Personal Story: Improving the quality of life for people with metastatic breast cancer
At a glance | Guidelines |
treats the whole patient | Questions to ask your doctor |
Mental health treatment | Clinical trials |
What does this mean for me? | Resources |
ARTICLE AT A GLANCE
This article is about:
The cancer experience of a young woman with breast cancer, and how supportive care improved her ability to cope with treatment.
Why is this article important?
Quality of life is an important and often less discussed aspect of the breast cancer experience.
Key points:
This Washington Post article focuses on Tori Geib, a 30-year-old breast cancer patient. After her diagnosis, Ms. Geib began to talk to supportive care specialists. They told her about pain management, nutrition, spiritual care, acupuncture and mental health therapy.
Hearing that her cancer was , Ms. Geib said:
“If I don’t live long, I want to make sure I live my best life. ”
Pain management helped her to deal with back pain and eventually to walk without a cane. Integrative medicine reduced the anxiety she felt about the quarterly diagnostic scans that she needed.
Now 33, Ms. Geib points out:
“I’ve since learned that not everyone gets access to this kind of care, so I feel lucky. No one knows the right way how to do cancer. They’re just there to help you adjust to a new normal and be present in everyday life.”
and integrative medicine treat the "whole person"
is an approach that focuses on patients’ emotional needs and physical symptoms in addition to treating the disease. Integrative medicine combines traditional medicine with alternative therapies to care for the mind, body, and spirit.
Studies show that and integrative medicine can improve patient outcomes. These therapies may include mind-body issues, massage, stress management and behavioral therapy. Tools for weight loss, alcohol and exercise management might also be helpful. also consists of management of medications for pain, nausea and other chemotherapy side effects that often affect a patient’s quality of life during cancer treatment.
In a study of cancer survivors, those who received lived five months longer than those who did not receive .
Talking about how cancer treatment has evolved, Dr. Siddartha Mukherjee, an oncologist and author of Emperor of All Maladies: A Biography of Cancer, stated:
"We don’t always give the maximal treatment. We do symptom management early. As a community, we woke up and realized we weren’t giving patients the psychological, spiritual and they needed."
and integrative medicine have become more commonplace
Combining medical care for cancer treatment with less traditional care has become a more common practice. By 2016, 1,831 U.S. hospitals reported having a program; this is nearly three times the number available in 2000.
Mental health treatment is now recognized as an important aspect of patient care
Studies of cancer patients show that depression is common and that they are 50 percent more likely to die by suicide that the general population.
The article quotes Jeremy Hirst, MD, a palliative psychiatrist at UC San Diego Health:
“There’s a growing awareness that if we take care of how people are feeling, they will be better able to focus on treatment...We find that validating people’s experiences by giving them the space to talk about the nightmare of a cancer diagnosis and how the experience steals so much of their life helps their physical symptoms improve.”
The 2016 American College of Surgeon's report, Cancer Program Standards: Ensuring Patient-Centered Care, determined that in order to maintain accreditation, cancer programs must ask patients during an office visit about whether they are experiencing emotional distress.
Addressing lifestyle factors may also help patients
Many patients seek to change their lifestyle, either to reduce their risk of additional cancer or to help cope with symptoms of cancer or cancer treatment. Increasingly, programs are providing support for weight loss, alcohol use and exercise.
Getting connected to support services can be challenging
Although recommendations suggest that healthcare providers regularly discuss the physical and emotional impacts of cancer treatment, getting referrals to the appropriate resources or specialists can be difficult. Some insurance plans cover these services, but others do not, which can increase the challenge of coordinating care.
There is growing awareness of the role of supportive care in the treatment of cancer patients.
Linda House, president of Cancer Support Community notes:
"People are surviving longer, and they’re living better with their disease. Now we’re able to focus on all the other issues like depression and anxiety.”
What does this mean for me?
If you have cancer, you may benefit from one or more types of supportive care services. addresses physical and emotional impacts of cancer and its treatment, including pain management, mental health care and stress management. Integrative care brings together resources and specialists from diverse fields to treat the whole person, including nutrition, massage, music therapy and acupuncture, among others.
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Posted 3/10/20
References
Sarah Elizabeth Richards. "A rising trend in cancer care targets physical, existential threats patients confront.” The Washington Post. Published May 5, 2019.
Basch E, Deal AM, Dueck AC, et al. "Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment." JAMA. 2017;318(2):197–198.
This article is relevant for:
People diagnosed with metastatic breast cancer
This article is also relevant for:
people with ER/PR + cancer
people with Her2-positive cancer
people with metastatic or advanced cancer
people with triple negative breast cancer
Be part of XRAY:
The National Comprehensive Cancer Network (NCCN) Practice Guidelines on Standards of include:
- All cancer patients should be screened for needs at their initial visit, at appropriate intervals and as clinically indicated.
- Patients/families/caregivers should be informed that is an integral part of their comprehensive cancer care.
- specialists should be readily available to provide consultation or direct care to patients/families/caregivers and/or healthcare professionals who request or require their expertise.
Patients, families or caregivers with any of the following conditions or situations should be referred for palliative care:
- uncontrolled symptoms or pain
- moderate-to-severe distress related to diagnosis or treatment
- additional serious physical, psychiatric or psychosocial conditions
- unresolved concerns or lack of understanding about the course of their disease
- advanced cancers
- evidence of worsening prognosis
- communication barriers
- financial limitations
- family discord
Updated: 06/26/2024
The American Society of Clinical Oncology (ASCO) endorses the Society for Integrative Oncology (SIO) guidelines that recommend the following evidence-based integrative therapies for reducing fatigue, pain, anxiety and depression.
Fatigue
To reduce fatigue during cancer treatment, the SIO recommends:
- Exercise
- behavioral therapy (CBT) uses exercises and skills to reduce symptoms
- Mindfulness-based programs
- Tai chi, a Chinese martial art, is composed of gentle, low-impact exercise while focusing on deep, slow breathing
- Qigong is a Chinese practice using movement, body posture, breathing and meditation to optimize energy within the body, mind, and spirit.
- American ginseng, an herb
- Psychoeducation is an intervention for patients and their loved ones that provides information and support to better understand and cope with illness
To reduce fatigue after cancer treatment the SIO recommends:
- Exercise
- CBT
- Mindfulness-based programs
- Yoga
- Acupressure
- Moxibustion (a type of therapy that involves burning the leaves of mugwort—a small spongy herb—close to the skin)
CBT and mindfulness-based programs are particularly effective for managing moderate to severe fatigue after treatment.
Pain
To reduce pain, the SIO recommends:
- Acupuncture for aromatase inhibitor-related joint pain
- Acupuncture, reflexology or acupressure for general cancer pain or musculoskeletal pain
- Hypnosis for patients who experience pain after a procedure
- Massage for patients experiencing pain during
ASCO provides guidelines on use of opioids to reduce pain in cancer patients:
- should be offered to patients experiencing moderate-to-severe pain from cancer or cancer treatment
- dose should start at lowest possible
- for patients with a substance use issues, clinicians should collaborate with a , pain, and/or substance use disorder specialist(s)
- patients should be monitored for adverse effects
Anxiety
To reduce anxiety during cancer treatment, the SIO recommends:
- Mindfulness-based programs, yoga, relaxation, music therapy, reflexology and aromatherapy (using inhalation).
To reduce anxiety after cancer treatment, the SIO recommends:
- Mindfulness-based programs, yoga, acupuncture, tai chi or qigong and reflexology.
Depression
To reduce depression during treatment, the SIO recommends:
- Mindfulness-based programs, yoga, music therapy, relaxation and reflexology.
To reduce depression after treatment, the SIO recommends:
- Mindfulness-based programs, yoga, tai chi or qigong.
Updated: 07/02/2024
- What supportive care would you recommend for me?
- How can I find a specialist in ?
- How can I find a specialist in integrative medicine? In nutrition? In acupuncture?
- How will integrative or supportive care services affect my cancer treatment?
- Will my insurance cover services?
The following studies are looking at for people diagnosed with cancer:
- Coaching for Family Caregivers of People with Advanced Cancer from Rural and Minority Communities. This study provides coaching to urban African Americans and white or African American families with cancer who live in the rural Southeast. Navigators working with a team provide six health coaching sessions either in person or over the phone to help with managing stress and coping, getting and asking for help, improving caregiving skills and decision-making/advance care planning.
- NCT04733469: EMPOWER 3: Improving Health Literacy and Utilization (EMPOWER 3). This study is designed to test an educational intervention to help patients understand , use it and feel better emotionally and physically.
- NCT04773639: of a Multi-Modal Intervention. This study evaluates a new approach to to address advanced care planning and psychosocial needs of patients with cancer.
- NCT06307535: Study of Meaning-Centered Psychotherapy for Caregivers to People With Cancer. Participants will complete questionnaires and will be assigned to receive psychotherapy for 7 sessions.
- NCT05477784: Cancer Parenting Program for the Enhancement of the Quality of Life of Patients With Advanced Cancer and Their Children (EC-PC). This trial examines the usefulness of two educational programs for parents with cancer who have a 5- to 17-year-old child.
Updated: 06/26/2024
The following studies are looking at integrative medical care for people diagnosed with cancer.
Multiple cancer types
- NCT04917796: The Effect of Electroacupuncture on Nerve Pain Caused by Chemotherapy (Chemotherapy-Induced Peripheral Neuropathy. The purpose of this study is to learn if Electroacupuncture can improve peripheral neuropathy pain caused by chemotherapy in cancer survivors.
Breast cancer
- NCT04837820: Effect of Acupuncture on Memory and Thinking Difficulties after Breast Cancer. The purpose of this study is to test whether acupuncture can improve difficulties and insomnia in survivors of breast cancer.
Gynecologic cancer
- NCT05053230: A Study Evaluating the Integrative Medicine at Home (IM@HOME) Program in People With Gynecologic Cancer. This study will look at whether the Integrative Medicine at Home (IM@Home) program can help reduce patients' symptoms (such as tiredness, pain, or insomnia). The IM@Home program offers virtual (online rather than in-person) group classes focusing on mind-body practice.
- NCT04533763: LIVING WELL: A Web-Based Program to Improve Quality of Life in Ovarian Cancer Survivors. LIVING WELL is a free research program offering mindfulness, coping, and healthy lifestyle skills for ovarian cancer survivors.
cancer
- NCT04519879: White Button Mushroom Sup for the Reduction of in Pts With Biochemically Rec or Therapy Naive Fav Risk Cancer. This phase II trial studies how well white button mushroom supplement works in reducing prostate-specific antigen () levels in patients with cancer that has come back (recurrent) or has favorable risk and has not undergone any therapy (therapy naive).
Updated: 06/06/2024
The following organizations offer peer support services for people with, or at high risk for breast cancer:
- FORCE peer support:
- Our Message Boards allow people to connect with others who share their situation. Once you register, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- Our Peer Navigation Program will match you with a volunteer who shares your mutation and situation.
- Connect online with our Private Facebook Group.
- Join our virtual and in-person support meetings.
- Other organizations that offer breast cancer support:
Updated: 05/07/2024