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Personal Story: Improving the quality of life for people with metastatic breast cancer

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Contents

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:

Expert Guidelines
Expert Guidelines

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

Expert Guidelines
Expert Guidelines

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

Questions To Ask Your Doctor
Questions To Ask Your Doctor

  • 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?

Open Clinical Trials
Open Clinical Trials

The following studies are looking at for people diagnosed with cancer:

 

Updated: 06/26/2024

Open Clinical Trials
Open Clinical Trials

The following studies are looking at integrative medical care for people diagnosed with cancer.

Multiple cancer types

Breast cancer

Gynecologic cancer

cancer

 

Updated: 06/06/2024

Peer Support
Peer Support

The following organizations offer peer support services for people with, or at high risk for breast cancer:

Updated: 05/07/2024

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