Metastatic Breast Cancer as a Chronic Condition (cont.)

"These drugs have been very beneficial, because they slow the breakdown of bone. One of the big problems with bone metastases used to be fractures," says Mayer. "With these drugs, you don't have the kind of damaging, progressive bone disease that we used to see."

Living Well in Spite of the Unknown

But despite all the progress, a diagnosis of metastatic breast cancer is still a fearful, life-changing one. "A lot of people are very afraid initially, and feel that many doors have been closed to them," says Mary Jane Massie, MD, attending psychiatrist at Sloan-Kettering's Breast Center.

"Our task is to help people see that they can move ahead with their lives -- always needing excellent health care follow-up, but often living for relatively uninterrupted periods of life."

The hardest part, for most women, is the uncertainty. "Over time, some people get used to the idea that they'll be living with, or despite, the disease, but they won't be rid of it. But what's hardest is confronting the uncertainty and the general lack of control -- not just the disease and the drugs, but more globally, the fact that we don't know what the next months will bring with anyone with this disease," says Hudis.

Coping with the "extended marathon" of life with metastatic breast cancer means different things to different women. Some seek support from counselors or group therapy sessions at their cancer centers, while others find it online. The web-based support group BCmets ( is one of the oldest and largest.

"Some women want to keep working full time for as long as possible and keep their focus away from the illness," says Mayer. "Others say, 'OK, I have a limited time, and I don't want to spend it in my office. I want to travel, work in my garden, spend time with my grandchildren.' Everyone has different priorities."

One of the most important things for women with breast cancer metastases to remember, says Winer, is the exciting progress of research. "This doesn't mean that we'll have new treatments in six months, but a lot more may be possible in just three or four years," he says.

"That informs much of our strategy: to keep you alive, in good shape, and functioning well, so that the approaches being worked on now may be something for you in a few years. Is that a guarantee? No. Is it possible? Absolutely."

Published May 2005.

SOURCES: Eric Winer, MD, director, Breast Program, Dana-Farber Cancer Institute, Boston. Clifford Hudis, MD, chief, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York City. Musa Mayer, author, Advanced Breast Cancer, A Guide to Living with Metastatic Disease. Mary Jane Massie, MD, attending psychiatrist, Memorial Sloan-Kettering Cancer Center, New York City. Giordano et al, "Improvement in breast cancer survival: results from M.D. Anderson Cancer Center protocols from 1975-2000," presented to the American Society for Clinical Oncology Annual Meeting 2002.

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