When the cancer returns, what should your next steps be? Find community, expert advice, and wisdom from fellow metastatic breast cancer patients and caregivers who have been there. 

So you got the diagnosis no one ever volunteers for: metastatic breast cancer. Deep breath. It’s a challenging disease for anyone to face and to muddy the waters even more, it can put a strain on even the most solid relationship. Now, more than ever, it’s crucial to open the lines of communication with your partner. “With this diagnosis, it completely changes the life of not only the patient, but the whole family, says Geeta Nampiaparampil, M.D., a psychiatrist at the Miami Cancer Institute. “It’s especially important that partners learn good communication skills and are open and honest with each other about their concerns.” These tips will help you navigate the relationship stress that inevitably arises with an MBC diagnosis. More than just managing this rollercoaster ride with your partner, with a little luck, you may come out the other side even stronger than before. 

## Address Your Feelings

It’s a simple-sounding but difficult-to-execute piece of advice: Be honest about your emotions right now. “Both partners can be inclined to hide their fear or avoid talking about the situation,” says Sanam Hafeez, Psy.D., a neuropsychologist in New York City. “This only puts unnecessary stress on a couple already going through so much. Being honest about how you’re feeling during this time helps avoid isolation within a relationship.”

Right. So, how to have these convos? Start by remembering it’s not just a one-and-done event. The dialogue needs to be ongoing, so if you don’t say everything you want in your first go-around, there will be more opportunities down the pike. To make sure of this, pencil in a regular “check-in” time each week where you and your partner sit down and listen to each other’s feelings. During these sessions, make a rule that when one person talks, the other person can only listen or ask questions. (“How does that make you feel?” and “Is there anything I can do to help?” are good ones.) Questions indicate someone is paying attention and wants to know more, which creates a safe, supportive space for each person to share their feelings.

## Schedule Dates 

Specifically, ones that have nothing to do with chemo, checkups, or therapy. When you’ve got a calendar X-ed out with doc appointments, it’s super important to make time for a dinner out or a weekend away. Mark it on the calendar along with all the other medical jumbo, and make a pact that when the date starts, you leave the cancer talk at the door. “It’s important to do things and plan things that are not related to cancer and devote time to returning to the roots of your relationship,” says Dr. Nampiaparampil.

## Remember Teamwork

Look, the two of you got together because your strengths and weaknesses balanced each other out, right? Cancer has an effed-up way of turning that sense of equal-ness in a relationship upside-down. And when one partner takes on more of a caregiver role, it can easily leave the other person feeling dependent, even powerless. While necessary at times, it’s also important that the sense of give-and-take in your relationship stays as normal as possible. “Keep relying on each other as partners,” advises Hafeez. “Make sure the caregiver isn’t taking on too much. This includes chores, decision-making, medical care, and emotional support.”

Because the natural inclination of your partner may be to do as much for you as possible (hey, they don’t call it love for nothing!), you might want to create a weekly chores chart (yes, like the kind you had as a kid). Each of you can initial certain tasks, eliminating any awkward sense of “Should I do this for her or not?”

## Shift the Focus

Clearly, you've landed the starring role in this metastatic breast cancer saga (we know, you didn’t ask to play it). But your partner needs attention, too. “In healthcare, I think we do a good job of asking the patient how they’re feeling, how they’re sleeping, and how they’re doing overall,” says Dr. Nampiaparampil. “Caregivers, though—we don’t often ask them how they’re doing. They may be suffering with anxiety and depression but feel they can’t say anything. And that can come out in all kinds of behaviors that are not good for your relationship.” 

Take a minute to find ways to make your partner feel appreciated. That might mean asking your friend to take over driving duties for one of your treatment appointments. Or maybe you’ll surprise your partner with takeout from a favorite restaurant so no one has to cook dinner. Little gestures can go a long way toward balancing the relationship during these times.

## Be Forgiving

It’s not only well-meaning friends and acquaintances who suffer from foot-in-mouth syndrome: Your soulmate can step in it, too, during these times when emotions are running high. “With metastatic breast cancer, a lot of times people don’t look as though they have what people think of as stage 4 cancer,” says Dr. Nampiaparampil. “Your partner may say ‘Oh, you don’t look that sick or tired,’” and mean it as a compliment, even though you truly feel like crap.  Instead of bristling at an offhand comment, use it to further communication. Tell your partner how it makes you feel—and how you really *do* feel (and have a sense of humor about it, too—who knows, it could become your new inside joke!). 

## Talk About Sex

If sex is the last thing you feel like having right now, you’re not alone. It’s common to temporarily want to hit the intimacy pause button during cancer treatment. But with MBC, that feeling can conflict with another one, namely, if not now…? As always, honesty is everything. Also, be open to creative solutions. “Make it a point to keep the romance active,” says Hafeez. Think outside the bedroom box: Massages, cuddling, and even small romantic gestures like holding hands on a walk can go a long way toward keeping the connection alive. 

## Be Vulnerable

You spent your life being tough and independent, so shifting into patient mode isn’t always an easy thing to do. But right now, let’s face it, it’s OK to let down your guard. “Sometimes patients feel they have to be stronger than they feel,” says Hafeez. “It can be hard to feel like you’re the cause of people worrying, especially if you’re someone who has always been the backbone of the family.” 

As President Roosevelt famously said, the only thing you have to fear is fear itself. Acknowledging your uncertainty during this time can be surprisingly cathartic. “It’s important to accept that you’re scared and you need your loved one,” says Hafeez. Remember, feeling afraid doesn’t make you weak, it just makes you honest. Cut through the bull and tell your partner the truth—it will give you both a better starting point as you take this journey together.

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Dealing with the disease is hard enough, but the strain it can put on your relationship makes it even worse. Here's help.

MBC Relationship Stress

Communication is everything with this disease. These seven tips can help you and your partner build an even stronger bond.

Handling Relationship Stress With Metastatic Breast Cancer

- __Metastatic Breast Cancer:__ National Breast Cancer Foundation. (n.d.). “Metastatic Breast Cancer.” [nationalbreastcancer.org/metastatic-breast-cancer](https://www.nationalbreastcancer.org/metastatic-breast-cancer)
- __Metastatic Breast Cancer Treatment:__ American Cancer Society. (2019). “Treatment of Stage 4 (Metastatic) Breast Cancer.” [cancer.org/cancer/breast-cancer/treatment/treatment-of-breast-cancer-by-stage/treatment-of-stage-IV-advanced-breast-cancer.html](https://www.cancer.org/cancer/breast-cancer/treatment/treatment-of-breast-cancer-by-stage/treatment-of-stage-IV-advanced-breast-cancer.html)
- __Metastatic Breast Cancer and Relationships:__ Breastcancer.org. (2020). “End of Life Issues: Emotions and Relationships.” [breastcancer.org/symptoms/types/recur_metast/stop_treat/emotions](https://www.breastcancer.org/symptoms/types/recur_metast/stop_treat/emotions)


How to Talk with Your Partner About Metastatic Breast Cancer

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What should your next steps be now that your cancer has spread? Learn how to get your needs met by your family, friends, and community; how to communicate with your care team; and what the future holds. 

Taking Charge with Metastatic Breast Cancer

Taking Charge With Metastatic Breast Cancer

Communication is everything with this disease. These 7 tips can help you and your partner build an even stronger bond.

Follow these tips for caregiving and support when a partner is diagnosed with metastatic breast cancer.

Breast Cancer Support

After a metastatic breast cancer diagnosis, you’ll want to make the most of your time. And while paperwork is probably the last thing you want to deal with, keeping your life organized can help.

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After a metastatic breast cancer diagnosis, keeping your life organized can help. Here are tips for handling your medical paperwork.

Stay Organized with Metastatic Breast Cancer

Tips for Staying Organized with Metastatic Breast Cancer

10 Tips For Organizing Your Medical Paperwork When You Have Metastatic Breast Cancer

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Your job: Be a vigilant caregiver and loving partner—at the same time. Here’s how to navigate this challenging period in both your lives.

9 Ways to Support a Partner with Metastatic Breast Cancer

- __MBC Survival Rate:__ American Society of Clinical Oncologists. (2020). “Breast Cancer – Metastatic: Statistics.” [cancer.net/cancer-types/breast-cancer-metastatic/statistics](https://www.cancer.net/cancer-types/breast-cancer-metastatic/statistics)
- __MBC Survival Rate:__ Susan G. Komen. (2020). “Metastatic Breast Cancer.”  [komen.org/BreastCancer/MetastaticBreastCancerIntroduction.html](https://ww5.komen.org/BreastCancer/MetastaticBreastCancerIntroduction.html)
- __MBC Treatments:__ Breastcancer.org (2020). “Metastatic Breast Cancer.”  [breastcancer.org/symptoms/types/recur_metast](https://www.breastcancer.org/symptoms/types/recur_metast)


How to Help When Your Partner Has Metastatic Breast Cancer

Team Up for Appointments

Run the Communications Department

Coordinate Efforts

Share Online Research

Avoid Information Overload

Schedule Say-Anything Time

Organize Cancer-Free Days

Celebrate Spontaneity

Establish Weekly Rituals

Treatment for late-stage breast cancer can be tough. But for some women, giving up their job to deal with health issues can feel like admitting defeat. These tips will help you keep working even when you have MBC.

MBC and Work

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Being diagnosed with late-stage breast cancer shouldn’t have to mean giving up your work life—if you don’t want it to. These tips will help you stay on the job while going through treatment.

How to Balance Your Career With Metastatic Breast Cancer

- __44% Keep Working:__ *Cancer*. (2015). “Working After a Metastatic Cancer Diagnosis: Factors Affecting Employment in the Metastatic Setting from ECOG‐ACRIN's Symptom Outcomes and Practice Patterns Study.” [acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.29656](https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.29656)

- __Metastatic Breast Cancer Treatment:__ Breastcancer.org (2020). “Metastatic Breast Cancer” [breastcancer.org/symptoms/types/recur_metast](https://www.breastcancer.org/symptoms/types/recur_metast)

- __Metastatic Breast Cancer Resources:__ National Breast Cancer Foundation. (n.d.) “Metastatic Breast Cancer.” [nationalbreastcancer.org/metastatic-breast-cancer](https://www.nationalbreastcancer.org/metastatic-breast-cancer)

- __Metastatic Breast Cancer and Work:__ Breastcancer.org. (2018). “Working After a Metastatic Breast Cancer Diagnosis.” [breastcancer.org/symptoms/types/recur_metast/living_metast/work](https://www.breastcancer.org/symptoms/types/recur_metast/living_metast/work)


Michael Hunter, M.D.

Medical Reviewer

How to Keep Working When You Have Metastatic Breast Cancer

Make a Plan

Talk to Your Boss

Be Friendly But Firm With Coworkers

Think Outside the Box

Rest and Recharge

Create Your Chemo "Office"

Keep It Clean

Find New Sources of Support

How to Balance Your Job With Metastatic Breast Cancer

With more than 1,000 apps available for breast cancer information, care, and treatment, it can be hard to know which ones to choose. We asked a team of breast cancer experts what to look for.

Breast Cancer Apps

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With more than 1,000 apps available for breast cancer information, care, and treatment, it can be hard to know which ones to choose. We asked a team of breast cancer experts for their favorites.

Best Apps for Managing Your Breast Cancer

- __Breast Cancer and Mobile Apps Benefit:__ *Journal of Medical Internet Research*. (2019). “Research-Tested Mobile Apps for Breast Cancer Care: Systematic Review.” [ncbi.nlm.nih.gov/pmc/articles/PMC6388100/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388100/)

- __Breast Cancer and Fitness Apps:__ *Frontiers*. (2017). “Cancer Survivors’ Experiences of Using Publicly Available Physical Activity Mobile Apps: A Qualitative Analysis.” [frontiersin.org/10.3389/conf.FPUBH.2017.03.00016/event_abstract](https://www.frontiersin.org/10.3389/conf.FPUBH.2017.03.00016/event_abstract)

- __MBC and Social Support:__ *The New England Journal of Medicine*. (2001). “The Effect of Group Psychosocial Support on Survival in Metastatic Breast Cancer.” [academic.microsoft.com/paper/2023305103/citedby/search?q=The%20Effect%20of%20Group%20Psychosocial%20Support%20on%20Survival%20in%20Metastatic%20Breast%20Cancer&qe=RId%253D2023305103&f=&orderBy=0](https://academic.microsoft.com/paper/2023305103/citedby/search?q=The%20Effect%20of%20Group%20Psychosocial%20Support%20on%20Survival%20in%20Metastatic%20Breast%20Cancer&qe=RId%253D2023305103&f=&orderBy=0)

- __Breast Cancer and Meditation:__ *Cancer*. (2014). “Mindfulness‐Based Cancer Recovery and Supportive‐Expressive Therapy Maintain Telomere Length Relative to Controls in Distressed Breast Cancer Survivors.” [acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.29063](https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.29063)


Use These Phone Apps to Take Control of Your Breast Cancer Care

The app: [MBC Connect](https://play.google.com/store/apps/details?id=org.mbcalliance.mbc_connect.staging&hl=en_US)

The app: [Breast Advocate](https://apps.apple.com/us/app/breast-advocate/id1435211076)

The app: [Breast Cancer Recovery](https://play.google.com/store/apps/details?id=au.com.appliquette.breastcancerrecovery)

The app: [ChemoWave](https://apps.apple.com/us/app/chemowave-cancer-health-app/id1199851760)

The app: [My Cancer Coach](https://play.google.com/store/apps/details?id=com.genomichealth.mycancercoach&hl=en_US)

The app: [CancerCare Meditation](https://apps.apple.com/us/app/cancercare-meditation/id1373888072?ls=1)

The app: [CaringBridge](https://apps.apple.com/us/app/caringbridge/id365726944)

The app: [CareZone](ttps://play.google.com/store/apps/details?id=com.carezone.caredroid.careapp.medications&hl=en)

Here is what patients who have been living with MBC—for three, six, even 23 years—want other patients and their loved ones to know.

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Metastatic Breast Cancer: The Advice I Needed Most

Patient to Patient: Statistics Do Not Dictate Your Journey

The First Few Months are the Most Stressful

Look for a Breast Specialist, Not Just a Cancer Doc

Seek an NCI Cancer Center If You Can 

Delegate, Delegate, Delegate

Get to Know Other Patients

Keep a Journal

Your Quality of Life Matters

Friends and Family: Listen More, Talk Less

If You Don't Know What to Say, Just Say That!

Offer to Set Up a Meal Train

Be Careful Not to Blame or Shame

Please Support Our Families, Too

Remember That We Have Lives Outside of Cancer

More Help and Advice

Six years ago, at age 31, Patti was diagnosed with an aggressive form of breast cancer. Three years after that, the cancer came back. At just 34, she faced a metastatic disease that has a [five-year survival rate](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833304/) of about 34%.  

But Patti knows statistics don’t tell her story. And she doesn’t live in fear. So when her sister Kristin offered to be a surrogate for Patti and her husband, she knew what she wanted to do. She would become a mother.   

Eight weeks ago, she did.  

“I’ve had people tell me that I shouldn’t do this with everything I have going on,” Patti says, who’s now 37. “I understand their concerns. I might have thought the same thing 10 years ago. But this is my life. I always thought I’d have kids. I had this opportunity, and I took it.”



Mother's Day MBC Video

Stories like this–of a woman with metastatic breast cancer having a child through surrogacy–are exceedingly rare, says Pallav Mehta, M.D., an oncologist specializing in breast cancer at [M.D. Anderson Cancer Care Center at Cooper](https://www.cooperhealth.org/locations/md-anderson-cancer-center-cooper-two-cooper-plaza) in New Jersey, who has treated Patti for more than six years. In his 15 years of practicing and of the thousands of patients he has seen, Patti is the only patient with [metastatic breast cancer](https://ww5.komen.org/BreastCancer/MetastaticBreastCancerIntroduction.html) who has found a way to become a mother.  

While it’s possible for some women with earlier forms of breast cancer to get pregnant after treatment, it’s not an option for those whose cancer has spread.  “Metastatic cancer isn’t curable,” Dr. Mehta says. “That doesn’t mean a woman can’t live a long time, but you also can’t take her off treatment for a year, which is about what it would take to have a baby. If you did that, she could die.” 

### Planning for a Future 

As an oncology nurse, Kristin knew exactly what her sister would face when she was first diagnosed at 31. Chemotherapy will put most women into a state of chemically induced menopause, meaning they will stop having a monthly period while they are undergoing treatment. What’s more, some chemo drugs may permanently impact ovarian function or hormone levels, increasing the odds of [infertility](https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/fertility-and-women-with-cancer/how-cancer-treatments-affect-fertility.html) later, according to the [American Cancer Society.](https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/fertility-and-women-with-cancer/how-cancer-treatments-affect-fertility.html)  

Just days after she had a double mastectomy and before she began chemotherapy, Kristin took Patti to an appointment with a fertility doctor to begin the process of freezing and preserving her eggs. It was a “just in case” insurance policy–a way to keep Patti’s options open, Kristin explains.  

"Keep living your life, and always have something to live for."

It would have been easy for Patti, who was still single at the time, to miss the window to harvest her eggs. “I don’t know if I would have gone through that whole process on my own, I was so drugged up and beat up after the surgery,” Patti said. Plus, the procedure is expensive; most insurance companies don’t cover the process or the on-going fees associated with cryopreservation. But thanks to Kristin and their mom, Patti didn’t have to worry about any of the planning. The sisters are close—they’re part of a set of quadruplets (they have another sister and brother), and they have a younger brother too. Patti’s family would be there for her no matter what.  

### Three Years of Stability, Then a Recurrence 

A few weeks later, Patti had 16 eggs frozen and began seven months of chemotherapy and radiation. She continued to take drugs that were intended to prevent her cancer from returning, and she had regular scans to make sure new tumors hadn’t developed.    

By the time she was 34, Patti had resumed her job as a high-school English teacher—and she had just started dating someone new, a quiet, kind man who was slowly winning her over. Life was good. 

Then she discovered a lump in her neck. A biopsy and a scan revealed that the cancer had spread to the lymph nodes in her neck and the peritoneum, or the lining of the abdominal cavity. Patti decided not to share the news the right away. The whole family was soon headed to Walt Disney World, and she didn’t see the point of letting cancer ruin the vacation.  

When Patti finally sat Kristin down to tell her, she simply pulled back her hair to reveal the biopsy scar on her neck, knowing her oncology-nurse sister would know what it meant. No one ever used the word [metastatic](https://www.cancer.gov/types/metastatic-cancer), Kristin says.

Soon after, Kristin went with Patti to an appointment with Dr. Mehta. Kristin listened intently as he explained the next steps for Patti. As they were getting ready to leave, Kristin overheard Dr. Mehta tell Patti, “Keep living your life, and always have something to live for.”

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Kristin and TJ

Those words stuck with Kristin. It was the kind of thing Dr. Mehta always said and one of the reason’s Patti liked coming to see him. But for Kristin, those words were a spark that would soon light the future. 

“It was something I would think about all the time,” says Kristin. “If you’re alive and you don’t do the things that you want to do, then it’s like cancer has already taken your life,” Kristin said. “Why shouldn’t Patti get to be happy, just because she got a crappy diagnosis?”  

Meanwhile, Patti wasn’t dwelling on the negative either. A newly approved targeted drug seemed to be keeping her cancer stable, and she was moving forward with finding happiness and living her life. She became engaged to the man she had just started dating not long before her second diagnosis. Patti knew they loved each other–so why wait? The couple got married about five months later. 

But there was still one thing missing. 

### Growing a Family 

After Patti had been married about a year, the two sisters got to talking about surrogacy. Neither of them can remember exactly how the conversation started, but they both remember that Kristin was the one who offered to be Patti’s surrogate. Her reasoning? If one of her siblings needed a kidney, Kristin would give it. So why not give her sister a baby?

“I thought, if Patti could keep battling cancer all this time, I can be pregnant for nine months,” Kristin says. “I love her so much. She’s been the best aunt to my three girls. I wanted to return the favor and be a great aunt for her. I wanted to see her become a mom. And I guess, there was a part of me that thought, this way I’ll always have a piece of her.”

<p><img src = "https://images.ctfassets.net/yixw23k2v6vo/3vHo2HdUYkRICNLIT4fpGt/d1a6889fc6eddfcffc6eb5d4a3b8b613/JessicaTodd_HARPER-2575-credit-2.jpg" width="400" height="600" align="left">Over the years of dealing with breast cancer, Patti had lost several good friends to the disease. And as heartbreaking as that was, she was also upset to see people living with fear and becoming absorbed in the possibility that they would die soon. To Patti, that was no way to live. She realized she had kept those eggs frozen all this time for a reason. This was her chance to be a mom.

It wouldn’t be an easy journey for either sister. Becoming a [surrogate](https://www.hrc.org/resources/overview-of-the-surrogacy-process) requires extensive legal, medical, and even psychological preparation. Once they were finally ready to begin the [IVF process](https://americanpregnancy.org/infertility/in-vitro-fertilization/), they discovered that only half of Patti’s 16 eggs survived once they were thawed. The remaining eight eggs were fertilized with her husband’s sperm, and five became viable embryos.</p>
  
Kristin underwent IVF with two of those embryos. There was excitement and elation when they discovered Kristin was pregnant—and then despair when Kristin miscarried in the first trimester.  

There were three embryos left. They decided to try again, but this would be their only chance. One embryo didn’t survive the thawing process. Another never took once it was transferred. But the third one stuck. Kristin willed the tiny developing fetus to hang tight. And it did.

“I liked to joke that it was her last egg in my basket,” Kristin said. “I was so scared throughout the pregnancy. I knew this was their last shot.”

### Feeling Pregnant  

Throughout her pregnancy, Kristin was careful to always remind herself that the baby she carried wasn’t her own. She played music that she knew Patti liked, including one of Patti’s favorites, Josh Groban’s Granted.  

Meanwhile, Patti was going through significant complications. The cancer had caused lesions in her abdomen, which resulted in painful partial [bowel obstructions](https://www.healthcentral.com/article/myths-about-small-bowel-obstruction). Patti was admitted to the hospital half a dozen times, feeling terribly ill and unable to eat solid food.  

“I was so bloated, I felt like I was pregnant,” Patti says. “Kristin would be like, ‘Feel my belly.’ And I was like, ‘No, feel my belly!’ I could feel bubbles moving through my intestines. I thought, it’s almost like a baby kicking.” 

During this time, Patti had to have a catheter inserted in her chest because a blood clot in her arm made it impossible to insert an IV there. But the port also made it difficult for her to shower or wash her hair. Kristin, who lives nearby, would come over to Patti’s house several times a week and help her.  

These visits were also a chance for Patti to have some face-to-face time with Kristin’s growing belly. As  Kristin blow-dried her hair, Patti would sometime place a hand on her sister, feeling the baby within. 

 “I remember the first time I was over helping her wash her hair,” Kristin says. She put her hand on my belly and started crying, and then I was crying. We just understood.”  

### A Life to Hold on To 

These days, Patti is like most new mothers, constantly tending to everything that comes with caring for a tiny person. She’s up in the middle of the night to feed him and she spends her days washing bottles and running loads of baby clothes through the laundry.  

Photo series

Unlike other new moms, she’s also juggling all the appointments and treatments she needs for her own care. But thankfully her family–including Auntie Kristin–and many friends have stepped up to help her and husband manage it all.  

Patti’s breast-cancer support group even threw her a big baby shower several weeks ago, surprising her with a pile of gifts and so much love. It’s all made her appreciate how many people want to help her celebrate, how many people want to share in her joy. And these days, she has a lot of joy to give. 

She feels her heart ache with it when she watches her son. When she sees his eyes light up or hears him coo. She sometimes thinks about his future, and what he’ll be like when he grows up. But mostly she focuses on each moment with him. 

She knows that no matter what happens, her son will be surrounded by people who love him.  And she knows a part of herself will always be with him.  

“I see myself in him, especially in his eyes, the way he looks at me,” Patti says, her voice heavy with tears. “When I look at him, I know there’s a little piece of me in there. It’s a miracle that he’s here.” 



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Patti and her son

After her first breast-cancer diagnosis, Patti froze her eggs. Six years later, her sister carried the baby she was always meant to have. 

Patti was faced with a seemingly impossible decision: live in fear or live for right now. She chose today. What would you do?

Becoming a Mother When You Have an Incurable Disease

Woman with Metastatic Breast Cancer Becomes New Mom

As a woman living with metastatic breast cancer, Patti faced a seemingly impossible decision: live in fear or live for right now. She chose today. What would you do?

If you have metastatic breast cancer, you may need to travel far from home for regular chemotherapy or radiation treatments. Even getting to a doctor's appointment in your own neighborhood can be a challenge. Several organizations are ready to help cancer patients with transportation.

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Need to find an affordable way to get to your frequent medical appointments? A mix of national and local resources can help.

Free Rides For Metastatic Breast Cancer Care

Finding Free Rides For Metastatic Breast Cancer Care

American Cancer Society’s Road to Recovery Program

CancerCare’s Get You There Program

The Ellie Fund

Angel Wheels

Patient Travel

Chemo Cars

Regional Organizations

Ask Your Medical Center

Network With Your Contacts

MBC Patients! Get a Free Ride to Your Next Appointment

When you have metastatic breast cancer, it's a time to live what life you have to the fullest and continue making memories with loved ones. It can also be a time to get your life in order and create a legacy for those you’ll eventually leave behind, especially when there are young children.

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Having metastatic cancer is a time to live to the fullest, continue making memories, and create a legacy for the loved ones you’ll leave behind.

Metastatic Breast Cancer: Leaving a Legacy

Metastatic Breast Cancer: Leaving Loved Ones a Legacy

Make a Legacy Gift

Leave a Unique Memento

Empower Yourself With Your Story

Communicate Your Values

Record Your Oral History

Write Letters for Life's Milestones

Create a Memory Holder

Let Them See You Share

Make Memorable Moments

Take a Journey Together

Maintain a Loving Influence Through Time

Metastatic Breast Cancer: Leaving Behind a Legacy

Cancer changes everything: our bodies, our perspective on the future, and even our relationship dynamics. But that doesn’t mean we have to give up intimacy and sex.

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Cancer changes bodies, and relationships. That doesn’t mean you have to give up intimacy and sex.

Intimacy After Metastatic Breast Cancer

Rediscovering Intimacy After Metastatic Breast Cancer

Navigate the Connections

Recognize and Redefine Intimacy

Talk More Deeply, More Often

Be Compassionate With Yourself

Acknowledge Changed Relationship Roles

Rediscover Date Night

Revisit Your Favorite Romantic Activities

Moisturize “Down There” Daily

Consider Your Partner's Perspective

Adjust Around Your Cancer

Talk to Your Doctor

When you’re managing metastatic breast cancer, getting better can come with an array of unwelcome challenges: nausea, hair loss, lowered libido, anxiety for the future, and, unfortunately, pain. 

About 90 percent of patients with advanced cancer name pain their most distressing symptom, according to the Cleveland Clinic. Managing pain can be a complex undertaking that involves not just medication but also lifestyle modifications and complementary approaches, says [Susan LeGrand, M.D.](https://my.clevelandclinic.org/staff/2889-susan-legrand), in the medical oncology department of Cleveland Clinic.

“With this type of cancer, unfortunately, there is often [chronic pain](https://www.healthcentral.com/category/chronic-pain),” she told HealthCentral by phone. “That pain can come in many forms. For example, you may have pain wherever the cancer has spread, especially if it’s in the bones, which is common. There’s also nerve pain, also common. Those would need to be handled in different ways.”

When trying to navigate pain management, it’s likely that you’ll find relief through a highly individualized combination of strategies. Here are some aspects to keep in mind:

## Opiates Will Likely Be Involved

As has been extensively covered in the news, the U.S. is facing an opioid crisis, with [addiction (and overdose) rates at record levels](https://www.healthcentral.com/slideshow/chronic-pain-confessions-about-opioid-use). That may cause some cancer patients to shy away from the medication, says Dr. LeGrand. 

But opiates remain the mainstay of cancer-related pain management, she adds, simply because they work so well.

“For some conditions, opiates are not recommended," Dr. LeGrand says. "But cancer is a different story. We haven’t found any alternate medications that can work on the multiple kinds of pain that cancer brings.”

That doesn’t mean that it's opiates or nothing, though. Dr. LeGrand, emphasizes that she and many other physicians try to include other medications in the therapy so that opiates work better at a lower dose. 

And for nerve pain, opiates may be skipped altogether in favor of medications like Lyrica or Gabapentin, which are more appropriate for neuropathy, she says. But in general, don’t be surprised if your doctor includes opiates in your pain mix.

## Complementary Approaches Can Help

In addition to adjusting medications to achieve the ideal mix — Dr. LeGrand says the goal is to be “awake, alert, and comfortable” — [other pain-relieving strategies can also be helpful](https://www.healthcentral.com/slideshow/how-to-deal-with-stress-metastatic-breast-cancer). 

She notes that many people find therapies like chiropractic care, acupuncture, reiki, and physical therapy to be useful. Yoga, mindfulness, a gratitude practice, and other de-stressing techniques can help quell emotional pain, she adds, and lower anxiety levels that can ramp up with metastatic breast cancer, as well.

Focusing on movement as a way to improve bone health is a great choice for those who may be experiencing metastases to the bones, but the benefits of physical activity go beyond soothing physical pain. Increasing your movement, even by taking a few walks every day, can enhance mood and improve digestion, Dr. LeGrand says.

For many, [medical marijuana may be another option](https://www.healthcentral.com/article/cannabis-and-pain-management), notes Karen Munkacy, M.D., an anesthesiologist and researcher who turned to cannabis during her own breast cancer treatment. 

“For conditions like chronic pain, medical marijuana can be very helpful, and it works very quickly,” she told HealthCentral by phone. “You know within hours if it brings relief for you or not.”

## Working Together on a Plan

In its guide on cancer pain management, the Cancer Pain Research Consortium notes that about 90 percent of cancer-related pain can be managed, and yet only half of those with this type of pain seek relief. In part, the researchers suggest, this may be a perception issue. 

Those with cancer — especially one that spreads, like metastatic breast cancer — might believe they have to accept pain as a permanent part of their “new normal.” But this definitely doesn’t have to be the case, Dr. LeGrand says. 

Working with your oncologist and other professionals. like a [palliative care specialist](https://www.healthcentral.com/article/palliative-care-treating-the-person-not-just-the-cancer), can provide an array of options when it comes to addressing multiple types of pain. And the time to start those conversations? Dr. LeGrand believes pain-relief strategies should be discussed as early in the process as possible.

“Start talking about pain management with your care team as soon as you can, so you know your options, and also know plans B, C, D, and so on,” she says. “Sometimes, just knowing that there are more choices to try can be a comfort in itself.”



woman with bald head looking relaxed-iStock-1077480094

From opiates and other medications to yoga, mindfulness, and other de-stressing techniques, an almost endless variety of options are available for cancer-related pain management.

Here’s how you can find pain relief with a highly individualized combination of strategies.

Metastatic Breast Cancer: Better Pain Management

Metastatic Breast Cancer: Pain Management Strategies

[Clinical trials](https://www.healthcentral.com/article/clinical-trials-faq) have become common for numerous conditions, as a way to evaluate new treatments and medications that might improve on what’s currently available. [Metastatic breast cancer](https://www.healthcentral.com/article/what-is-metastatic-breast-cancer) is no different, according to Nicole Williams, M.D., of the Ohio State University Comprehensive Cancer Center. She notes that this type of cancer has a number of clinical trials in progress, geared toward improving quality of life, minimizing or eliminating symptoms of ongoing treatment, and lengthening life.

If you have metastatic breast cancer, how do you know if a clinical trial might be right for you? And what can you expect if you do join one? Here are some factors worth considering:

## Cancer Trials Don’t Use a Placebo Group

One very common concern among those considering [clinical trials](https://www.healthcentral.com/article/how-to-join-a-clinical-trial) is that they’ll get placed in a group given only a placebo, which means they won’t receive “real” treatment, says Dr. Williams. But this is never the case for cancer, or for any condition where treatment is essential. 

Often, she says, you’ll receive some type of standard care, and what’s involved in the trial will be a complement to your regular treatment. Even if the clinical trial has a novel therapy, or you’re using a single drug, you’ll still be closely monitored to ensure this is the best treatment for you. 

“You’ll never be in a situation where you’re either receiving treatment OR you’re in a clinical trial,” says Dr. Williams. “They’re one and the same.”

## You May Want to Join a Trial Early in Your Treatment

Another misconception is that clinical trials are only offered to patients toward the end of their disease, when treatment options are limited. Dr. Williams believes that considering a trial earlier can broaden your possibilities.

“Clinical trials are an excellent option for anyone with metastatic breast cancer, because it gives you more choices in terms of potential therapies,” she says. “Some of our patients with this type of cancer join a trial right after being diagnosed.”

## Trials Have Specific Goals

Clinical trials for metastatic breast cancer aren’t focused on a cure, Dr. Williams notes. Instead, they are mostly geared toward helping patients live longer or improving their symptoms. For example, a trial might be attempting to lower chronic pain related to metastases.

Other trials might be related to targeting gene mutations associated with the cancer, she adds, especially when it comes to delivering treatment based on those genetic markers. 

“When looking at trials, understand what the larger purpose is,” Dr. Williams suggests. “This can help you determine if that matches with your own interests and goals.”

## Not Everyone Is a Good Fit for a Trial

There are disqualifying factors for many clinical trials, like confounding medical issues such as liver failure and kidney failure. 

Also, there are trials where you will be randomized in terms of what type of therapy is planned, and not everyone is happy with the group they’re assigned, says Janie Grumley, M.D., breast surgical oncologist and director of the Margie Petersen Breast Center at Providence Saint John’s Center and associate professor of surgery at the John Wayne Cancer Institute in Santa Monica, California.

Fortunately, you’re never locked into a trial, and you can leave it whenever you want. For example, Dr. Grumley notes, some people who don’t like their randomized group simply stop participating in the trial. That happens so often that researchers anticipate that reaction when developing their trial protocols. 

## You’ll Probably Join When a Trial Is in a Later Phase

By the time a clinical trial is evaluating the effects of a drug or therapy on humans, it’s gone through several phases already, says Jack Jacoub, M.D., medical oncologist and medical director of the California-based MemorialCare Cancer Institute at Orange Coast Medical Center. 

Earlier phases look at patient safety and efficacy, while later phases are geared toward replicating results, he notes. That means if you join a “phase 4” trial—which is the last step before FDA approval is sought—there will be plenty of data about results, including potential side effects and benefits. 

Dr. Jacoub suggests talking with your doctor and the trial researchers about these aspects, so you know what to expect with that particular treatment, based on what trial participants have reported previously.

“In general, having an in-depth conversation about every aspect of a trial can help you gain a clearer understanding of the anticipated result,” he says.


Scientist pipetting in lab-iStock-1093654354

In metastatic breast cancer clinical trials, every participant receives real treatment; there are no placebo groups. These trials don’t focus on a cure; instead, they aim to help patients live longer or improve symptoms. You can join a clinical trial early in your treatment; it may give you more therapy choices.

If you have metastatic breast cancer, how do you know if a clinical trial might be right for you? And what can you expect if you join one?

Metastatic Breast Cancer Clinical Trials

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