optimal supportive care for mBC according to phase of disease

moth

I want to share this excellent resource from JCO Oncology Practice.

It differentiates among different phases of metastatic disease - smoldering, gradual, rapid, de novo poor.

For each of those they talk about priorities for the oncology team and the patient, including the usually well covered bases of symptom control and pain relief but then they talk about psychological distress, exercise, nutrition, and advance care planning.

They provide checklists!

It is a very interesting way of looking at mBC care, and stratifying the various phases and what will be important in each phase. Also, it tries to ensure that some of the important but less urgent tasks are completed during the periods of stability.

One simple take away essentially is get things done when things are going well

"In the stable phase, the patient has more time and energy for maintenance or improvement of physical strength and emotional condition through exercise and other wellness activities. Such efforts to maintain and improve quality of life are important in preparation for future acute phases of disease; improvement of physical strength and performance status leads to better survival outcome.37-40 Because in the acute phase of disease, patients have to focus on the urgent difficulties in front of them, patients and caregivers must try to maintain or improve their condition while in the stable phase."

https://ascopubs.org/doi/full/10.1200/OP.20.00622

Kida K, Olver I, Yennu S, Tripathy D, Ueno NT. Optimal Supportive Care for Patients With Metastatic Breast Cancer According to Their Disease Progression Phase. JCO Oncol Pract. 2021 Jan 22:OP2000622. doi: 10.1200/OP.20.00622. Epub ahead of print. PMID: 33492987.

Elderberry

moth: thank you for this!! A useful reminder "get things done when things are going well"

ShetlandPony

Moth, you share such great information and resources with us! You are a great nurse. Doing it in a different way than planned, but still helping lots of people.

The checklists in this article provide such a nice, useful summary that is quite comprehensive. It is easy to see what I can be doing for myself as well as what I can ask my doctor to do. And the lists include some items one doesn't often see mentioned such as advance care planning and relief of caregiver burden. I need to think more about those. And I like that the list includes, in the stable phase, personal growth and enhanced meaning, and strengthened relationships.

A while ago I was feeling so bad that I was not doing everything I had identified that I could/should be doing for well-being. This article made me reflect that during that time I was sort of in an acute phase rather than my more typical stable phase, and needed to cut myself some slack, change my focus: “In the acute phase, close monitoring of the patient's status and symptom management take priority. In the stable phase, the focus can shift to maintenance or improvement of physical strength and emotional condition.”

moth

aw, SP, thank you so much for your kind words. You're gonna make me cry in the supply closet.... (it's a health care student joke; all nursing and med students are at some point crying in a supply closet...)

I'm glad you found it helpful, too.

Chicagoan

Moth-Thanks so much for posting this. Lots of useful information. It's nice to see clinical validation of some things I've experienced-such as that exercise reduces fatigue and increases functionality in MBC patients.