Palliative care is often underused in breast cancer. However, when utilized, it can help manage symptoms and medication side effects and improve overall quality of life during breast cancer treatment.
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People living with metastatic breast cancer may receive many different types of treatment to help manage their condition. Part of a well-rounded treatment plan includes palliative care.
Traditional types of treatment for breast cancer try to control or destroy cancer cells. Palliative care is symptom-focused treatment. It is intended to help manage the physical and mental effects caused by cancer and anticancer medications.
In this article, experts share their insights on the role of palliative care in metastatic breast cancer treatment, including why it may be underused for some people who may benefit.
Palliative care usually works in conjunction with the oncology team. That way, the oncology team and palliative care team talk with each other and coordinate the patient and family’s care around what is happening from the medical and quality of life perspectives.
“In the case of breast cancer, palliative care would focus on improving symptoms such as pain, nausea, or fatigue, and also work to emotionally support people as they go through their cancer and its treatment,” explained Kate Lally, MD, clinical director of ambulatory palliative care at Dana-Farber Cancer Institute.
“Palliative care is usually delivered at the same time as medical care, so patients would receive it while they are receiving things like chemotherapy,” she said.
“We are typically a team of interdisciplinary providers — nurse practitioners, doctors, social workers, nurses, chaplains — who are skilled at managing the physical, emotional, and spiritual challenges that can accompany a diagnosis of metastatic cancer,” added Jennifer S. Shaw, AGPCNP-BC, ACHPN, a nurse practitioner who specializes in palliative care at the University of Utah’s Huntsman Cancer Institute.
Palliative care can be delivered in either the hospital or in the clinic, depending on the symptoms a person is experiencing. “Regardless of the setting, our focus is on helping people living with metastatic cancer have the best possible quality of life throughout their illness experience,” Shaw noted.
Projecting someone’s prognosis is very difficult with breast cancer. This frequently makes it hard for healthcare professionals, patients, and family members to know when palliative care may be most appropriate. As such, diagnosis is often a good time to start discussions around palliative care.
“Ideally, palliative care starts at the time of diagnosis so that people feel and function as well as possible while undergoing cancer therapy,” said Shaw. “This also gives them the opportunity to talk about what matters most to them — what their hopes, worries, and challenges are.”
“Sometimes it is appropriate to receive palliative care when [a person is] first diagnosed to get help with coping with the diagnosis and also to receive guidance about what kind of symptoms [a person] may experience,” added Dr. Lally.
From there, palliative care evolves with a person’s breast cancer journey. “With metastatic disease, the treatment plan can be complicated and [may] evolve over many months or years with the involvement of different treatment teams,” Shaw noted. “Symptoms can get tricky, emotions can ride a roller coaster, and goals can change over time. This is when a palliative care team can help navigate with keen attention to an individual’s priorities, past experiences, and values.”
It can be used as support the entire time. “Palliative care is appropriate at any stage of a serious illness,” emphasized Dr. Lally. “There is never really a wrong time to [consider] palliative care.”
That includes end of life care. “At the end of life and if desired, palliative care can transition to the full spectrum of hospice support, whether this is provided at home or in the hospital,” added Shaw. Hospice care is
- In hospice care, no curative treatment is provided.
- Hospice care is typically reserved when long-term survival (beyond 6 months) is not expected.
“At this time, someone may shift to only receiving care that is focused on their comfort,” noted Dr. Lally.
Despite the differences, palliative care and hospice care are often misunderstood to be the same service. “Although I am weary of generalities, both providers and patients can be off-put by a perceived stigma that palliative care is equated with a loss of hope and the end of life, as if we will ask people to give up and stop fighting,” suggested Shaw.
Dr. Lally agreed. “There is a lot of fear and concern about what palliative care means. Many patients and doctors worry that if they refer someone to palliative care, it will imply that the doctor feels they are not doing well or are not responding well to treatment.”
However, that is not the case. “We know that getting palliative care involved early in cancer treatment helps people
Shaw also suggested that people may put off visiting a palliative care specialist if they are uncomfortable discussing their health concerns, or if a well-intentioned family member or friend tries to steer them in another direction.
“Palliative care is considered standard of care for cancer treatment and most cancer treatment guidelines recommend involving palliative care early,” noted Dr. Lally. If someone feels like they need more support, or if their oncologist does not initiate care, she added that most oncologists will be receptive to the discussion.
“If a person wants additional support, ask if there is a palliative care team associated with the oncologist’s practice,” suggested Shaw. “Referrals are typically easy and can happen electronically or with a phone call.”
Dr. Lally also suggested checking out the Center to Advance Palliative Care for more information and resources about palliative care, including information on palliative care professionals around the country.
Living with metastatic breast cancer can affect many aspects of a person’s mental well-being. That includes their emotional health as well as their body image and sexuality.
Shaw offered some tips for helping cope with the emotional aspects of metastatic breast cancer diagnosis, including:
- prioritizing self-care
- learning relaxation techniques, such as guided meditation or mindfulness practices
- exploring guided imagery and breathwork
- trying massages or acupuncture
- journaling
- connecting with a support group
- meeting with a social worker or counselor
A person should also “remember to talk honestly with others about how they are doing,” she added.
Palliative care can help a person cope with the physical and emotional effects of their metastatic breast cancer and treatment.
“We want to understand the source, depth, and nature of a person’s hope for the future, and to do our best to make sure that treatment decisions keep this in mind,” explained Shaw.
“Often people will say they do not want to see palliative care because they are worried that seeing palliative care means that time is short or they are approaching the end of their life,” said Dr. Lally. “When they finally do meet with palliative care, they often feel incredibly well supported and wish they had met with them sooner.”