious personal challenge for patients.
This challenge is one the team at Lehigh Valley Topper Cancer Institute, part of Sidney Kimmel Comprehensive Cancer Center and Jefferson Health, is uniquely equipped to handle. Its clinicians are experts in specialized cancer treatments and have created an environment of compassionate palliative care to help patients live longer – possibly years or decades – beyond their diagnosis.
There are numerous treatment options available – but absent a cure – they focus on slowing growth of the tumors and enhancing quality of life. The most effective treatments for metastatic breast cancer are medicines that circulate throughout the body and kill cancer cells wherever they are.
“These drugs help shrink tumors, slow progression, and extend survival,” says hematologist oncologist Kidist Tarekegn, MD, who specializes in breast cancer at the Cancer Institute. “We also participate in national clinical trials that bring new drugs into play and can open a different avenue of treatment for the patient.”
The normal course for patients with stage 4 breast cancer involves regular, close monitoring. Patients see their oncologist regularly so any problems can be addressed as soon as possible. “There may be long periods when the cancer is under control, and patients can get on with their daily life,” Dr. Tarekegn says.
While treatments are tailored to each patient, any metastatic breast cancer care plan typically requires long-term treatment. As a result, managing side effects is an important part of breast cancer therapy.
Side effects from the disease and treatment can include pain, nausea, vomiting, fatigue, and a frustrating fogginess referred to as “chemo brain.”
The team at the Cancer Institute may prescribe medicines called antiemetics, taken before or after chemotherapy treatments – or before eating – to prevent nausea and vomiting. Clinicians work with the Cancer Nutrition Program and its dietitian staff trained in cancer nutrition. They assist patients with education and a personalized nutrition plan to help them feel better.
Teams of specialists help patients find comfort in pain management and palliative care (OACIS Supportive Care) programs. They employ integrative medicine, counseling, rehabilitation, and psychosocial support in a plan designed along with the patient’s oncologist and primary care clinician.
For cancer-related fatigue, the team involves Cancer Rehabilitation Services, where patients learn techniques for managing it. The rehabilitation therapists provide help for lymphedema – swelling of certain areas of the body because of treatment – and neuropathy, which causes weakness and pain, usually in the hands and feet.
“Even ‘chemo brain,’ the mental cloudiness that can result from drug treatment, can be addressed in rehabilitation,” Dr. Tarekegn says. “Often, cognitive therapy is helpful, both for the patient and their family members.”
The emotional aspects of metastatic breast cancer can sometimes be the most difficult. The Cancer Institute team believes a quality-of-life focus is essential. The following are available for Cancer Institute patients: