Palliative Care for Breast Cancer

You might think of palliative care as end-of-life care — the two are often mistakenly linked. As a result, many people don’t think it’s an option for them, and they miss out on receiving care and support that can help them feel better. 

Simply put, palliative care, which is also sometimes called supportive care, helps manage symptoms and stress. It’s an additional layer of support that doesn’t replace any other medical care you receive. Instead, palliative care adds extra symptom management, and provides emotional, legal, spiritual, and social support. 

Unlike hospice, you qualify for palliative care regardless of your life expectancy. You can begin it as early as you receive a breast cancer diagnosis. And you can receive palliative care while getting treatment for breast cancer — and even if your breast cancer goes into remission.

The purpose of palliative care is to increase quality of life for both people with serious illnesses, including breast cancer, and their caregivers and family. Palliative care providers specialize in pain and other side effects — whether they’re physical, mental, or spiritual. Palliative care for cancer complements the care that you’re getting to treat the cancer itself. 

Palliative care teams can also serve as liaisons with cancer care teams: They can talk you through your treatment options and help you make medical decisions that align with your values, needs, and preferences.

Some studies show that palliative care can lengthen life. Other studies show that palliative care can improve quality of life, decrease depression and anxiety, and increase how satisfied people with cancer and their families are with their medical care.

“We're there to help patients optimize their quality of life as they go through their cancer treatment, regardless of if the anticipated outcome is a cure, prolonged survival, or limited survival,” says Laura Shoemaker, DO, a palliative care specialist at Cleveland Clinic.

One key part of palliative care is symptom management. Doctors and nurses on a palliative care team can help you manage symptoms of the cancer or of your treatment. One of the most common symptoms they help manage is pain. They can also help manage symptoms and side effects like fatigue, neuropathy, difficulty breathing, constipation, nausea, loss of appetite, and trouble sleeping.

Another key element of palliative care is helping you make decisions about your medical care. Palliative care specialists have meetings with people who have cancer and their loved ones — sometimes called family meetings — to help them understand their health and treatment options. They listen to your goals and help you choose the treatment options that best align with them. They can also help people with cancer and their families decide when to stop trying to treat the cancer and instead focus on comfort. They also make sure that all of your providers know what your goals and choices for treatment are and coordinate communication between your care teams.

But palliative care isn’t just about medicine. Palliative care teams are interdisciplinary. In addition to physicians and nurses, they also often include social workers and chaplains.

“The social worker serves many purposes,” Shoemaker explains. Social workers can help identify if you or your family members are struggling with anxiety, depression, or stress, she says. Then, they can refer you to psychologists or psychiatrists who can help you manage these challenges.

Social workers also can help people with cancer and their families access social support. For example, they can connect them to programs run by the community or the cancer center that help them with transportation, food, insurance, and finances. They can also help caregivers coordinate tasks like picking up prescriptions and getting to and from appointments.

Social workers can also connect you with legal resources. These resources can help you determine a power of attorney and write or finalize your will.

A chaplain, or spiritual care advisor, is the final person on a palliative care team. “The chaplain can address some of the spiritual or existential concerns or questions that come up with cancer,” Shoemaker says. “They engage with patients in any way that they interpret their spirituality.” Chaplains aren’t limited to one religion, or to religion at all, she says. A chaplain can help people with cancer figure out how they interpret meaning in their life and the world around them — something that people may think more about when they’re diagnosed with and going through treatment.

There is no one way to receive palliative care. You and your family can meet with your palliative care team via a virtual appointment or in person at a clinic or cancer center.

If you have trouble leaving your home, your palliative care team can come to you. You can receive palliative care while staying in a hospital or other care facility. You also can receive palliative care in a hospice center if you’re enrolled in hospice. Your team can help you figure out which is the best option for you.

People often confuse palliative care for hospice care, but the two are very different. Hospice care is palliative care, but palliative care is not necessarily hospice care. 

Like palliative care, hospice care is focused on increasing the comfort and improving the quality of life of the person with cancer and their family. But hospice care is for people who have decided to no longer receive treatment aimed at the cancer. And hospice care is specifically for people who are expected to have less than six months left in their life. Because of this, hospice offers all of the support of palliative care, in addition to care for symptoms and challenges specific to end of life.

In contrast, you can receive palliative care while receiving treatment for cancer. And there’s no life expectancy requirement for palliative care — you can get palliative care at any stage of disease.

Some people may move from palliative care to hospice care over time. Palliative care teams can help people make the transition to hospice care, whether it’s in their homes, at a hospital, or at a hospice center.

You can start receiving palliative care as soon as you get a diagnosis of breast cancer, no matter the stage. Or you can start getting palliative care later, whenever you think you would benefit from extra support and care — for some people, that’s when they’re admitted to the hospital, if the cancer metastasizes to another part of their body, or when they transition from treatment to supportive care alone.

You don’t need to wait until you’re in a crisis to start receiving palliative care, and in fact it’s better to start sooner rather than later. Cancer guidelines from the American Society of Clinical Oncology recommend that you start getting palliative care within eight weeks of your diagnosis. 

“More and more studies are coming out that demonstrate that having early palliative care — even as early as from the day of diagnosis — can truly improve the quality of life for patients and their loved ones, regardless of stage of illness,” said Caroline Cubbison, MD, a palliative-care specialist at Dana-Farber Cancer Institute, in a webinar produced by the Metastatic Breast Cancer Alliance. “There's really no downside to getting palliative care in early,” she explained. “There are only upsides.”

She thinks that a culture change is already underway. “One thing that I hope would not be surprising in the future,” she said, “is that the moment a patient is diagnosed with something like cancer, their oncologist is calling in palliative care right from the first day.”

If you’re unsure if palliative care is right for you, this quiz can help you decide.

What Is Palliative Care and When Do You Use It?

Jul 26, 2024

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It’s a good idea to connect with palliative care before you need it. Consider setting up a consultation early in your treatment, so that you have a point of contact if and when you need to reach out down the road. 

You’ll usually need your cancer care team to put in a referral for palliative care specialists in the same health system. Most oncologists recognize the value of palliative care, but some may not, especially if you’re looking to meet with palliative care early in your treatment, so you may need to bring it up.   

Cubbison recommends starting with your care team as early as you feel comfortable. “You can just talk to your oncologist and be like, ‘Hey, I read that palliative care is good earlier in cancer and I know that I'm still on treatments and I'm not worried about being at the end of my life right now, but… do you think it would be helpful for me to just meet with someone?’” 

It may just be one meeting, but that way, she explains, “we just have that connection already established so that farther down the road if you ever do want to have that sounding board, we're already connected.”

You can also look for palliative care providers on your own, although Cubbison points out that they won’t be as connected with your care team if they’re not part of the same cancer center, so you may need to do more coordinating. This provider directory can help you find palliative care near you.

Most insurance plans cover palliative care in part or in full, including Medicare and Medicaid. If cost is a concern, the social worker on the care team can help you find ways to manage payment.