Recurrent and Metastatic Breast Cancer Treatment Choices

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There are a number of different approaches to treating recurrent and metastatic breast cancer. Each person will have a different approach because everyone is unique and every cancer is unique. Most treatment decisions depend on where the cancer has come back, the characteristics of the cancer (such as hormone-receptor status and HER2 status), and which treatments you have had before, including:

  • type of surgery (lumpectomy or mastectomy)
  • type of lymph node removal (sentinel node or axillary dissection)
  • type and amount of radiation therapy
  • type and amount of chemotherapy
  • type and amount of targeted therapy

You and your doctor need to be in agreement about the approach to your care. Let your doctor know how aggressive you want to your treatment to be. For example, your doctor may recommend very aggressive treatment that may have severe side effects. You may want a less aggressive treatment with fewer side effects. If you’re in pain, pain control may be your number one concern. Open, clear communication with your doctor is important as you develop a treatment plan that honors your feelings and decisions. Listen carefully to your doctor, and at the same time, make sure you’re being heard.

Tell your doctor exactly what's important to you regarding treatment — whether it's quality of life, pain control, or being as aggressive as possible. Talk about the risks and benefits of each treatment choice. Listen to your doctor's recommendations and then, together, develop a plan.

Remember that you can change your mind about your treatment choices. You may want to alter your treatment plan depending on how you feel, how treatment is affecting your daily life, family issues, and financial concerns. Your treatment plan isn't written in stone. You can talk to your doctor about changing it at any time.

It’s also a good idea to get a second opinion from another breast oncologist to provide an outside perspective on the pathology of the cancer and your treatment recommendations. A second opinion consultation can be arranged by making an appointment with an oncologist at a different hospital. The office staff of the new oncologist will explain how to prepare for this appointment. It may feel odd to go outside your own doctor’s office for additional insight, but getting a second opinion can be an important part of treatment planning. Learn more about getting a second opinion.

Things to consider when making treatment choices for recurrent or metastatic breast cancer:

  • How aggressive do you want to be? Do you want to push the envelope and try any and all treatments that may stop the cancer from growing?
  • What is your general overall health? Can you tolerate more aggressive treatment?
  • How important are quality of life issues? Are you willing to put up with side effects that may reduce your quality of life?
  • How important is pain control?
  • Are you willing to participate in a clinical trial?
  • Do you have health insurance? Is the cost of treatment a concern for you?
  • Do you have a support network of people who can help you with day-to-day activities if you need it?
  • What's the best way for your medical team to talk to you? Do you want direct, straightforward scientific information about your health? Or do you prefer a softer approach?

Questions to ask your doctor about treating recurrent or metastatic breast cancer:

  • How did you determine the hormone-receptor status and HER2 status of the cancer?
  • Do I need a biopsy to find out whether the hormone-receptor or HER2 status has changed?
  • Why are you recommending a particular treatment?
  • What are the benefits of each possible treatment? What are the side effects?
  • How will each treatment affect my quality of life?
  • How will I know the treatment is working?
  • What kinds of tests will I have?
  • What happens if a treatment stops working?
  • How do I know when to switch treatments?
  • What happens if I decide to not have a treatment?
  • Are there clinical trials that you think would be beneficial for me?

On the following pages, you can read about:

Expert Quote

"Which treatments we use depends on the biochemistry of the cancer cells, sites of involvement, and any prior treatment for cancer that the patient has received."

Larry Norton, M.D.

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