Metastatic breast cancer and palliative care

Let's begin by defining palliative care. A growing subspecialty of medicine, it is care that is focused on improving the quality of life (QOL), physical and psychological, of anyone living with serious illness. Palliative care and hospice care are not one and the same although many people think that they are. This distinction is important because a suggestion of including a palliative care specialist in the care of someone living with metastatic breast cancer, or other Stage IV cancer, does not mean that the individual is dying. Hospice care is appropriate for someone with an anticipated life expectancy of six months or less; palliative care may be offered to someone who might live for several more years.

Over the past ten or so years, a number of studies have shown that people living with a range of Stage IV cancers who consulted with palliative care specialists reported an improved QOL and had fewer symptoms and side effects from medications. Additionally, some lived longer than expected and had lower healthcare costs. So why isn't everyone automatically offered a chance for this consultation?

One reason would be that there are not enough palliative care specialists to go around, and not all oncologists regularly refer to these colleagues. Some oncologists believe that they are well enough informed to provide the same care and others may not consider a referral unless a patient is extremely compromised. At BIDMC, we have interdisciplinary palliative care teams available both to work with hospitalized patients and to meet with others in the ambulatory setting. Read more about our Palliative Care Services.

Good reasons to consult with Palliative Care include physical problems like pain, fatigue, shortness of breath, or intractable nausea. Attention is also paid to emotional and spiritual issues, and helping to coordinate the best possible care for someone who is meeting with a number of specialists.

Including palliative care in the treatment of women with metastatic breast cancer is often tricky because the progression and history of the disease are so variable. Some women live for years, always on treatment, with this diagnosis while others have a much shorter survival. Typical problems for women with advanced breast cancer include pain, shortness of breath, fatigue, delirium, and confusion. The most common psychological issues are anxiety, depression, and existential angst. Other concerns abound, and may include issues with intimacy and chemobrain. While there are not quick fixes for any of these problems, there is help available for them all. The best possible team might include a medical oncologist, oncology social worker, and the palliative care team.

Increasingly, the standard of care for women with advanced cancer includes a palliative care consultation. My experience has been that making such a referral fairly early is often wise. That way, the women meets the team, learns what is available, and can then return as needed as time passes.