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My treatment

My treatment

Choosing between breast cancer treatment options can be daunting, and there are a lot of questions to ask your oncologist about your available options. You want to choose a treatment that is effective, but it is also important to understand the possible side effects and consider how a treatment might affect your lifestyle. It is important to discuss with your oncologist to find out which breast cancer treatment is best suited for you here in Thailand.

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Remember:

  • Treatment options for metastatic breast cancer are long term and you may have to take different treatments over time.
  • The goals of breast cancer treatment are to prevent your cancer from spreading further (progressing), relieve the symptoms and ensure you have the best possible quality of life1,2.
  • Always tell your oncologist about any treatment side-effects you experience – there are things they can do to help.

WHAT ARE THE TYPES OF TREATMENT FOR METASTATIC BREAST CANCER?

The treatment you will receive for your metastatic breast cancer will largely depend on the type and location of your cancer. You may be given a combination of therapies or you might only receive one therapy at a time.

The three main types of drug therapy that you can be offered to control your cancer are chemotherapy, anti-hormonal therapy (also called endocrine therapy) and targeted therapy1,2. Radiotherapy, and rarely surgery, may also be used when necessary for disease or symptom control.

In addition, you may be given treatments to help relieve the symptoms of the cancer or of the metastases in your body. Among the most important of these treatments are bone stabilizing agents such as bisphosphonates or denosumab which are given to help strengthen your bones, particularly if you have bone metastases3,4.

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  • Chemotherapy
  • Radiotherapy
  • Anti-hormonal therapy
  • Targeted therapies
  • Bone stabilising agents
  • Surgery
  • Chemotherapy

    Chemotherapy drugs are substances that kill cancer cells. However, they can harm normal cells too and this can cause side effects. Some chemotherapy drugs are given as a pill that you can take at home2. Others are given by intravenous infusion and you may have to go to hospital in order to receive them2.
    Whether you receive chemotherapy or not will depend on your health, what medicines you have taken before and the type of cancer you have. There are many different types of chemotherapies2. If you have too many side effects with one kind, please consult your oncologist5.

  • Radiotherapy

    Radiotherapy is the use of high-energy radiation that kills cancer cells. Radiotherapy may be given to control your cancer. It can also be used to relieve bone pain if cancer drug therapy does not relieve it fast enough. It is common to radiate metastases in the bone that are causing pain2.
    Radiotherapy for metastatic breast cancer is usually given as a single dose or as a short course over a few days. If you are well enough, you are usually given radiotherapy as an outpatient, and do not have to stay overnight in hospital .
    However, if you are having chemotherapy at the same time your oncologist may decide that you need to stay in hospital. The side effects of radiotherapy will depend on which part of your body is being treated.

  • Anti-hormonal drug therapy

    Anti-hormonal therapies (or endocrine therapies) are used to treat breast cancer that is sensitive to hormones, particularly estrogen. Some types of breast cancer are stimulated to grow by hormones, such as estrogen. Anti-hormonal therapies work by blocking the actions of particular hormones in the body – by suppressing the production of the hormones estrogen and progesterone or by blocking the receptors for these hormones2,6.
    There are several different hormone-based therapy drugs that work in different ways. Anti-hormonal therapies are usually given as pills, but some are given as injections. You may take them with or without chemotherapy2,6.

    Whether you are given anti-hormonal therapy, and what type, will depend on whether you have gone through the menopause, how much time has passed since your diagnosis and what kind of treatment you took for your initial breast cancer (if you were diagnosed and treated previously for early breast cancer)2,6. If you have had anti-hormonal therapy in the past you may still take it again.

  • Targeted drug therapy

    Targeted therapies work on specific types of breast cancer by blocking specific pathways that breast cancer cells use to multiply. To determine if any targeted therapies are right for you, your oncologist will have to determine what type of cancer you have2.
    There are therapies which are used in the treatment of HR-positive breast cancer that specifically target the signaling pathways that are activated by hormones, such as estrogen2.
    There are also several therapies that target HER2 receptors2. These drugs work in people with high levels of HER2 in the cancer cells, but they do not work in cancers that do not have this protein.

  • Bone stabilizing agents

    These are drugs that are often used when there are metastases in the bone. They work by helping to strengthen your bones and help reduce bone loss.
    They can help relieve bone pain and reduce the long-term risk of bone breaks3. They are taken as pills or injections.

  • Surgery

    Surgery is rarely used in metastatic breast cancer2. When it is used, it is because removing tumor tissue will help to improve your body function or relieve pain.
    If you have surgery, you may receive drug therapy and/or radiotherapy.


WHAT ARE THE TREATMENT OPTIONS FOR SPECIFIC METASTATIC BREAST CANCER TYPES?

Treatment options can vary depending on the type of metastatic breast cancer you have1,7. For example, your oncologist may recommend a combination of an anti-hormonal treatment and a targeted therapy if your cancer is HR-positive, or a HER2-targeted therapy for HER2-positive cancer. Consult with your oncologist to understand which treatment is best suited for you.

WHAT BREAST CANCER TREATMENT IS
BEST FOR ME?

There is no single ‘best’ treatment option for metastatic breast cancer, and what works for one person may not necessarily work for you2.

There are many different factors that affect which cancer treatment is best for you. These factors include the biology of the tumor (the type of breast cancer), the sites of metastases in your body, any prior treatments you have received for breast cancer and any treatments you are currently taking for other diseases.

Expect to change treatments over time. This is because your cancer can develop resistance to a given treatment, and you may need to switch to another treatment to which your cancer is more likely to respond. Your oncologist may stop your treatment for other reasons. You should consult your oncologist if you are experiencing too many side effects.

HOW DO I KNOW IF MY TREATMENT IS WORKING?

People react differently to different cancer treatments, so it is difficult to predict if your cancer will respond to a treatment or not. Your oncologist will conduct a variety of tests over time to find out if your treatment is working. These may include looking at:

The size of your tumor/metastases

Your oncologist may use imaging procedures to see if your tumor or metastases are growing, shrinking or staying the same size. These may include computed tomography (CT) or magnetic resonance imaging (MRI) scans.

The level of tumor markers

Tumor markers are proteins or other substances that are often, but not always, found in the blood when tumors are active in the body8. The presence of high levels of tumor markers often indicates active disease.

The levels of tumor markers over time can be used by your oncologist to monitor the efficacy of your treatment8.

The level of circulating tumor cells

Circulating tumor cells (CTCs) are cancer cells that have detached from the primary tumor and are circulating in the bloodstream8.

CTCs can act as ‘seeds’ for new tumors (metastases) at other sites in the body. Your oncologist here in Thailand may monitor the level of CTCs in your blood to see how well you are responding to breast cancer medication or treatment8.

Development of new metastases

Your oncologist will want to make sure that cancer cells have not spread to other parts of the body. For this, imaging procedures such as computed tomography (CT) or magnetic resonance imaging (MRI) scans can be used.

FOR HOW LONG DO I TAKE TREATMENT?

Treatment for stage 4 breast cancer is long term. This is because ongoing treatment is needed to control your cancer and prevent it from getting worse, and to help control symptoms of metastases. Your treatment may change over time and you may be given the same treatment several times, alternated with other treatments.

Remember that there is no single best treatment for metastatic or stage 4 breast cancer and each person’s situation is different.

You may be tempted to stop treatment once you feel better or if it makes you feel sick. However, as much as possible, it is critical to keep taking your treatment for as long as it is prescribed. Talk to your oncologist if you are thinking about stopping your treatment. There are things that can be done to help reduce side effects.

WHAT TREATMENT SIDE
EFFECTS CAN I EXPECT?

The side-effects you experience will depend on the type of treatment you are receiving2. Also, everyone reacts differently to treatment. The side-effects you have may be very different to those of another person on the same treatment.

If you are receiving an intravenous chemotherapy treatment, the side effects will usually be worse the first few days after treatment. It is a good idea to plan for this until you know how you will feel.

Not everyone experiences side effects when it comes to stage 4 breast cancer treatment. If you do not experience any side-effects, it does not mean that your cancer treatment is not working.

Always tell your oncologist or nurse about any side-effects you experience. There are supplemental treatments that can help with the side effects or in some cases your cancer treatment may be adjusted. Also, what feels like a side effect could be a sign of the cancer growing.

Common side effects and how to manage them

Some of the most common side effects of breast cancer treatment include fatigue, pain, nausea and vomiting, diarrhea, hair loss, low white blood cell count, and weight gain or weight loss.

Pain

If you are having pain it is important to let your oncologist or nurse know. They can give you drugs to help and recommend pain relief methods3.

It might help to keep a record of the frequency and the severity of your pain – does the pain get worse at night, or when doing specific things? Relieving your pain effectively will have a large impact on the way you feel – it can help reduce fatigue, anxiety and depression, and improve your sleep and overall well-being.

Cancer pain is usually treated with medicine and complementary therapies2. Therapies such as acupuncture, massage therapy and relaxation techniques can help you to control your pain. Exercise can also help.

Fatigue

Fatigue is so much more than feeling tired: it is complete exhaustion. It may be related to the physical effect of the cancer itself or be a side effect of treatment. Or it may be related to changes in your sleeping patterns and added stress and anxiety3.

Tips for dealing with fatigue2,3:

  • Eat regularly and eat healthy foods
  • Do regular gentle exercise
  • Plan your day and only do what is most important to you
  • Ask for help from friends and family
  • Take short breaks or naps
  • Tell your oncologist or nurse – they may be able to prescribe medicine to help with fatigue

Nausea and vomiting

Untreated nausea and vomiting can make you feel very tired and can also lead to more serious problems. Tell your oncologist or nurse if you experience nausea or vomiting – there is breast cancer medication available here in Thailand to help you control them.

Tips to reduce nausea and vomiting2,3:

  • Gentle exercise and fresh air
  • Avoid spicy, greasy or very sweet foods – try bland and easy-to-digest foods
  • Ginger and lemon can reduce nausea
  • Eat regular small meals

Sleeping problems and insomnia

Several things can prevent you from having a good night’s sleep, including pain, stress, side effects of the treatment, anxiety and depression. You may feel like you cannot sleep, wake up frequently in the night, or wake up very early.

This can affect your ability to function day-to-day. Tell your oncologist if you experience sleeping problems – there is breast cancer medication that may help.

Tips to help you sleep2,3:

  • Try to maintain your usual sleeping pattern
  • Reduce noise and light in your room
  • Try relaxation techniques, meditation or mindfulness
  • Have a warm drink before bedtime (but avoid caffeine)
  • Keep a diary by the bed to record thoughts or worries that are keeping you awake

Lack of concentration and cognitive changes

These can be caused by physical or emotional changes that may or may not be related to your breast cancer treatment3. It is important you report any problems with concentration to your oncologist or nurse.

Hair loss

If you are receiving chemotherapy as a treatment you may experience thinning or drying-out of your hair, or hair-loss3. Even anti-hormonal therapies can sometimes lead to hair thinning.

For some, but not all chemotherapies, scalp cooling may be an effective way to prevent hair loss. Ask your oncologist whether this may help for your particular treatment and whether scalp cooling is offered at your clinic.

Having your hair fall out can be very upsetting, and it might be a good idea to cut your hair short if you know you are going to lose it2. This can help you regain some control of the situation, rather than waiting for your hair to fall out. Do what feels right for you.

Frequently Asked Questions

How will I know what treatment is right for me?

Deciding what treatment is right for you should be done with the consultation of your oncologist. Various treatments may work better for your situation, but it is important to understand the potential side-effects of each one. Together, we can find the solution that works best for you.

What are some of the side-effects of treatment?

Potential side-effects will differ based on the type of breast cancer treatment you are receiving. However, some common side-effects are pain, vomiting/nausea, hair loss, lack of concentration and more. Read more above to find out in detail how these changes can affect your daily life and how to mitigate them.

How will I know if my treatment is successful?

With the stage 4 breast cancer treatment and medication we recommend in Thailand, success generally is when the cancer is relatively stable. This means it has neither grown nor shrunk. Your oncologist will run regular tests to find out whether the cancerous tumor has changed at all or not, and then adjust the treatments if necessary.

Is treatment a one-time thing, or will it be continuous?

Metastatic breast cancer treatment is a continuous process, as the disease is not curable. The goal of this kind of treatment is to stop the tumor from spreading further in order to make your life as comfortable and long as possible.

References
  1. National Breast Cancer Foundation Australia (2019). Stage 4- Metastatic Breast Cancer. Retrieved from https://nbcf.org.au/about-national-breast-cancer-foundation/about-breast-cancer/stages-types-treatment-breast-cancer/stage-4-metastatic-breast-cancer Accessed February 12, 2019.
  2. Australian Government Cancer Australia (September 2017) Metastatic Breast Cancer. Retrieved from https://breast-cancer.canceraustralia.gov.au/types/metastatic-breast-cancer Accessed February 12, 2019.
  3. National Cancer Institute (2019). Breast Cancer Treatment -Patient Version. Retrieved from https://www.cancer.gov/about-cancer/treatment/side-effects/pain/pain-pdq Accessed February 11, 2019.
  4. National Cancer Institute (2019). NCI Dictionary of Cancer Terms. Retrieved from https://www.cancer.gov/publications/dictionaries/cancer-terms Accessed February 11, 2019.
  5. National Cancer Institute (2019). Chemotherapy to Treat Cancer. Retrieved from https://www.cancer.gov/about-cancer/treatment/types/chemotherapy Accessed February 12, 2019.
  6. National Cancer Institute (2019). Hormone Therapy for Breast Cancer. Retrieved from https://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet Accessed February 12, 2019.
  7. NCCN Clinical Practice Guidelines in Oncology Breast Cancer Version 1.2018 – March 20,2018. https://www.nccn.org/patients
  8. Breastcancer.org (2018) Blood Marker Tests. Retrieved from https://www.breastcancer.org/symptoms/testing/types/blood_marker Accessed February 12, 2019.