It happens. The cancer has spread. Now what?
Metastasis – what to expect at end of life
Data from clinical trials is what puts new treatments and drugs onto the market and available for cancer patients. Four types of clinical trials exist:
Phase 1 looks into whether a new treatment is safe to use and explores a range of doses.
Phase 2 trials study how well a drug or treatment works for specific cancers.
Phase 3 compares new treatments with standard treatments, and may involve different dosages, combinations or sequences. Patients are divided into new and standard treatment groups, without the opportunity to choose which group. Placebos are never used in breast cancer trials.
Phase 4 looks at long-term side effects for drugs or treatment approved by Food and Drug Administration.
Information from the Susan G. Komen website (ww5.komen.org).
What to expect as end nears
Fatigue – energy dissipates quickly. Use walker or wheelchair if unsteady on feet. A bedside commode will save energy spent walking to and from the bathroom. Ask for quiet time when you need it. Plan short activities when energy is at best.
Pain – can be controlled and managed. Medications can be long-acting, others fast-acting, and can be given intravenously, in patches, lozenges, drops under the tongue and even as rectal suppositories. Taking pain medication does not indicate weakness. Massage, music, conversation can provide distraction from pain.
Eating – the body slows down naturally during the dying process. A diminished appetite is normal should not be the cause of battle with family.
Breathing – common in cancer patients at end of life. Prop up in bed, use an oxygen supplement, turn on a fan, open a window. Medication is available to reduce anxiety and relax breathing.
Metastatic breast cancer can be treated, but not cured.
Only 6 percent of women initially diagnosed with breast cancer are diagnosed Stage IV, the most advanced stage. Usually Stage IV diagnosis is made after treatment when the cancer returns and spreads to other organs. Even though it may spread to, say, the bones, doctors still treat it as breast cancer.
Doctors don’t routinely order tests if cancer patients have no symptoms of metastasis, such as shortness of breath, weight loss, or bone pain. If those occur, testing might include tumor marker blood tests; bone scans, CT scans, PET scans and chest X-rays; and tissue biopsy.
“Using blood or imaging tests to check for early metastases in people with no symptoms of metastases does not increase survival,” the Susan G. Komen website states.
By the time the cancer has spread, patients’ choice of treatment depends on the type of tumor they have, what stage the cancer is in at the time of diagnosis, and what treatments already have been used. Whether to continue treatment and what kind, how long they wish to take part, is all up to the patient.
One option to consider might be joining a clinical trial. There are drawbacks that could include unexpected side effects, lack of or poor insurance coverage, other medical conditions, and locating a trial that meets the needs of the patient.
PREPARING FOR END
Regardless of what treatment decision the patient chooses, end of life planning is essential, beginning with making out or updating a will — actually good advice for everyone. Some may want to place their assets in a trust, which requires the service of an attorney.
Next, consider adding a second person to bank accounts, titles of vehicles, homes and property. Make sure beneficiary information is up to date. If they wish, now is the time to sign a Do Not Resuscitate order and prepare paperwork for signing over Durable Power of Attorney for healthcare and finances.
Write down computer, cell phone, and electronic device passwords; location of bank accounts, safe deposit and other keys; and investment and insurance information. Make a list of what bills need to be paid and which, if any, are automatic withdrawals. Provide for future care of pets.
Leaving instructions for funeral or memorial service can be a wonderful gift to family members left behind.
WHAT TO EXPECT
As quality time dwindles, patients will begin to focus on what is important to them. Find ways to let go of regrets. Apologize if you feel like it, offer forgiveness if you feel like it. Fix what can be fixed and let it go if it can’t. Let others know of the importance they had in your life. Write or dictate letters if energy level permits.
Feelings of fear often surface — fear of suffering, fear of being a burden, fear of dying alone, fear of the process of dying. Asking questions about what to expect physically and emotionally as the end of life approaches can ease anxiety of the patient and family members.
Another feeling may be anger that you’re not ready to die, and grief that you no longer have a future. There already may be grief around loss of strength, eating, doing the things you once enjoyed, even loss of friends who — for their own reasons — have difficulty visiting.
Hospice is a resource that helps patients as well as family members. It is available when a disease can’t be cured and with a life expectancy of six months or less. The hospice team provides palliative care — treatment to ease symptoms and continue with the best quality of life for as long as possible.
Medicare pays 100 percent of the cost for those who qualify. Medicaid and many insurance plans also cover hospice care. “People will be granted hospice regardless of their ability to pay,” states Kindred Hospice website.