Median survival for women with advanced breast cancer is around three years. Oncologists are fully aware there is little can be done to improve the outcome for advanced breast cancer. Women faced with metastatic illness deserve a positive, evidenced based approach and support systems that lessen the frequent isolation experienced by people with such an incurable condition.
Metastatic Disease Kills Patients
Oncologists will never cure breast cancer unless they focus more on its advanced stage. A small subset of patients with metastatic cancer show promise for a cure if identified and managed correctly. Results from research work in early stage breast cancer are meaningful when resulting in years or decades of survival, however metastatic patients may survive for only weeks or months.
The median survival of advanced disease has improved from two to three years in a decade however improvements in supportive and palliative care may improve the patient's quality of life.
In 2007 the European Breast Cancer Conference (EBCC) published a set of recommendations in The Breast (Vol. 16, pp. 9–10) on managing metastatic breast cancer with improved international management guidelines.
Dr Cardoso, Champalimaud Cancer Centre, Lisbon
Dr Cardoso is an advocate for the personalised management of metastatic disease allied with psychsocial support, informed decision making, quality of life assessments and enrolment in well designed trials along with multidisciplinary teams is essential.
The European School of Oncology (ESO) has published review papers on combination versus sequential single agent chemotherapy, and on a patient subset who have a chance of a cure due to few metastatic lesions fortunately on one organ. Technologically advanced procedures such as stereotactic radiotheapy on brain metastases provide hope for advanced breast cancer patients.
Dr Cardoso wrote an editorial in CancerWorld 41 advocating the difficulty in confronting the invariably fatal side of the disease often leaving women with metastatic diisease isolated and forgotten. The Metastatic Breast Disease Advocacy Group has published its own consensus report Metastatic Breast Disease Advocacy Working Group identifying improving access to information, resources and support services; raising the profile of metastatic disease and increasing understanding of and access to clinical trials.
The Future
The prospects of maintenance therapy, the number of treatment lines to give and greater psychosocial support for patients and their families are improving. In the 1970s adjuvant chemotherapy was not credible now it is standard practice.
A young woman presenting with metastatic breast cancer may survive for three months or if fortunate to present with only one metastatic lesion on one organ may have a chance of a cure and resume a normal life. This latter case is rare. Some metastatic breast cancer patients reject chemotherapy and seek solace with alternate therapists with unfortunate and predictable results.
Sources
Michael Manning - ' The best lack all conviction while the worst are full of passionate intensity' W.B.Yeats
