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Your healthcare partners are committed to providing you with the most up-to-date and timely therapies and interventions to treat breast cancer. One of these interventions is palliative care, also known as supportive care. Palliative care aims to help you maintain the best quality of life possible as you undergo treatment.

Palliative care is not the same as hospice care. While there is overlap, hospice care provides support and care for people who are nearing -- usually within 6 months -- the end of life.

Although palliative care and hospice care both focus on improving quality of life, you can remain on active treatment while receiving palliative care.

Palliative care can be an important part of your treatment plan, regardless of disease stage or treatment.

People who have received palliative and supportive care have reported less severe symptoms, better quality of life, and greater satisfaction with treatment.

What Is Palliative Care?

Managing the physical pain associated with breast cancer treatment is an important component of palliative care. Palliative care providers also put an equal emphasis on helping you control the natural and normal stress and anxiety that accompany a diagnosis of breast cancer.

Nutrition, exercise, rest, meditation, mental health, and overall well-being are all part of palliative care.

Disease Progression

Every person with breast cancer experiences the disease in ways that are unique to them, and not everyone responds in the exact same way to treatment.

There are four general of metastatic breast cancer:

• Smoldering: Very slow progression, patients are often asymptomatic, and survival is generally considered in terms of years and in some cases, over 10 years

• Gradual: Gradual progression of the disease over time, with increasing symptoms and rate of progression

• Rapid: Rapid progression, with severe symptoms, and survival is typically characterized by a prognosis of several months

• De novo poor condition: A person in poor general health when diagnosed with breast cancer

Palliative Drug Therapy for Bone Metastases

Bone is one of the most common sites for distant metastases in metastatic breast cancer. More than half of patients with metastatic breast cancer will develop metastases to bone. Patients with breast cancer and bone metastases should be treated with bone-modifying agents and options include zoledronic acid, pamidronate, or denosumab. These medications can reduce bone complications and bone pain caused by bone .

These medications can sometimes have rare but serious side effects, such as osteonecrosis of the jaw. It is important to keep track of your symptoms and alert your healthcare providers if you experience any changes.

Palliative Radiation Therapy

Palliative radiation therapy may be used to alleviate pain caused by breast cancer. The treatment can target specific areas where the cancer has spread, such as bones or soft tissues, to reduce tumor size and relieve pain. This is especially beneficial when there are bone metastases.

Palliative Surgery

Palliative surgery for breast cancer can help alleviate pain and improve mobility, via procedures known as vertebroplasty or kyphoplasty, for people whose cancer has spread to their bones.

For other people, surgical removal of tumors may be necessary when an obstruction or bleeding is caused by the tumor.

Nerve block procedures can be performed to manage pain caused by nerve compression or invasion by cancer.

If the breast cancer has caused fluid to collect in the abdomen (known as ascites) or led to the buildup of too much fluid around the lungs (known as pleural effusion), surgical procedures such as paracentesis or thoracentesis, respectively, can be performed to drain excess fluid and provide relief. (6)

Pain Management

Over-the-counter pain medications such as aspirin, ibuprofen, acetaminophen, and naproxen are typically used to treat mild to moderate pain associated with breast cancer.

Opioid medicines, either in , can be used to treat moderate-to-severe pain.

Careful routine pain assessments will be conducted by your healthcare providers to ensure you are receiving the pain relief you require.

approaches such as acupuncture, massage, or hypnosis, are options for pain management and can be combined with standard medical treatment.

Fatigue Management

Fatigue, or extreme tiredness, is a normal response to breast cancer treatment. Prioritizing your daily rest, nutrition, and exercise can help ease the symptoms of fatigue. Treating other side effects, such as pain, can help ease . Complementary or integrative medicine approaches may also help with the management of fatigue.

Shortness of Breath Management

The management of shortness of breath (also called dyspnea) includes treatment of conditions that may contribute to it, including but not limited to the presence of lung metastases, pleural effusion, infections, anemia, drug toxicities, blood clots in the lungs (pulmonary embolus), or airway obstruction.

If you are experiencing shortness of breath on a regular basis, you need to alert your healthcare providers as soon as you can. A work-up can be done to evaluate the cause of the dyspnea and interventions considered. In addition to potential treatment of the underlying cause, certain breathing techniques can help, along with supplemental oxygen and morphine, in some situations.

Mental Health Management

Coping with breast cancer, and its associated treatments, is a challenging and sometimes daunting experience – both physically and emotionally.

It is also an experience that you should not, and do not, have to go through on your own.

The emotional and social effects of a breast cancer diagnosis and treatment are areas in which palliative care can help.

This can include working with an oncology social worker, counselor, or clergy on an ongoing or as-needed basis.

You can expect that your healthcare providers will be assessing your levels of distress and anxiety as part of your treatment.

Advance Care Planning, End-of-Life Care

Advance care planning is a process of communication between the person with metastatic breast cancer, their family and loved ones, and their healthcare team.

Research has shown that people with metastatic breast cancer -- and patients with advanced disease in general, along with family members and providers -- consider these to end-of-life care:

• Managing physical symptoms

• Avoiding a useless prolongation of dying

• Having good self-esteem

• Relieving burden on family or caregivers

• Deepening ties with loved ones

Advance care planning should be regarded as a to improve the quality of life of people with metastatic breast cancer. Physicians will , including hospice and emotional support specialists, to help patients and family members make informed decisions.

Read previous installments in this series:

For Your Patients: Breast Cancer Basics

For Your Patients: The Crucial Role of the Biopsy in Breast Cancer

For Your Patients: Understanding Early-Stage Breast Cancer

For Your Patients: New Therapies, New Hope in Later-Stage Breast Cancer

For Your Patients: The Importance of Genes in Breast Cancer

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.