Treatment options and supportive care

In Germany, metastatic breast cancer can be treated in certified breast cancer centers (Brustkrebszentren) or tumor centers as well as practices that are specialized in oncology. There, specialists from different disciplines work together to treat the various effects that both the disease and the treatment have on your body and mind. Metastatic breast cancer can also be treated in hospitals or practices without this certification.

If breast cancer has spread to other parts of the body, the entire body is usually treated with medication (systemic therapy) to limit tumor growth. Either hormone treatment or chemotherapy can be used for this purpose. Certain types of breast cancer can also be treated with targeted therapies, for example antibody therapy.

Usually, different treatments are used one after the other or combined with each other. If tumor cells stop responding to a certain drug after a while, another drug or treatment approach can be used. This step-by-step approach is known as sequential therapy.

Depending on where they are growing, some metastatic tumors can be treated individually – they can be targeted with radiation, for instance, or perhaps removed surgically.

Because the type of breast cancer and the way it progresses varies so much from woman to woman, there is no such thing as “the” best treatment. It is important to find suitable, individually tailored treatments for each phase of the disease and to coordinate the different treatments in the best possible way. That requires close cooperation between the doctors and within the treatment team.

Questions often arise in these situations – about the various treatments options, the expected symptoms or participation in clinical studies, for instance. It can help to write these questions down before going to an appointment or have someone you trust come with you to speak with the doctor so that you don't forget anything.

There is usually no immediate time pressure when deciding whether or not to have (further) treatment because starting treatment a bit later hardly influences the outcome of treatment. So you can take your time to consider the pros and cons of the suggested options and think them over for a few days or weeks. If necessary, you can get additional information or a second opinion too. You also always have the right to refuse having a treatment or to stop it – no matter whether it has been offered or started at a doctor‘s practice, in a hospital, or as part of a study.

Some people set their hopes on alternative approaches if conventional medicine can't guarantee a cure or significant improvement (anymore). But constantly trying out new therapies can lead to repeated disappointments. You should be particularly careful when it comes to remedies or methods that are meant to be used instead of medical treatment rather than alongside it, that promise to cure the cancer and/or that are very expensive and that you have to pay for yourself. People making these kinds of promises may turn out to be charlatans.

Cancer treatment can be difficult to go through. It often has severe side effects and sometimes leads to complications. The side effects vary depending on the kind of treatment, but they can usually be effectively treated themselves. The treatment of side effects is part of what is known as supportive care. If the treatment is too distressing, though, there may be good reasons for deciding not to have (further) treatment.

One common side effect is fatigue. Fatigue is debilitating physical and mental exhaustion. People may be affected by fatigue the whole time they are having treatment, and sometimes even longer. It is most likely caused by physical and psychological reactions to the disease and the treatment. Fatigue can be a big problem and make people feel (more) down. Even small tasks may become impossible or very difficult to perform. It is important to talk to your doctor and find your own personal way to deal with fatigue. Exercise, endurance sports and strength training can help to relieve the fatigue when adjusted to suit your overall physical condition.

Any life-threatening disease that requires repeated courses of physically draining treatment will inevitably end up affecting your mental health too. Most people in this situation will feel down from time to time. If these feelings last for a longer period of time, depression may develop. Depression is also a serious illness, so it's important to seek treatment.

You do not need to face the physical and mental distress caused by the disease and its treatment on your own. It is anything but easy to come to terms with the shock of the diagnosis, dealing with worries about the future and existential questions concerning life and death. Accepting help can allow you to save your strength and make it easier to find ways to be able to live as good a life as possible with the disease.

Nowadays, counseling is an important part of good cancer treatment. Psycho-oncologists are psychological experts, medical experts and/or social workers who are specially trained to help cancer patients. If you wish, they can support you and your family in coping with the emotional and social aspects of the disease. They may offer things like relaxation therapy, individual or group therapy sessions or couples counseling.

In the hospital, psycho-oncological support is mainly provided by doctors and nurses. They may work together with psycho-oncological services. Psycho-oncological support is also offered as part of rehabilitation. People who are at home (again) can make use of outpatient help. This kind of support is offered by the following specialists and facilities:

• Outpatient psycho-oncology departments of hospitals and certified centers
• Practices specialized in oncology
• Psychosocial cancer information centers
• Practice-based psychotherapists

Disease management programs are structured treatment programs for people who have chronic diseases. They aim to provide patients with treatments that have a scientifically proven benefit and are tailored to their individual situation. People with a chronic disease should be offered comprehensive care, advice and information. Statutory health insurance funds in Germany have offered DMPs since 2002.

The programs include regular doctor’s appointments, consultations and examinations. Participation is voluntary and doesn't involve any extra costs. But people who take part in a DMP commit to active participation in their treatment. That includes regularly going to doctor's appointments, for example. Doctors and medical facilities that take part in these programs commit themselves to comply with certain quality requirements. You can contact your statutory health insurer to find out whether they offer a DMP for breast cancer.

Clinical studies test medications and non-drug treatments and compare them with other treatments. For example, participants might be given new drugs, the effects of which are not yet completely known, or for which more experience with larger patient groups is needed in order for them to be approved. But this doesn't mean that patients are exposed to incalculable risks. Clinical studies are carefully planned according to strict quality standards, reviewed by expert committees and carried out by specialists. Both the effectiveness and the side effects of the medications that are used are closely monitored. You can choose to leave a clinical study at any time.

Under certain conditions it might be possible to receive treatment as part of a clinical study. Patients then have more involved care. But they also have to be prepared to deal with the treatment more intensively and, in many cases, to have more check-ups than usual. In order to weigh the pros and cons of participating in a clinical study, it's important to get all the information and advice you need, and coordinate things with your doctors.

In Germany, the German Society of Senology and the German Clinical Trials Register can provide further information and help you to look for clinical trials of breast cancer treatments.

Cancer therapies that aim to slow down or to stop cancer cell growth often have severe side effects. Some women might decide not to have further treatment if their treatment is having little effect, but a lot of unpleasant side effects.

If women decide not to have treatment to fight the cancer itself, they can still have palliative treatment to relieve the pain and symptoms caused by the disease. In other words, If you decide not to have a (new) course of treatment, you will still receive medical care. You can also decide to have cancer treatment again after a treatment-free period whenever you wish.

Treatment that doesn't aim to cure a disease, but instead to help you live with it and relieve symptoms like pain, is also called “palliative treatment." Palliative treatment is often thought to be treatment and care during the last few weeks of someone’s life. But you can have palliative treatment for many months or years. Depending on the patient’s symptoms and wishes, this treatment can already start shortly after metastatic cancer is diagnosed.

Palliative treatment, care and support can either be provided at home or in an inpatient facility. It is also provided in hospitals or hospices that offer care during the day.

A specially trained team of doctors, nurses, physiotherapists, social workers, chaplains and volunteers manages the palliative care. Depending on the person's physical and mental health, the focus may be on managing day-to-day activities or on accompanying them towards the end of life.